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Regis D, Cason M, Magnan B. Dislocation of primary total hip arthroplasty: Analysis of risk factors and preventive options. World J Orthop 2024; 15:501-511. [PMID: 38947255 PMCID: PMC11212535 DOI: 10.5312/wjo.v15.i6.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/10/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
Total hip arthroplasty (THA) is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease. However, dislocation continues to be a troublesome complication after THA, as it is a leading cause of revision and is associated with substantial social, health, and economic costs. It is a relatively rare, usually early occurrence that depends on both the patients' characteristics and the surgical aspects. The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility, which is closely related to the incidence of dislocation. Consequently, clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup. Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA. Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size, dual mobility constructs, constrained liners, and modular neck stems.
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Affiliation(s)
- Dario Regis
- Department of Orthopedic and Trauma Surgery, Integrated University Hospital, Verona 37126, Veneto, Italy
| | - Mattia Cason
- Department of Orthopedic and Trauma Surgery, Integrated University Hospital, Verona 37126, Veneto, Italy
| | - Bruno Magnan
- Department of Orthopedic and Trauma Surgery, Integrated University Hospital, Verona 37126, Veneto, Italy
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Gerber CD, Lee A, De Silva V, Yatsonsky D, Georgiadis GM. Malseated Liner in Modular Dual Mobility Total Hip Replacement: A Report of Three Cases. Cureus 2024; 16:e60437. [PMID: 38883007 PMCID: PMC11179678 DOI: 10.7759/cureus.60437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Modular dual mobility total hip arthroplasty (THA) can be associated with complications if the liner is malseated, which can be unappreciated intraoperatively. A meticulous surgical technique is needed to ensure that the liner is perfectly seated. In addition, a malseated liner can be missed if the postoperative films are not carefully reviewed by the surgeon. We present three cases of THA associated with a malseated modular dual mobility liner. In one case, the malpositioned liner was appreciated intraoperatively, but it was wedged in place and could not be removed. The entire shell needed to be revised. In two other cases, malseating was not detected intra-operatively. Both were appreciated postoperatively, and early revision surgery was needed.
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Affiliation(s)
- Caleb D Gerber
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Anderson Lee
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Vihan De Silva
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - David Yatsonsky
- Department of Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA
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Karczewski D, Andronic O, Akgün D, Adelhoefer S, Kriechling P, Bäcker H. No clinical consequence of liner malseating in dual-mobility THAs at short term: a systematic review. Arch Orthop Trauma Surg 2023; 143:6453-6459. [PMID: 37036501 PMCID: PMC10491507 DOI: 10.1007/s00402-023-04855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Liner malseating is well described in ceramic-on-ceramic total hip arthroplasties (THAs). However, limited information is known on this complication among dual-mobility articulations. As such, this systematic review analyzed liner malseating in dual-mobility THAs concerning prevalence, clinical implications, and associated risk factors. METHODS A PRISMA criteria-based systematic review was performed, and PubMed, Web of Science, MEDLINE, and Cochrane used as data bases. All original studies from 1980 to 2022 were considered eligible for inclusion, and Methodological Index for Nonrandomized Studies (MINORS) used for quality assessment. RESULTS In total, five retrospective cohort studies with 2330 patients (2673 dual-mobility THAs) were included. Mean age was 66.9 years, mean BMI was 29.8 kg/m2, and 35% of patients were female. Rates of malseating ranged from 0.15% to 5.8%, with a total of 53 malseated liners identified throughout all studies (1.98%). Based on THA manufacturer, malseating occurred in 48 Stryker (1.96%) and 5 Biomet Zimmer (2.14%) THAs. Mean clinical follow-up was 2.2 years (mean range, 1.3 to 6.4 years). Except one patient reporting of pain at 2 years, no revision or negative clinical implication was noted in any of the malseated liners, including normal ranged metal ions measured in four cases. A smaller acetabular component size was identified as a statistically significant risk factor for malseating in one study. Mean MINORS score was 9.8. CONCLUSIONS Liner malseating is a rare finding in patients undergoing THAs with dual-mobility articulations. While prelim results demonstrate no negative clinical consequences to date, existing studies are limited, refer to short-term outcomes only, and do not prospectively follow-up affected patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Daniel Karczewski
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany.
| | - Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Doruk Akgün
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Siegfried Adelhoefer
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Henrik Bäcker
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
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Manson TT, Adrados M, Gililland JM, Mahmood BM, Samuel LT, Moskal JT. The Role of Dual-Mobility Components in Total Hip Arthroplasty. J Bone Joint Surg Am 2023; 105:250-261. [PMID: 36473055 DOI: 10.2106/jbjs.22.00185] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
➤ Dual mobility (DM) refers to a now widely available option for total hip articulation. DM implants feature a small inner head, a hard bearing, that connects via a taper fit onto the femoral trunnion. This head freely rotates but is encased inside a larger, outer polyethylene head that articulates with a smooth acetabular component. ➤ DM acetabular components are available in the form of a monoblock shell or as a liner that is impacted into a modular shell, providing a metal articulation for the polyethylene outer head. ➤ DM is designed to increase hip stability by providing the arthroplasty construct with a higher jump distance, head-to-neck ratio, and range of motion prior to impingement. ➤ The use of DM in total hip arthroplasty continues to increase in the United States for both primary and revision arthroplasty. Surgeons should be aware of the potential benefits and pitfalls. ➤ Long-term data are lacking, especially for modular DM implants. Points of concern include a potential for accelerated polyethylene wear, intraprosthetic dislocation, and modular backside fretting corrosion.
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Affiliation(s)
- Theodore T Manson
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland
| | - Murillo Adrados
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Orthopaedic Surgery, Carilion Clinic Institute of Orthopaedics and Neurosciences, Roanoke, Virginia
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Bilal M Mahmood
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Carilion Clinic Institute of Orthopaedics and Neurosciences, Roanoke, Virginia
| | - Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Orthopaedic Surgery, Carilion Clinic Institute of Orthopaedics and Neurosciences, Roanoke, Virginia
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Foissey C, Batailler C, Rajput V, Premkumar AB, Servien E, Lustig S. No dislocation and low complication rate for a modern dual mobility cup with pre-impacted femoral head in primary hip replacement: A consecutive series of 175 hips at minimum 5-year follow-up. SICOT J 2023; 9:1. [PMID: 36648274 PMCID: PMC9878999 DOI: 10.1051/sicotj/2022050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Despite its excellent results in preventing dislocation, the dual mobility cup (DMC) is still struggling to be adopted by some teams due to premature wear and loosening reported on first-generation implants. Therefore, this study aimed to assess the mid-term survivorship of a modern DMC with a pre-impacted head and the radio-clinical results at a minimum follow-up of 5 years. METHODS This was a retrospective single-centre study performed on patients who had a primary total hip replacement for osteoarthritis in 2016. The cup was a third-generation DMC with a pre-impacted femoral head. Clinical (harris hip score (HHS)) and radiological (cup abduction, anteversion, overhang, and radiolucent lines) results were recorded, as well as complications, particularly dislocations and survivorship. A minimum of five years of follow-ups was required. RESULTS One hundred and seventy-five hips (167 patients) met the inclusion criteria. Five hips (2.9%, 5/175) were lost to follow-up and excluded from the postoperative analysis. The mean follow-up period was 70 ± 2.9 months [63.6-76.5]. Three cups needed revision surgery (1.8%, 3/170): one for septic loosening, and two for chronic infection. At 77 months, the global survival probability was 98.2% ± 1, and the survival probability excluding septic aetiology was 100%. There was a significant improvement in the HHS from pre-operatively (48.3 ± 6.0 [14.0-70.0]) to post-operatively (96 ± 4.5 [50-100]) (p < 0.0001). There were no postoperative dislocations recorded, nor any iliopsoas-impingement or symptomatic cam-effect. DISCUSSION This study showed excellent survival and good radiological and clinical results of this dual mobility cup at a mid-term follow-up. None of the patients had dislocation or any specific complication feared with dual mobility cups.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France,Corresponding author:
