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Tarasevicius S, Smailys A, Grigaitis K, Robertsson O, Stucinskas J. Short-term outcome after total hip arthroplasty using dual-mobility cup: report from Lithuanian Arthroplasty Register. INTERNATIONAL ORTHOPAEDICS 2017; 41:595-598. [PMID: 28078363 DOI: 10.1007/s00264-016-3389-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of the study was to investigate how the use of dual-mobility cups (DMCs) affected the risk of revision due to dislocation as well as overall risk of revision compared with a conventional total hip arthroplasty (THA) system in the short term. METHODS A total of 12,657 primary THAs were registered from the start of 2011 to the end of 2014. 620 THAs were with DMCs. For comparison, we included all registered THAs with Exeter cup and a cemented Exeter stem combined with 28-mm femoral head. Patients were followed up with respect to revision and/or death until 1 January 2016. For survival analysis, we used revision as an endpoint. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, surgical approach, THA model and pre-operative diagnosis). RESULTS Of the 620 dual-mobility THAs and 2170 Exeter THAs, 100 had been revised. The overall unadjusted cumulative revision rate (CRR) for any reason of revision at five years after surgery was 3.9% in the dual-mobility group and 5.2% in the Exeter group. Cox regression analysis, adjusting for age, gender, THA type, surgical approach and pre-operative diagnosis, showed that the risk of revision was less in patients operated with DMCs and in patients having their operation for osteoarthritis. CONCLUSION The DM implant had a lower short-term complication rate than a conventional well defined THA. Low dislocation rate suggests that it is a good choice for high risk patients.
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Affiliation(s)
- Sarunas Tarasevicius
- Department of Orthopedics, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Alfredas Smailys
- Department of Orthopedics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kazimieras Grigaitis
- Department of Orthopedics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Otto Robertsson
- Department of Orthopedics, Lund University and Lund University Hospital, Lund, Sweden
| | - Justinas Stucinskas
- Department of Orthopedics, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Hargunani R, Madani H, Khoo M, Fotiadou A, Pressney I, Calleja M, O'Donnell P. Imaging of the Painful Hip Arthroplasty. Can Assoc Radiol J 2016; 67:345-355. [PMID: 27221697 DOI: 10.1016/j.carj.2015.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022] Open
Abstract
The incidence of complications following total hip arthroplasty is low, but due to the frequency of the procedure, they are quite commonly encountered and require appropriate investigation. Complications include aseptic loosening, infection, foreign body granulomatosis (osteolysis), adverse reactions to metal debris, periprosthetic fracture, heterotopic ossification, hardware failure, and a range of soft tissue complications, all of which may result in pain. Relevant imaging findings are illustrated and the role of various imaging modalities is reviewed. A suggested approach for the radiological investigation of each potential complication is outlined, based on our experience at a specialist referral unit.
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Affiliation(s)
- Rikin Hargunani
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom.
| | - Hardi Madani
- Royal Free Hospital NHS Trust, London, United Kingdom
| | - Michael Khoo
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom
| | - Anastasia Fotiadou
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom
| | - Ian Pressney
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom
| | - Michele Calleja
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom
| | - Paul O'Donnell
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, United Kingdom
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Vaishya R, Agarwal AK, Gupta N, Vijay V. Chronic Lymphedema of the Lower Limb: A Rare Cause of Dislocation of Total Hip Arthroplasty. Cureus 2016; 8:e579. [PMID: 27226940 PMCID: PMC4876007 DOI: 10.7759/cureus.579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Total hip arthroplasty (THA) in a patient with chronic lymphedema of both lower limbs is rarely reported in the literature. Chronic lymphedema is a challenging condition associated with various complications especially in a patient with THA. However, dislocation of the total hip prosthesis due to acute exacerbation of lower limb swelling in the postoperative period is an extremely rare complication. The cause that led to the dislocation of the prosthesis is intricate and difficult to assess, as this has not been discussed in the literature yet. We believe that the excessive weight of the limb due to chronic lymphedema had a deleterious effect on the biomechanics of total hip prosthesis, thereby increasing the tendency for dislocation. This case illustrates that chronic lymphedema of the lower limb should be dealt with aggressively using various modalities like intermittent pneumatic compression pumps and compression stockings after THA in such patients.
