1
|
Jassim SS, Bhatia T, McMahon JRD, Pierrepont JW, McMahon SJ. Reliability of the transverse acetabular ligament as a landmark for functional cup anteversion in total hip arthroplasty. Hip Int 2024; 34:608-613. [PMID: 38572714 DOI: 10.1177/11207000241243035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND The transverse acetabular ligament (TAL) can be a useful and reproducible landmark in the orientation of the acetabular cup in total hip arthroplasty (THA). Its role in guiding cup orientation when aiming to implant in a functional anteversion orientation is unclear. The aim of this study was to assess the relationship between the TAL and the planned acetabular cup anteversion when implanted in a function orientation. MATERIAL AND METHODS In a retrospective study the anteversion of the TAL in the contralateral un-replaced hip was measured in CT scans of patients undergoing THA and compared to the functional cup anteversion using the patient-specific spinopelvic parameters. Comparative measurements of the native acetabular version were made from the superior rim to the inferior rim and at 10 mm intervals between the 2, all in reference to the anterior pelvic plane. RESULTS 96 hips were measured. The mean TAL anteversion angle was 17.2° ± 4.5°. The mean planned acetabular cup anteversion angle was 26.3° ± 4.7°. Pearson's correlation coefficient of this measurement with the TAL was -0.03 (p = 0.769). There was a significant difference between the planned acetabular cup anteversion and the measurement of the TAL (p < 0.0001). CONCLUSIONS If cups are implanted parallel to the TAL, almost 80% will be >5° different to targeted functional cup version. It should be aimed to implant cups with more anteversion than the TAL indicates.
Collapse
Affiliation(s)
| | | | - Jack R D McMahon
- Malabar Orthopaedic Clinic, Windsor, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | | | - Stephen J McMahon
- Malabar Orthopaedic Clinic, Windsor, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Waters GC, Jones C, D'Alessandro P, Yates P. Functional assessment of component positioning in patients with groin pain after total hip arthroplasty as a tool to guide management. Hip Int 2024; 34:336-343. [PMID: 37861204 DOI: 10.1177/11207000231205843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Persisting groin pain post total hip arthroplasty (THA) is a common and complex issue that can be difficult to diagnose and manage. Acetabular component positioning is often implicated. AIMS AND METHODS We used a previously well described and validated functional positioning protocol to determine if functional acetabular malpositioning was a factor in groin pain post THA and hence to determine if acetabular revision would be indicated. We compared patient-specific functional acetabular positioning to traditional CT evaluation of cup position and assessment of anterior cup overhang. RESULTS 39 patients with groin pain post-THA were investigated. Functional acetabular malpositioning was diagnosed in 31% (12/39). Revision THA was performed in those 12 patients, resulting in resolution of functional malpositioning (100%), with an overall accuracy of 5.6° (range 1-12), and resolution of groin pain in 67% (8/12). 33% (4/12) of the revised implants had functional positioning located outside the traditional "40/20 zone". Comparison with CT indicated that 40% (4/10) of implants with anterior overhang were well positioned, however only 50% (6/12) of functionally malpositioned implants had CT evidence of anterior cup prominence. Of the 8/12 revision patients who had resolution of their groin pain, only 1 had cup prominence. CONCLUSIONS This study suggests that the utilisation of a patient specific functional positioning algorithm in the analysis of persistent groin pain following THA can assist in identifying the underlying cause of pain and help to guide treatment. For a functionally malpositioned acetabulum, revision surgery offers a potential resolution of groin pain.