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France
| | - Vishal Rajput
- The Midyorkshire Hospitals NHS Trust WF14DG Wakefield United Kingdom
| | | | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1 69100 Lyon France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
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Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation. INTERNATIONAL ORTHOPAEDICS 2022; 46:789-795. [DOI: 10.1007/s00264-021-05280-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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Mavrogenis AF, Auffret Babak I, Caton JH. Writing for SICOT-J. SICOT J 2021; 7:E1. [PMID: 34397380 PMCID: PMC8366388 DOI: 10.1051/sicotj/2021042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/17/2021] [Indexed: 11/15/2022] Open
Abstract
Every time a paper is submitted to the journal, we realize the effort and amount of work it takes for performing the study, writing, formatting, and submitting the paper for peer review. However, how many of these papers are suitable for publication? Medical writing considerations, including an understandable text that does not confuse reading, formality, and ethics in writing, should be kept in mind when preparing and writing a paper to be submitted for publication to a journal. This editorial note offers useful advice for the authors submitting their papers to a journal on what to keep in mind before submission, how to prepare a quality submission, how to win the editor for their paper to avoid rejection, and how to make it to the review process and maybe to get published. It is our belief that these tips and advice on medical writing apply to any author and any journal.
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Affiliation(s)
- Andreas F. Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine 11527 Athens Greece
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Jinnai Y, Homma Y, Baba T, Zhuang X, Kaneko K, Ishijima M. Use of Dual Mobility Acetabular Component and Anterior Approach in Patients With Displaced Femoral Neck Fracture. J Arthroplasty 2021; 36:2530-2535. [PMID: 33744082 DOI: 10.1016/j.arth.2021.02.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the antidislocation effect of total hip arthroplasty (THA) via the direct anterior approach (DAA) with dual mobility cup (DMC) for displaced femoral neck fracture (FNF) has already been reported, the clinical result of DMC-DAA-THA for displaced FNF in terms of mortality, complications, and walking ability are still unclear. METHODS 106 cases with DMC-DAA-THA for displaced FNF were investigated of dislocation; perioperative complications; 3-, 6-, and12-month mortality rate; and pre/early postoperative walking ability. The walking ability was stratified into the following four categories: (1) use of a wheelchair (no walking), (2) walking alongside a support (including walkers designed for the elderly), (3) walking using one stick, and (4) unaided walking. RESULTS There was no dislocation withing one-year postoperative. The 3-, 6-, and 12-month mortality rate was 2.8%, 4.7%, and 5.7%. Total complications occurred in 14 cases (14.7%). Although there was no revision surgery, two cases (1.9%) of intraoperative fracture treated without additional fixation, and one case of postoperative fracture was occurred. Among patients with preinjury walking category 2, 3, and 4 (total 94 cases), the number of patients who recovered same walking category at two-week postoperation was 56 cases (59.6%). CONCLUSIONS Our study demonstrated that DMC-DAA-THA for displaced FNF offered quick recovery of walking ability with no dislocation and low one-year mortality rate. We believe that the combination of early postoperative recovery due to the minimal invasiveness of the DAA and decreased dislocation rate due to increased range of motion by DMC and adequate soft tissue tension by DAA contributed to null dislocation.