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Zajonz D, Philipp H, Schleifenbaum S, Möbius R, Hammer N, Grunert R, Prietzel T. [Larger heads compensate for an increased risk of THA dislocation in high-risk patients]. DER ORTHOPADE 2016; 44:381-91. [PMID: 25869176 DOI: 10.1007/s00132-015-3093-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dislocation is a devastating complication after total hip arthroplasty (THA) and occurs in 2-5% of primary THA cases and 5-10% of revision THA cases. Assuming correct implantation, dislocation risk can be reduced primarily by capsular repair and the use of larger prosthetic heads. However, larger heads are also associated with risks like accelerated wear or implant loosening, which is why heads with a maximum diameter of 36 mm are currently standard in primary THA. In cases with high dislocation risk, the use of 40 mm and 44 mm heads should be considered. OBJECTIVES This study aimed to quantify THA dislocation risk and retrospectively analyze the course of disease in high-risk patients treated with 40 mm or 44 mm femoral heads after primary or revision THA, concerning dislocation and other complications suffered. MATERIALS AND METHODS All patients with increased THA dislocation risk, treated from 2009-2014, were evaluated regarding dislocations. The cases with installation of 40 mm or 44 mm prosthetic heads were classified using a self-developed 5-level risk score and retrospectively analyzed. RESULTS During the observation period, 288 THA interventions with increased dislocation risk were performed. In 278 cases with ball diameters ≤ 36 mm the dislocation rate was 15.1% (n=42). In 10 high dislocation-risk cases (3A to 4B according to recommended scoring system), 40 mm and 44 mm heads were used. After a 22.8 month mean follow-up, no THA dislocations were reported. CONCLUSION Our results with 40 and 44 mm heads and the existing literature confirm much higher joint stability and, thus, significantly reduced dislocation risk with larger prosthetic heads in THA. Their use is, therefore, justified in high-risk patients and should be considered in future THA.
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Affiliation(s)
- D Zajonz
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
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Matsen Ko LJ, Pollag KE, Yoo JY, Sharkey PF. Serum Metal Ion Levels Following Total Hip Arthroplasty With Modular Dual Mobility Components. J Arthroplasty 2016; 31:186-9. [PMID: 26318084 DOI: 10.1016/j.arth.2015.07.035] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/14/2015] [Accepted: 07/21/2015] [Indexed: 02/01/2023] Open
Abstract
Dual mobility acetabular components can reduce the incidence of total hip arthroplasty (THA) instability. Modular dual mobility (MDM) components facilitate acetabular component implantation. However, corrosion can occur at modular junctions. Serum cobalt and chromium levels and Oxford scores were obtained at minimum two year follow-up for 100 consecutive patients who had THA with MDM components. Average Oxford score was 43 (range 13-48). Average serum cobalt and chromium values were 0.7 mcg/L (range, 0.0 to 7.0) and 0.6 mcg/L (range, 0.1 to 2.7), respectively. MARS MRI was performed for four patients with pain and elevated serum cobalt levels. Two of these studies were consistent with adverse local tissue reaction. We recommend use of MDM implants in only patients at high risk for dislocation following THA.
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Affiliation(s)
- Laura J Matsen Ko
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Kimberley E Pollag
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Joanne Y Yoo
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Peter F Sharkey
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort. BIOMED RESEARCH INTERNATIONAL 2015; 2015:641958. [PMID: 26146625 PMCID: PMC4471248 DOI: 10.1155/2015/641958] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/24/2015] [Indexed: 01/16/2023]
Abstract
Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA) complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan's National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab) and delayed rehabilitation (Delayed Rehab). Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p < 0.001) higher medical and rehabilitation expenses and more outpatient department (OPD) visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR): 3.152; 95% confidence interval (CI): 1.211–8.203; p < 0.05) than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA.
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Abstract
Dislocation remains among the most common complications of, and reasons for, revision of both primary and revision total hip replacements (THR). Hence, there is great interest in maximising stability to prevent this complication. Head size has been recognised to have a strong influence on the risk of dislocation post-operatively. As femoral head size increases, stability is augmented, secondary to an increase in impingement-free range of movement. Larger head sizes also greatly increase the 'jump distance' required for the head to dislocate in an appropriately positioned cup. Level-one studies support the use of larger diameter heads as they decrease the risk of dislocation following primary and revision THR. Highly cross-linked polyethylene has allowed us to increase femoral head size, without a marked increase in wear. However, the thin polyethylene liners necessary to accommodate larger heads may increase the risk of liner fracture and larger heads have also been implicated in causing soft-tissue impingement resulting in groin pain. Larger diameter heads also impart larger forces on the femoral trunnion, which may contribute to corrosion, metal release, and adverse local tissue reactions. Alternative large bearings including large ceramic heads and dual mobility bearings may mitigate some of these risks, and several of these devices have been used with clinical success.