Collapse
Affiliation(s)
| | | | | | - Piers Yates
- University of Western Australia, Fremantle Hospital and Health Service, Perth, WA, Australia
| |
Collapse
|
4
|
Scholz J, Perka C, Hipfl C. Dual-mobility bearings reduce instability but may not be the only answer in revision total hip arthroplasty for recurrent dislocation. Bone Joint J 2024; 106-B:89-97. [PMID: 38688508 DOI: 10.1302/0301-620x.106b5.bjj-2023-0828.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims There is little information in the literature about the use of dual-mobility (DM) bearings in preventing re-dislocation in revision total hip arthroplasty (THA). The aim of this study was to compare the use of DM bearings, standard bearings, and constrained liners in revision THA for recurrent dislocation, and to identify risk factors for re-dislocation. Methods We reviewed 86 consecutive revision THAs performed for dislocation between August 2012 and July 2019. A total of 38 revisions (44.2%) involved a DM bearing, while 39 (45.3%) and nine (10.5%) involved a standard bearing and a constrained liner, respectively. Rates of re-dislocation, re-revision for dislocation, and overall re-revision were compared. Radiographs were assessed for the positioning of the acetabular component, the restoration of the centre of rotation, leg length, and offset. Risk factors for re-dislocation were determined by Cox regression analysis. The modified Harris Hip Scores (mHHSs) were recorded. The mean age of the patients at the time of revision was 70 years (43 to 88); 54 were female (62.8%). The mean follow-up was 5.0 years (2.0 to 8.75). Results DM bearings were used significantly more frequently in elderly patients (p = 0.003) and in hips with abductor deficiency (p < 0.001). The re-dislocation rate was 13.2% for DM bearings compared with 17.9% for standard bearings, and 22.2% for constrained liners (p = 0.432). Re-revision-free survival for DM bearings was 84% (95% confidence interval (CI) 0.77 to 0.91) compared with 74% (95% CI 0.67 to 0.81) for standard articulations, and 67% (95% CI 0.51 to 0.82) for constrained liners (p = 0.361). Younger age (hazard ratio (HR) 0.92 (95% CI 0.85 to 0.99); p = 0.031), lower comorbidity (HR 0.44 (95% CI 0.20 to 0.95); p = 0.037), smaller heads (HR 0.80 (95% CI 0.64 to 0.99); p = 0.046), and retention of the acetabular component (HR 8.26 (95% CI 1.37 to 49.96); p = 0.022) were significantly associated with re-dislocation. All DM bearings which re-dislocated were in patients with abductor muscle deficiency (HR 48.34 (95% CI 0.03 to 7,737.98); p = 0.303). The radiological analysis did not reveal a significant relationship between restoration of the geometry of the hip and re-dislocation. The mean mHHSs significantly improved from 43 points (0 to 88) to 67 points (20 to 91; p < 0.001) at the final follow-up, with no differences between the types of bearing. Conclusion We found that the use of DM bearings reduced the rates of re-dislocation and re-revision in revision THA for recurrent dislocation, but did not guarantee stability. Abductor deficiency is an important predictor of persistent instability.
Collapse
Affiliation(s)
- Johann Scholz
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Hipfl
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| |
Collapse
|
5
|
White C, Abdalla W, Awasthi P, Iranpour F, Subramanian P. Outcomes of Dual Mobility Bearings in Revision Total Hip Replacements. Cureus 2024; 16:e55585. [PMID: 38576664 PMCID: PMC10993088 DOI: 10.7759/cureus.55585] [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: 03/03/2024] [Indexed: 04/06/2024] Open
Abstract
Background Dual mobility bearings have gained attention in the prevention of instability in revision total hip replacement. This study aimed to evaluate the use of dual mobility bearings in revision total hip replacement. The primary outcome was the rate of dislocation. Secondary outcomes included the rate of re-operation for any reason, surgical complications, serious medical adverse events, and 90-day mortality rate. Methods A single-centre case series of 55 consecutive operations in 49 patients who underwent revision total hip replacement using dual mobility bearings with a minimum follow-up of three months was studied. Results Early dislocation occurred in one case (2%), and there were no intra-prosthetic dislocations at a mean follow-up of 16 months. The rate of re-operation for any reason was 6/55 (11%) cases, and the post-operative infection rate was 2/55 (4%) cases. Serious medical adverse events occurred in 2/55 (4%) cases. The 90-day mortality rate was 1/55 (2%) cases. Two cases (2%) had cup abduction or anteversion angles outside of the safe zones although there were no dislocations in these patients. Conclusion This case series demonstrates a low dislocation rate in the early post-operative period for dual mobility bearings in revision total hip replacement. Dual mobility bearings show promise as an early low dislocation implant in revision total hip replacement. It remains to be determined whether dual mobility bearings are low-wear implants in the long term.