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Affiliation(s)
- Yuta Jinnai
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Xu Zhuang
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Unter Ecker N, Kocaoğlu H, Zahar A, Haasper C, Gehrke T, Citak M. What Is the Dislocation and Revision Rate of Dual-mobility Cups Used in Complex Revision THAs? Clin Orthop Relat Res 2021; 479:280-285. [PMID: 32898046 PMCID: PMC7899605 DOI: 10.1097/corr.0000000000001467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dual-mobility cups have been shown to reduce the dislocation risk after THA. Although dual-mobility cups can be a useful strategy to mitigate against recurrent dislocation after revision surgery, few clinical studies have focused on the results of complex revision THAs with extensive bone and soft-tissue loss or in patients who have undergone more than one previous surgical procedure. QUESTIONS/PURPOSES (1) What is the survival free from revision for dislocation of dual-mobility cups used in complex revision THAs? (2) What is the survival free from any dislocation? METHODS Between January 1, 2009 and December 31, 2013, 327 patients underwent a complex revision THA that included an acetabular revision, defined as preexisting massive bone loss in the acetabulum (at least Paprosky Type 2B) and/or proximal femur (at least Paprosky Type 3), substantial gluteal soft-tissue involvement, at least two previous surgical procedures or a one-stage septic revision, or history of dislocation. All 327 complex revision patients received a dual-mobility cup. Of those, 34% (111) were lost to follow-up before 5 years and were not known to have reached a study endpoint (revision for dislocation, and any dislocation) before then, leaving 216 patients for analysis. For patients with bilateral hip surgeries only the first operated hip was included for analysis. The median (range) follow-up duration was 69 months (60 to 110). The primary endpoint was dislocation or re-revision for dislocation. Fifty-six percent (120 of 216) of the patients were women and 44% (96 of 216) were men. The mean age of the patients was 69 ± 9 years. The patients underwent a median of four surgical procedures (1 to 4) before the index procedure (the revision evaluated in this study). A survival analysis was performed using the Kaplan-Meier method; any dislocation or revision for dislocation was determined as the endpoint. RESULTS The dislocation-free survival rates were 96% (95% confidence interval 92 to 98) at 5 years and 82% (95% CI 72 to 89) at 9 years. The overall dislocation rate was 11% (24 of 216 patients) at the final follow-up interval. Survival free of revision for dislocation was 99% (95% CI 96 to 100) at 5 years and 85% (95% CI 75 to 92) at 9 years. CONCLUSIONS Dual-mobility cups used in complex revision THA in this series had a higher rate of dislocation and revision than expected, based on earlier studies of dislocations of these components. Although we believe dual-mobility cups are still the first choice of implant if the patient has instability, these cups should be used cautiously if severe bone loss or soft-tissue involvement is present. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Niklas Unter Ecker
- N. U. Ecker, H. Kocaoğlu, C. Haasper, T. Gehrke, M. Citak, Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
- H. Kocaoğlu, Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
- A. Zahar, Department of Orthopaedic Surgery, Helios Klinik Berlin- Zehlendorf, Berlin, Germany
| | - Hakan Kocaoğlu
- N. U. Ecker, H. Kocaoğlu, C. Haasper, T. Gehrke, M. Citak, Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
- H. Kocaoğlu, Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
- A. Zahar, Department of Orthopaedic Surgery, Helios Klinik Berlin- Zehlendorf, Berlin, Germany
| | - Akos Zahar
- N. U. Ecker, H. Kocaoğlu, C. Haasper, T. Gehrke, M. Citak, Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
- H. Kocaoğlu, Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
- A. Zahar, Department of Orthopaedic Surgery, Helios Klinik Berlin- Zehlendorf, Berlin, Germany
| | - Carl Haasper
- N. U. Ecker, H. Kocaoğlu, C. Haasper, T. Gehrke, M. Citak, Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
- H. Kocaoğlu, Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
- A. Zahar, Department of Orthopaedic Surgery, Helios Klinik Berlin- Zehlendorf, Berlin, Germany
| | - Thorsten Gehrke
- N. U. Ecker, H. Kocaoğlu, C. Haasper, T. Gehrke, M. Citak, Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
- H. Kocaoğlu, Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
- A. Zahar, Department of Orthopaedic Surgery, Helios Klinik Berlin- Zehlendorf, Berlin, Germany
| | - Mustafa Citak
- N. U. Ecker, H. Kocaoğlu, C. Haasper, T. Gehrke, M. Citak, Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
- H. Kocaoğlu, Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Turkey