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Affiliation(s)
- H J Cooper
- Lenox Hill Hospital, Department of Orthopaedic Surgery, 130 East 77th Street, New York, 10075, USA
| | - C J Della Valle
- Rush University Medical Center, Department of Orthopaedic Surgery, 1611 West Harrison Street, Chicago, Illinois, 60612, USA
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Sedrakyan A, Graves S, Bordini B, Pons M, Havelin L, Mehle S, Paxton E, Barber T, Cafri G. Comparative effectiveness of ceramic-on-ceramic implants in stemmed hip replacement: a multinational study of six national and regional registries. J Bone Joint Surg Am 2014; 96 Suppl 1:34-41. [PMID: 25520417 PMCID: PMC4271430 DOI: 10.2106/jbjs.n.00465] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rapid decline in use of conventional total hip replacement with a large femoral head size and a metal-on-metal bearing surface might lead to increased popularity of ceramic-on-ceramic bearings as another hard-on-hard alternative that allows implantation of a larger head. We sought to address comparative effectiveness of ceramic-on-ceramic and metal-on-HXLPE (highly cross-linked polyethylene) implants by utilizing the distributed health data network of the ICOR (International Consortium of Orthopaedic Registries), an unprecedented collaboration of national and regional registries and the U.S. FDA (Food and Drug Administration). METHODS A distributed health data network was developed by the ICOR and used in this study. The data from each registry are standardized and provided at a level of aggregation most suitable for the detailed analysis of interest. The data are combined across registries for comprehensive assessments. The ICOR coordinating center and study steering committee defined the inclusion criteria for this study as total hip arthroplasty performed without cement from 2001 to 2010 in patients forty-five to sixty-four years of age with osteoarthritis. Six national and regional registries (Kaiser Permanente and HealthEast in the U.S., Emilia-Romagna region in Italy, Catalan region in Spain, Norway, and Australia) participated in this study. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. We present the results of the fixed-effects model and include the results of the random-effects model in an appendix. SAS version 9.2 was used for all analyses. We first compared femoral head sizes of >28 mm and ≤28 mm within ceramic-on-ceramic implants and then compared ceramic-on-ceramic with metal-on-HXLPE. RESULTS A total of 34,985 patients were included; 52% were female. We found a lower risk of revision associated with use of ceramic-on-ceramic implants when a larger head size was used (HR [hazard ratio] = 0.73, 95% CI [confidence interval] = 0.60 to 0.88, p = 0.001). Use of smaller-head-size ceramic-on-ceramic bearings was associated with a higher risk of failure compared with metal-on-HXLPE bearings (HR = 1.36, 95% CI = 1.09 to 1.68, p = 0.006). Use of large-head-size ceramic-on-ceramic bearings was associated with a small protective effect relative to metal-on-HXLPE bearings (not subdivided by head size) in years zero to two, but this difference dissipated over the longer term. CONCLUSIONS Our multinational study based on a harmonized, distributed network showed that use of ceramic-on-ceramic implants with a smaller head size in total hip arthroplasty without cement was associated with a higher risk of revision compared with metal-on-HXLPE and >28-mm ceramic-on-ceramic implants. These findings warrant careful reflection by regulatory and clinical communities and wide dissemination to patients for informed decision-making regarding such surgery.
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Affiliation(s)
- Art Sedrakyan
- Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065
| | - Stephen Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia
| | - Barbara Bordini
- Register of Orthopaedic Implants (RIPO), c/o Medical Technology Laboratory, Istituto Ortopedico Rizzoli, via de Barbiano 1/10, 40136 Bologna, Italy
| | - Miquel Pons
- Hip and Knee Replacement Unit, Orthopaedic Surgery Department, Hospital Sant Rafael, Paseo Vall d’Hebrón 107-117, Barcelona 08035, Spain
| | - Leif Havelin
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Mollendalsbakken 11, N-5021 Bergen, Norway
| | - Susan Mehle
- HealthEast Joint Registry (HEJR), 1690 University Avenue West, Data Science, Suite 400, Minneapolis, MN 55104
| | - Elizabeth Paxton
- Surgical Outcomes & Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
| | - Thomas Barber
- Department of Orthopedic Surgery, Kaiser Permanente, 280 West MacArthur Boulevard, Oakland, CA 94611
| | - Guy Cafri
- Surgical Outcomes & Analysis Department, Kaiser Permanente, 8954 Rio San Diego Drive, Suite 406, San Diego, CA 92108
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Sivertsen EA, Borgen PO. Acetabular wall augmentation in selected patients with recurrent dislocation after THA. J Arthroplasty 2014; 29:2202-5. [PMID: 25052045 DOI: 10.1016/j.arth.2014.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 02/01/2023] Open
Abstract
We reviewed 42 patients operated with PMMA augmentation of the acetabular wall for recurrent posterior dislocation of cemented total hip arthroplasties with a cemented all-poly acetabular component. 38 patients never experienced subsequent dislocations after the procedure. 4 patients had recurrent dislocations, and two additional patients underwent a revision procedure due to aseptic loosening of the acetabular component. 1, 5 and 10 years survival of the prosthesis free of dislocation were 95%, 95% and 64% respectively. 90% of the patients were satisfied, four patients experienced pain and 3 patients sustained an infection. The procedure is simple, effective, takes less time and results in less blood loss compared to full revision surgery. It should be considered in cases of recurrent posterior dislocation in elderly patients.