Collapse
Affiliation(s)
- Christopher White
- Department of Trauma and Orthopaedic Surgery, Imperial College Healthcare NHS Trust, London, GBR
| | - Waleed Abdalla
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
| | - Prashant Awasthi
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
| | - Farhad Iranpour
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
| | - Padmanabhan Subramanian
- Department of Trauma and Orthopaedic Surgery, Royal Free London NHS Foundation Trust, London, GBR
| |
Collapse
|
6
|
Stan G, Roman MD, Orban H, Georgeanu VA, Deculescu RS, Brinduse LA, Gheorghiu N. Survival Analysis and Failure Modes of Total Hip Arthroplasty Using a Cemented Semi-Retentive Acetabular Cup. J Clin Med 2023; 12:7506. [PMID: 38137575 PMCID: PMC10744007 DOI: 10.3390/jcm12247506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/18/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
To reduce the incidence of total hip revisions, there have been continuous efforts to enhance prosthetic materials and designs to optimize implant survival. A primary implant with a constrained acetabular component is often used to minimize the risk of dislocations even though this approach has some drawbacks as reported in the literature. To address these concerns, this study aimed to assess the survivorship and dislocation rate of a semi-retentive cemented acetabular cup when used as a primary implant. The specific cemented cup that we studied was not present in any study that we consulted, so to fill this gap, we conducted a retrospective examination of 527 cemented hip prostheses that utilized the semi-retentive cup between the years 2005 and 2012. We employed Cox multiple regression models for our statistical analysis. The revision due to dislocation occurred in 12.8% of all cases, with a lower incidence of 5% (14 cases) in age groups >70 years than in age groups <70 years (14%-32 cases) (p < 0.001). The survival rates of the semi-retentive cemented acetabular cup were 98.6% (520 cases) at 5 years and 92.2% (487 cases) at 10 years. The survival rates were significantly lower in women than men, with 1.9% (7 cases) toward 0% at 5 years and 8.1% (30 cases) toward 5% (7 cases) at 10 years (p = 0.002). The difference in failure rates between age groups over 70 years (2.3%-10 cases) and age groups under 70 years (11.5%-34 cases) was also statistically significant (p < 0.001). Our study indicates that the semi-constrained design may cause frequent damage to the polyethylene liner due to impingement and wear, which are the primary factors for failure. Also, this implant has a similar risk of revision due to dislocation as reported in studies and may be beneficial as a primary implant in elderly patients with low-demanding lifestyles, muscular insufficiency, and low compliance regarding hip prosthetic behavior, without a major effect on survivorship.
Collapse
Affiliation(s)
- Gabriel Stan
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (G.S.); (V.A.G.); (N.G.)
| | - Mihai Dan Roman
- Faculty of Medicine, University “Lucian Blaga” of Sibiu, 550024 Sibiu, Romania
| | - Horia Orban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (G.S.); (V.A.G.); (N.G.)
| | - Vlad Alexandru Georgeanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (G.S.); (V.A.G.); (N.G.)
| | - Rares Stefan Deculescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (G.S.); (V.A.G.); (N.G.)
| | - Lacramioara Aurelia Brinduse
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (G.S.); (V.A.G.); (N.G.)
| | - Nicolae Gheorghiu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (G.S.); (V.A.G.); (N.G.)
| |
Collapse
|
7
|
McCrosson M, Broadfoot J, Yeager M, Marquess B, Scheinberg M, Naranje S. Femoral stem taper geometry and porous coating in cementless direct anterior primary total hip arthroplasty. J Orthop 2023; 46:169-173. [PMID: 38031626 PMCID: PMC10682507 DOI: 10.1016/j.jor.2023.11.009] [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: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to compare the clinical outcomes and complications between a fully coated, dual-tapered hip stem versus a proximally coated, triple-tapered hip stem in patients undergoing cementless direct anterior (DA) primary total hip arthroplasty (THA). Methods A retrospective analysis was conducted on patients who underwent primary THA with either a fully coated, dual-tapered hip stem or a proximally coated, triple-tapered stem with at least a 1-year follow up. Exclusion criteria included any patients that did not receive either femoral stem, those undergoing bilateral THA, those with a surgical approach other than DA, those with an indication other than osteoarthritis, avascular necrosis (AVN), or femoral neck fracture, and those that had a cemented femoral component. Complications and clinical outcomes were assessed. Statistical analyses were conducted to identify significant differences between the groups. Results A total of 95 patients were included in the study. The average ages for the dual-tapered and triple-tapered stem cohorts were 63.6 and 59.5, respectively (p = 0.168). At 1-year follow-up, no significant differences were seen between the groups in terms of ambulatory status, ROM, and patient satisfaction (p = 0.414, p = 0.106, and p = 0.126). 6 (18 %) of the patients receiving the dual-tapered, fully coated hip stem had at least one complication while 8 (13 %) of the triple-tapered, proximally coated hip stem patients did (p = 0.550). Conclusion Both hip stem cohorts demonstrated comparable clinical outcomes and complication rates in patients undergoing primary DA THA and we believe that either hip stem may be a reasonable choice for patients. Future studies with larger sample sizes and longer follow-up periods are warranted to validate these findings.