- A. Zahar, Department of Orthopaedic Surgery, Helios Klinik Berlin- Zehlendorf, Berlin, Germany
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Wolf O, Mukka S, Notini M, Möller M, Hailer NP. Study protocol: The DUALITY trial-a register-based, randomized controlled trial to investigate dual mobility cups in hip fracture patients. Acta Orthop 2020; 91:506-513. [PMID: 32567472 PMCID: PMC8023882 DOI: 10.1080/17453674.2020.1780059] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Physically and mentally fit patients with a displaced femoral neck fracture (FNF) are mostly treated with total hip arthroplasty (THA). Dislocation is a severe and frequent complication in this group, and dual mobility cups (DMC) were developed to reduce the risk of dislocation after THA. The DUALITY trial investigates whether the use of DMC in FNF patients treated with a THA reduces the risk of dislocation.Patients and methods - The trial is a national, multicenter, register-based, randomized controlled trial (rRCT). Patients ≥ 65 years with a non-pathological, displaced FNF (Type Garden 3-4/AO 31-B2 or B3) who are suitable for a THA according to local guidelines are assessed for eligibility using the web-based registration platform of the Swedish Fracture Register (SFR). 1,600 patients will be randomized 1:1 to either insertion of a DMC (intervention group) or a standard cup (control group). The study is pragmatic in that the choice of implant brands, surgical approach, and peri- and postoperative protocols follow the local routines of each participating unit. All outcome variables will be retrieved after linkage of the study cohort obtained from the SFR with the Swedish Hip Arthroplasty Register and the National Patient Register.Outcomes - The primary outcome is the occurrence of any dislocation of the index joint treated with closed or open reduction within 1 year after surgery, expressed as a relative risk when comparing groups, and a risk reduction of at least 45% is considered clinically relevant. Secondary outcomes are the relative risk of any reoperation of the index joint, periprosthetic joint infection, and mortality within 90 days and 1 year. Patient-reported outcomes and health economics are evaluated.Start of trial and estimated duration - The DUALITY trial started recruiting patients in January 2020 and will continue for approximately 5 years.Trial registration - The trial is registered at clinicaltrials.gov (NCT03909815; December 12, 2019).
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Affiliation(s)
- Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University; ,Correspondence:
| | - Sebastian Mukka
- Department of Surgical and Perioperative Science (Orthopaedics), Umeå University;
| | - Maja Notini
- Department of Surgical Sciences, Orthopaedics, Uppsala University;
| | - Michael Möller
- Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Orthopaedics, Uppsala University;
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Abstract
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
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Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
| | - Soren Overgaard
- The Danish Hip Arthroplasty Register, Aarhus, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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Yoon JY, Moon JK, Kim CH, Lee S, Yoon PW. Korean epidemiology and trends in hip joint replacements. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.8.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to analyze the epidemiologic characteristics of patients who underwent hip arthroplasty using the Korean nationwide database and investigate the recent trends in implant fixation methods and bearing surface selection. We aimed to compare clinical characteristics and differences with the results from the registry of other western countries. We analyzed the data collected by the Health Insurance Review and Assessment Service database of Korea from 2007 to 2011 and the Main Surgery Statistical Yearbook from 2014 to 2018, published by the National Health Insurance Service. The number and rate of patients who underwent hip joint arthroplasty per 10,000 persons have been steadily increasing since 2007. There was a big difference in mean age and preoperative diagnosis of patients between the bipolar hemiarthroplasty and total hip arthroplasty groups. Most patients underwent surgery using a cementless biological fixation method, and the cemented fixation method was selectively used for a small portion of old aged osteoporotic patients. In relation to the use of bearing surfaces, the registry data showed that ceramic-ceramic bearings were used at an overwhelmingly high rate (81%) in Korea compared to other countries. The reason was attributable to various factors, such as patient’s age or economic status, differences in the health insurance system between countries, and recently reported complications, such as ceramic fracture or noise.