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Affiliation(s)
| | - Pål Oliver Borgen
- Department of Orthopedic Surgery, Martina Hansen Hospital, Pb 823, Sandvika, Norway
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Insull PJ, Cobbett H, Frampton CM, Munro JT. The use of a lipped acetabular liner decreases the rate of revision for instability after total hip replacement: a study using data from the New Zealand Joint Registry. Bone Joint J 2014; 96-B:884-8. [PMID: 24986940 DOI: 10.1302/0301-620x.96b7.33658] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the rate of revision for instability after total hip replacement (THR) when lipped and non-lipped acetabular liners were used. We hypothesised that the use of a lipped liner in a modular uncemented acetabular component reduces the risk of revision for instability after primary THR. Using data from the New Zealand Joint Registry, we found that the use of a lipped liner was associated with a significantly decreased rate of revision for instability and for all other indications. Adjusting for the size of the femoral head, the surgical approach and the age and gender of the patient, this difference remained strongly significant (p < 0.001). We conclude that evidence from the New Zealand registry suggests that the use of lipped liners with modular uncemented acetabular components is associated with a decreased rate of revision for instability after primary THR.
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Affiliation(s)
- P J Insull
- Auckland City Hospital, Department of Orthopaedics, Park Road, Grafton, New Zealand
| | - H Cobbett
- Northshore Hospital, Takapuna, Auckland, New Zealand
| | | | - J T Munro
- Auckland City Hospital, University of Auckland, Grafton, Auckland, New Zealand
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61
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Delgado FG, Broch A, Reina F, Ximeno L, Torras D, García F, Salvador A. MAASH Technique for Total Hip Arthroplasty: A Capsular Work. HSS J 2013; 9:171-9. [PMID: 24009535 PMCID: PMC3757492 DOI: 10.1007/s11420-013-9332-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 03/27/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure. PURPOSES Modified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the "weak area" of the capsule, in the so called "internervous safe zone" and introducing the "box concept" for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier. METHODS From November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique. RESULTS MAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development. CONCLUSION MAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.
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Affiliation(s)
- Felipe G. Delgado
- Orthopedic and Trauma Department of the Hospital de Sant Celoni, Av. Hospital, 19, 08470 Sant Celoni, Barcelona, Catalonia Spain
- Arthrocat SLP, Group of Orthopedic Surgery and Sports Medicine, Sant Celoni, Spain
| | - Albert Broch
- Orthopedic and Trauma Department of the Hospital de Sant Celoni, Av. Hospital, 19, 08470 Sant Celoni, Barcelona, Catalonia Spain
- Arthrocat SLP, Group of Orthopedic Surgery and Sports Medicine, Sant Celoni, Spain
| | - Francisco Reina
- Medicals Sciences Department, NEOMA Group Research, Faculty of Medicine, University of Girona, Girona, Catalonia Spain
| | - Lluís Ximeno
- Orthopedic and Trauma Department of the Hospital de Sant Celoni, Av. Hospital, 19, 08470 Sant Celoni, Barcelona, Catalonia Spain
| | - David Torras
- Orthopedic and Trauma Department of the Hospital de Sant Celoni, Av. Hospital, 19, 08470 Sant Celoni, Barcelona, Catalonia Spain
| | - Francesc García
- Orthopedic and Trauma Department of the Hospital de Sant Celoni, Av. Hospital, 19, 08470 Sant Celoni, Barcelona, Catalonia Spain
| | - Antoni Salvador
- Orthopedic and Trauma Department of the Hospital de Sant Celoni, Av. Hospital, 19, 08470 Sant Celoni, Barcelona, Catalonia Spain
- Arthrocat SLP, Group of Orthopedic Surgery and Sports Medicine, Sant Celoni, Spain
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