Collapse
Affiliation(s)
- Matthew McCrosson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Jackson Broadfoot
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Matthew Yeager
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Ben Marquess
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Mila Scheinberg
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| | - Sameer Naranje
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313th Street S, Ste 226, Birmingham, AL, 35205, USA
| |
Collapse
|
8
|
Sai Sathikumar A, Jacob G, Thomas AB, Varghese J, Menon V. Acetabular cup positioning in primary routine total hip arthroplasty-a review of current concepts and technologies. ARTHROPLASTY 2023; 5:59. [PMID: 38037156 PMCID: PMC10691035 DOI: 10.1186/s42836-023-00213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/15/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) has revolutionized the treatment of hip joint arthritis. With the increased popularity and success of the procedure, research has focused on improving implant survival and reducing surgical complications. Optimal component orientation has been a constant focus with various philosophies proposed. Regardless of the philosophy, achieving an accurate acetabular position for each clinical scenario is crucial. In this paper, we review the recent developments in improving the accuracy and ideal positioning of the acetabular cup in routine primary THA. METHODOLOGY A review of the recent scientific literature for acetabular cup placement in primary THA was performed, with available evidence for safe zones, spinopelvic relationship, preoperative planning, patient-specific instrumentation, navigation THA and robotic THA. CONCLUSION Though the applicability of Lewinnek safe zones has been questioned with an improved understanding of spinopelvic relationships, its role remains in positioning the acetabular cup in a patient with normal spinopelvic alignment and mobility. Evaluation of spinopelvic relationships and accordingly adjusting acetabular anteversion and inclination can significantly reduce the incidence of dislocation in patients with a rigid spine. In using preoperative radiography, the acetabular inclination, anteversion and intraoperative pelvic position should be evaluated. With improving technology and the advent of artificial intelligence, superior and more accurate preoperative planning is possible. Patient-specific instrumentation, navigated and robotic THA have been reported to improve accuracy in acetabular cup positioning as decided preoperatively but any significant clinical advantage over conventional THA is yet to be elucidated.
Collapse
Affiliation(s)
- Aravind Sai Sathikumar
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital: Lakeshore Hospital and Research Centre Ltd, Kochi, Kerala, 682040, India.
| | - George Jacob
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital: Lakeshore Hospital and Research Centre Ltd, Kochi, Kerala, 682040, India
| | - Appu Benny Thomas
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital: Lakeshore Hospital and Research Centre Ltd, Kochi, Kerala, 682040, India
| | - Jacob Varghese
- Division of Joint Replacement and Sports Medicine, VPS Lakeshore Hospital: Lakeshore Hospital and Research Centre Ltd, Kochi, Kerala, 682040, India
| | - Venugopal Menon
- Department of Orthopaedics, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, 411043, India
| |
Collapse
|
9
|
Patamarat A, Laoruengthana A, Kitcharanant N, Khantasit J, Thremthakanpon W. Direct Anatomic Registration in Computer-Assisted Total Hip Arthroplasty Improves Accuracy of Acetabular Cup Alignment. Arthroplast Today 2023; 21:101148. [PMID: 37274835 PMCID: PMC10238448 DOI: 10.1016/j.artd.2023.101148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 06/07/2023] Open
Abstract
Background Computer-assisted total hip arthroplasty using direct anatomic registration (DAR) with acetabular center axis software is an alternative method to the indirect anterior pelvic plane method. The software maps the center of hip rotation and orientation of the native acetabulum in 3 dimensions. This study aimed to evaluate the accuracy of acetabular cup alignment using DAR navigation combined with a mechanical guide device (MGD). Methods This prospective nonrandomized controlled study included 106 patients who underwent primary cementless total hip arthroplasty through the posterolateral approach. Fifty-four patients in the study group underwent DAR combined with MGD, whereas 52 patients underwent MGD only for acetabular cup positioning. Plain radiographs of both hips and computerized tomographic scans were obtained 2 months postoperatively for the evaluation of acetabular cup inclination and anteversion, respectively. Results The acetabular cup alignment in the study group was within the Lewinnek safe zone more than that in the control group (81.5% vs 59.6%, P < .05). The study group had a mean inclination angle of 43.88°° (standard deviation [SD] 5.38) and anteversion angle of 12.82° (SD 5.99), whereas the control group had 41.10° (SD 6.79) and 12.82° (SD 9.53), respectively. There were no significant differences in estimated blood loss, length of stay, and Harris hip scores at preoperative and 3 and 6 months postoperatively, except for the operative time, which was longer in the study group (P < .01). There was 1 posterior hip dislocation in each group. Conclusions DAR navigation combined with MGD provides better accuracy for acetabular cup positioning within the Lewinnek safe zone compared with the conventional technique.