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Castiello E, Amendola L, Barca P, Tigani D, Caton JH, Neri T, Prudhon JL. Letter to the editor on "Asymptomatic intraprosthetic dual mobility cup dislocation with increased metal ion levels". Arthroplast Today 2020; 6:132-133. [PMID: 32211491 PMCID: PMC7083734 DOI: 10.1016/j.artd.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Emanuela Castiello
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Luca Amendola
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Paolo Barca
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Domenico Tigani
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | | | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Etienne, EA 7424 - Inter-University Laboratory of Human Movement Science, University Lyon, University Jean Monnet, Saint Etienne, France
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Dubin JA, Westrich GH. Anatomic dual mobility compared to modular dual mobility in primary total hip arthroplasty: a matched cohort study. Arthroplast Today 2019; 5:509-514. [PMID: 31886399 PMCID: PMC6920720 DOI: 10.1016/j.artd.2019.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 01/19/2023] Open
Abstract
Background Dual mobility (DM) has been used in primary total hip arthroplasty recently for their low dislocation rates, low revision rates, and improved patient functional outcomes. We compared 2 DM systems, anatomic dual mobility (ADM; Stryker, Mahwah, NJ) and modular dual mobility (MDM; Stryker, Mahwah, NJ), to determine differences in dislocation rates, revision rates, and patient outcome scores. Methods The study was a single-center matched retrospective review of prospectively collected data of patients who underwent primary total hip arthroplasty surgery with an ADM or MDM system by a single surgeon from 2012 to 2017. Demographics, operative details, postoperative patient-reported outcomes, and clinical outcomes were recorded. A Kaplan-Meier survivorship curve to compare survival time between groups was collected as well. Results Five hundred seventy-four patients were included in the study with 287 patients matched in each group with mean 2.86 years of follow-up. The dislocation rate in each cohort was 0%, the acetabular-specific revision rate was 0%, and in each cohort, overall revision rate in each cohort was 1.7%. In general, patient-reported outcomes were similar for each group (Harris Hip Score Pain (P = .919), Harris Hip Score Function (P = .736), Western Ontario and McMaster Universities Osteoarthritis Index (P = .139), Pain Visual Analog Scale (P = .146), Veterans RAND 12-Item Health Survey (P = .99), University of California, Los Angeles (P = .417), and Harris Hip Score Total (P = .136). There was a slight clinically insignificant increase in hip flexion between the cohorts favoring the ADM group (98.6 ± 9.8 vs 94.0 ± 9.7, P < .001). Conclusions Both DM systems had similar patient-reported outcomes that were quite favorable. At 2.86 years of follow-up, neither the ADM nor MDM systems demonstrated dislocation, and both had low acetabular-specific and overall revision rates in this matched cohort study.
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Affiliation(s)
- J A Dubin
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - G H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Assi C, Caton J, Fawaz W, Samaha C, Yammine K. Revision total hip arthroplasty with a Kerboull plate: comparative outcomes using standard versus dual mobility cups. INTERNATIONAL ORTHOPAEDICS 2018; 43:2245-2251. [PMID: 30370452 DOI: 10.1007/s00264-018-4209-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting. MATERIALS AND METHODS This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months. RESULTS Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed. CONCLUSION The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | | | - Wissam Fawaz
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon. .,Center for Evidence-Based Anatomy, Sports & Orthopedic Research, Beirut, Lebanon.