Collapse
Affiliation(s)
- Apisit Patamarat
- Department of Orthopaedic Surgery, Phra Nakhon Si Ayutthaya Hospital, Ayutthaya, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Nitchanant Kitcharanant
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | |
Collapse
|
10
|
Frandsen JJ, Rainey JP, Kahn TL, Blackburn BE, Pelt CE, Anderson LA, Gililland JM. A Novel Method to Calculate Functional Pelvic Tilt Using a Standing Anteroposterior Pelvis Radiograph. Arthroplast Today 2023; 21:101145. [PMID: 37274836 PMCID: PMC10238463 DOI: 10.1016/j.artd.2023.101145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 06/07/2023] Open
Abstract
Background Functional patient-specific acetabular component positioning is important in total hip arthroplasty. We preoperatively evaluate the pelvic tilt (PT) on standing anteroposterior (AP) pelvis radiographs using a novel measurement and then recreate this intraoperatively using imaging. The purpose of this study was to determine if there is a linear correlation between this novel measurement and the actual PT. Methods A retrospective study of 200 patients was performed, measuring PT on standing lateral radiographs as the angle between the anterior superior iliac spines and the pubic symphysis. On the AP pelvis radiographs, the trans-teardrop (TT) line was drawn between the teardrops. The vertical distance between the TT line and the top of the pubic symphysis (TTPS) was then measured. A ratio was made between the lengths of both lines to account for the overall size of the pelvis (TTPS/TT). Linear regression analysis was then performed between PT and TTPS/TT. Results There was a strong linear correlation between the TTPS/TT ratio on AP pelvis radiographs and PT on lateral radiographs (r = 0.785, r2 = 0.616, P < .001). On subanalysis of the female cohort, the correlation became even stronger (r = 0.864, r2 = 0.747, P < .001). Using regression analysis, a linear equation was created (PT = 97.32 [TTPS/TT] - 5.51), to calculate the PT using the TTPS/TT ratio. Conclusions There is a strong linear correlation between the TTPS/TT ratio and PT. Using this information, a surgeon can reliably use the distance between the TT line and the superior pubic symphysis on an AP radiograph to recreate the patient's functional PT intraoperatively, allowing for a more accurate patient-specific placement of the acetabular component.
Collapse
Affiliation(s)
| | - Joshua P. Rainey
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Lucas A. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | |
Collapse
|
11
|
Toyoda T, Oe K, Iida H, Nakamura T, Okamoto N, Saito T. Treatment strategies for recurrent dislocation following total hip arthroplasty: relationship between cause of dislocation and type of revision surgery. BMC Musculoskelet Disord 2023; 24:238. [PMID: 36991409 PMCID: PMC10053790 DOI: 10.1186/s12891-023-06355-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
There are many therapeutic options for dislocation following total hip arthroplasty (THA). The aim of this study was to evaluate the results of revision surgery for dislocated hips.
Methods
Between November 2001 and December 2020, 71 consecutive revision hip surgeries were performed at our institution for recurrent dislocation following THA. We conducted a retrospective study of all 65 patients (71 hips), who were followed for a mean of 4.7 ± 3.2 years (range, 1–14). The cohort included 48 women and 17 men, with a mean age of 71 ± 12.3 years (range, 34–92). The mean number of previous surgeries was 1.6 ± 1.1 (range, 1–5). From intraoperative findings, we created six categories of revision hip surgery for recurrent dislocation following THA: open reduction and internal fixation (2 hips); head change or liner change only (6 hips); cup change with increased head size only (14 hips); stem change only (7 hips); cup and stem change (24 hips); and conversion to constrained cup (18 hips). Prosthesis survival was analyzed by the Kaplan-Meier method, with repeat revision surgery for re-dislocation or implant failure as the endpoint. A cox proportional hazards model was used for risk factors of re-revision surgery.
Results
Re-dislocation occurred in 5 hips (7.0%) and implant failure in 1 hip (1.4%). The 10-year survival rate was 81.1% (95% confidence interval, 65.5–96.8). A Dorr classification of “positional” was a risk factor for re-revision surgery due to re-dislocation.
Conclusion
Clear understanding of the cause of dislocation is essential for optimizing revision procedures and improving the rate of successful outcomes.
Collapse
|
12
|
Krull P, Steinbrück A, Grimberg AW, Melsheimer O, Morlock MM, Perka C. [Standard and special liner in primary hip arthroplasty : Current study and survey results from the German Arthroplasty Registry (EPRD)]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:222-232. [PMID: 36635446 DOI: 10.1007/s00132-022-04333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Instability constitutes the main reason for revision hip arthroplasties. Modified polyethylene liners are designed to improve the stability of a hip replacement. In July 2022 The Bone & Joint Journal published a study with data of the German Arthroplasty Registry (EPRD). The study investigated mechanical failure of standard and modified liner designs in primary, cementless total hip arthroplasty. Following the study, the EPRD conducted a survey of German clinics to research the utilization of lipped liners in primary total hip replacement. METHODS The liner study included 151,096 primary, elective, cementless total hip arthroplasties. Data from November 2012 to November 2020 were obtained from the EPRD. Standard polyethylene liners were compared with lipped, angulated, offset and angulated/offset inlays. Cumulative incidences for endpoint revision due to mechanical complication were calculated with a competing risk analysis. The influence of other variables was investigated with a multivariate Cox regression. In the following online survey, 237 out of 789 hospitals completed a form. RESULTS AND CONCLUSION In our analysis, only offset liners were, compared to standard liners, associated with a reduced risk of mechanical failure in a short to medium follow up. However, the resultant joint reaction force is increased with offset liners due to the lateralization of the hip center of rotation. Thus, the long-term performance of offset liners needs to be observed. Our survey indicated that lipped liners were implanted more often if the posterior approach was used. Moreover, lipped liners were mostly positioned with the elevated rim in the biomechanically less optimal posterior-superior quadrant. To improve stability it is suggested to position the elevated rim in the posterior-inferior quadrant.
Collapse
Affiliation(s)
- Paula Krull
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland. .,Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Arnd Steinbrück
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland.,Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Vinzenz-von-Paul-Platz 1, 86152, Augsburg, Deutschland
| | - Alexander W Grimberg
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
| | - Oliver Melsheimer
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
| | - Michael M Morlock
- Technische Universität Hamburg (TUHH), Am Schwarzenberg-Campus 1, 21073, Hamburg, Deutschland
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| |
Collapse
|
13
|
Outcomes After Abductor Reattachment to Proximal Femur Endoprosthesis After Tumor Resection. J Am Acad Orthop Surg 2023; 31:34-40. [PMID: 36548152 DOI: 10.5435/jaaos-d-22-00369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Resection of the proximal femur raises several challenges including restoration of the abductor mechanism. Few evaluated the outcomes of different techniques of abductor fixation to the proximal femur endoprosthesis. METHODS A retrospective review of patients who underwent proximal femoral arthroplasty with a minimum follow-up of 12 months was conducted. Patients were divided into two groups: (1) those with preserved greater trochanter (GT) reattached to the implant and (2) those with direct abductor muscle reattachment. Both groups were compared for surgical and functional outcomes. Group 1 patients were subdivided into those who received GT reinsertion using grip and cables and those reattached using sutures. RESULTS Fifty-three patients were included with a mean follow-up of 49 months. There were 22 patients with reinserted GT and 31 patients with soft-tissue repair. The endoprosthesis revision rate was comparable between groups (P = 0.27); however, the incidence of dislocations was higher in group 2 (0/22 versus 6/31; P = 0.035). Trendelenburg gait (77% versus 74%), use of walking aids (68% versus 81%), and abductor muscle strength were comparable between both groups (P > 0.05). In group 1, 15 patients had GT reinsertion with grip and cables. Of those, five patients (33%) had cable rupture within 13 months of follow-up. GT displacement reached 12 mm at 12 months of follow-up in patients with grip and cables compared with 26 mm in patients with GT suture reinsertion (P < 0.05). DISCUSSION Although GT preservation did not improve functional outcomes, it was associated with a lower dislocation rate despite frequent cable failure. Less displacement was observed when GT reattachment used grip and cables.