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Scarlat MM, Pećina M, Quaile A. High-volume surgeons and high-volume journals in a multivariate orthopedic environment. INTERNATIONAL ORTHOPAEDICS 2018; 42:2011-2014. [PMID: 30066100 DOI: 10.1007/s00264-018-4073-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Marius M Scarlat
- Clinique Chirurgicale St Michel, Toulon, France. .,International Orthopaedics - SICOT Official Journal, Brussels, Belgium.
| | - Marko Pećina
- International Orthopaedics - SICOT Official Journal, Brussels, Belgium.,Department of Orthopaedic Surgery, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Andrew Quaile
- International Orthopaedics - SICOT Official Journal, Brussels, Belgium.,FRCS, Spineworks, London, UK
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Scarlat MM, Pećina M. Six thousand papers already: "the outcome of a matter is better than its beginning…". INTERNATIONAL ORTHOPAEDICS 2018; 42:979-981. [PMID: 29637280 DOI: 10.1007/s00264-018-3929-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Marko Pećina
- Department of Orthopaedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
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Comparison of dual mobility cup and other surgical construts used for three hundred and sixty two first time hip revisions due to recurrent dislocations: five year results from Lithuanian arthroplasty register. INTERNATIONAL ORTHOPAEDICS 2017; 42:1015-1020. [PMID: 29196791 DOI: 10.1007/s00264-017-3702-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/21/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Recently, there has been increasing interest in the use of dual mobility systems in the treatment of hip instability. The aim of this study was to investigate the re-revision rate of dual mobility cup compared to different surgical concepts when used for first-time hip revisions due to recurrent dislocations. METHODS The data were derived from the Lithuanian Arthroplasty Register. For survival analysis, we used both re-revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age, gender, and implant concept). RESULTS A total of 1388 revisions were recorded from 2011 to 2015, of which 362 were performed due to recurrent dislocation. Of the revisions, 247 were performed using dual mobility cups, while 115 were performed using a variety of other surgical constructs including constrained acetabular cups, conventional cups, femoral head exchanges, stem exchanges or anti-luxation rings. There were 27 re-revisions of which 15 were for additional dislocations. There were only 2% re-revisions due to dislocation with dual mobility vs 9% when using other surgical constructs. Cox regression adjusting for age and gender showed that in the short-term, dual mobility cup had a lower risk of revision due to dislocation as well as for all reasons compared to the other surgical constructs. CONCLUSION In revision of total hip arthroplasties for dislocation, significantly lower short-term re-revision rate was observed for patients revised with dual mobility cup.
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Kasparek MF, Renner L, Faschingbauer M, Waldstein W, Rueckl K, Boettner F. Salvage of a monoblock metal-on-metal cup using a dual mobility liner: a two-year MRI follow-up study. INTERNATIONAL ORTHOPAEDICS 2017; 42:1035-1041. [PMID: 28929204 DOI: 10.1007/s00264-017-3641-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/05/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Revision of failed modular metal-on-metal total hip replacement (MoM-THA) can be technically difficult. A dual mobility liner can help to salvage a well-fixed acetabular component. The present paper reports the clinical and radiographic outcome of revision of failed Birmingham modular MoM-THA using a dual mobility liner. METHODS The present study reports on ten patients (3 female and 7 male) with 11 revision THAs. Patients underwent revision an average of 51 months (range 40-73 months) after index procedure. Mean follow-up after the revision was 31 months (range 24-37 months) and all patients underwent an MRI with metal artifact reduction software (MARS) at least two years after revision to assess for local polyethylene wear and osteolysis. RESULTS The Harris Hip score improved from 92.2 (range 63.0-100.0) to 100.0 (p = 0.072). One patient had a one-time dislocation within seven days of surgery. No patient required additional surgeries. Radiographs showed no signs of component loosening and osteolysis and MRI imaging revealed no evidence of polyethylene wear or osteolysis. CONCLUSION A dual mobility liner in an existing Birmingham cup can provide excellent clinical and radiological short-term results without MRI evidence of increased polyethylene wear. Post-operative hip precautions should be enforced.
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Affiliation(s)
- Maximilian F Kasparek
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lisa Renner
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Wenzel Waldstein
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kilian Rueckl
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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