Collapse
|
14
|
Peng L, Zeng Y, Wu Y, Si H, Pei F, Shen B. Radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty: a retrospective study with propensity score matching. Arch Orthop Trauma Surg 2022; 142:3995-4005. [PMID: 34821944 DOI: 10.1007/s00402-021-04263-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dislocation is a complicated process and associated with multivariate etiology and risk factors. The purpose of this study was to verify if radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty (THA) individually or synergistically. METHODS From 2017 to 2020, we identified 76 (1.9%) patients who suffered postoperative dislocations from 3926 THAs in our institution. After excluded patients with previously proven patient-related and implant-related risk factors, the remaining patients were used to match a 1:1 control patients who were without dislocation. The cup position (inclination and anteversion angles), hip offset (HO), leg length discrepancy (LLD), and abductor lever arm (ALA) were analyzed by univariate analyses and multivariate logistic regressions. RESULTS Measurements on radiographs showed excellent interobserver agreement (intraclass correlation coefficient (ICC) 0.922-0.952) and intraobserver agreements (ICC 0.933-0.967). HO restoration inaccuracy (without ± 5 mm) was associated with higher dislocation risk (OR 4.241 95% CI 1.440-12.492, P = 0.009). The restoration inaccuracy of the cup position, LLD, or ALA could not increase the dislocation risk individually. When combining the radiologic restoration inaccuracy factors, the HO + LLD restoration inaccuracy and HO + ALA restoration inaccuracy increased the odds of postoperative dislocation (OR 12.056, 95% CI 1.409-103.127, P = 0.023; OR 4.770, 95% CI 1.336-17.028, P = 0.016, respectively). Combining the four risk factors of cup safe zone, HO, LLD, and ALA, patients with 3 or 4 radiologic restoration inaccuracy factors showed a higher risk of dislocation (OR 13.500, 95% CI 1.340-135.983, P = 0.027). CONCLUSION Hip offset (HO) restoration inaccuracy increased the risk of dislocation following primary THA. Multivariate radiologic restoration accuracy is critical for the prevention of dislocation and needs to be valued by surgeons.
Collapse
Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
| |
Collapse
|
15
|
Daji AV, Workman KK, Yoo CJ, Smith CN, Kumar D, Weber MA, Snyder MJ, Urish KL. Risk Stratification and Pain Outcomes Following Revision Total Hip Arthroplasty for Adverse Local Tissue Reactions. J Arthroplasty 2022; 37:2406-2411. [PMID: 35738363 DOI: 10.1016/j.arth.2022.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (THA) for adverse local tissue reactions (ALTRs) secondary to head-neck taper corrosion is associated with a high complication rate. Diagnosis of ALTR is based on risk stratification using the patient's history and examination, implant risk, serum metal ion levels, and imaging. The purpose of this study was to determine if stratification using similar risk factors is predictive of outcomes following revision THA for metal-on-polyethylene (MoP) ALTR. METHODS We performed a retrospective review on 141 patients revised for ALTR due to head-neck taper corrosion. Pain outcomes following surgery were analyzed using a generalized linear mixed model. Complications were defined as instability/dislocation, infection, fracture, nerve palsy, leg-length discrepancy, or reoperation. RESULTS The overall complication rate was 17.7%. The odds of having pain decreased by 44% after revision surgery (Odds Ratio = 0.56, 95% Confidence Interval: 0.324 to 0.952). There was no significant difference in instability/dislocation based on either increased or decreased head-neck offset (P = .67) or magnetic resonance imaging findings of abductor loss, effusion size, and degree of ALTR (P = .73). Increased serum cobalt (P = .31) and chromium (P = .08) levels did not predict complications; however, a decreased cobalt-chromium ratio was associated with postoperative complications (2.8 versus 3.5; P = .002). CONCLUSION These findings are the first to suggest that patients who have ALTR after MoP THA undergoing revision surgery demonstrated major pain relief. Increasing femoral head offset did not change rates of instability/dislocation. In clinical scenarios where preoperative cobalt-chromium femoral head offsets were greater than available ceramic head offsets, a mandatory decrease in femoral head offset did not increase rates of instability/dislocation.
Collapse
Affiliation(s)
- Akshay V Daji
- Department of Orthopaedic Surgery, HCA Florida JFK/University of Miami Miller School of Medicine, Palm Beach, Florida
| | - Kalain K Workman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center-Pinnacle, Harrisburg, Pennsylvania
| | - Charlie J Yoo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center-Pinnacle, Harrisburg, Pennsylvania
| | - Clair N Smith
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Deepak Kumar
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Margaret A Weber
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Matthew J Snyder
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kenneth L Urish
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
16
|
Xiao Q, Ling T, Zhou K, Yuan M, Xu B, Zhou Z. Constrained acetabular liners are a viable option in second-stage re-implantation for chronic infected total hip arthroplasty with abductor or greater trochanter deficiency and large acetabular bone defects. BMC Musculoskelet Disord 2022; 23:915. [PMID: 36242038 PMCID: PMC9563789 DOI: 10.1186/s12891-022-05861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Abductor mechanism deficiency is a clear indication for using constrained acetabular liners (CALs), and large acetabular bone defects are considered a relative contraindication to CALs. We report the results of using CALs in special cases in which abductor or greater trochanter deficiency was accompanied by large acetabular bone defects at second-stage re-implantation for chronic infected total hip arthroplasty (THA). Methods Between January 2010 and January 2018, 19 patients who used CALs at second-stage re-implantation and had abductor or greater trochanter deficiency and large acetabular bone defects were included in this study. We followed up with the clinical and radiological results of these patients. Complications and infection-related information were also recorded. Results Eight patients, 4 patients, and 7 patients had Paprosky type IIB, type IIC, and type IIIA acetabular bone defects at second-stage re-implantation, respectively. The indication for using CALs was abductor deficiency in 14 patients and greater trochanter deficiency in the other 5 patients. The mean follow-up was 74.4 months (range 50–96). The mean Harris Hip Score (HHS) was 76.3 points (range 62–86) at the last follow-up. Three patients presented acetabular radiolucent lines with no progress: zone 3, zone 3 and zone 2 and 3, respectively. One patient suffered transient sciatic nerve palsy. There was no dislocation, failure of the CALs, reoperation, or recurrence of infection. Conclusion Our results suggested that for screened patients, CALs are a viable option in second-stage re-implantation for chronic infected THA with abductor or greater trochanter deficiency and large bone defects.
Collapse
Affiliation(s)
- Qiang Xiao
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China.,Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Tingxian Ling
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Kai Zhou
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Mingcheng Yuan
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Bing Xu
- Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China.
| |
Collapse
|
17
|
Jungwirth-Weinberger A, Schmidt-Braekling T, Rueckl K, Springer B, Boettner F. Anterior hip replacement: lower dislocation rates despite less restrictions? Arch Orthop Trauma Surg 2022; 142:2413-2417. [PMID: 33687529 DOI: 10.1007/s00402-021-03849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/27/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dislocation in Total hip arthroplasty (THA) is a common postoperative complication and reason for revision surgery. The direct anterior approach has become more popular over the last decade. The purpose of this study was to compare postoperative dislocation rates of the direct anterior and the posterior approach at a one-year follow-up. MATERIAL AND METHODS 797 consecutive hips operated through a posterior approach [698 patients (307 male, 391 female)] between 2009 and 2012, were compared to 690 selected THA [610 patients (423 female, 187 male)] operated since 2012. Anterior hip replacement surgery was primarily indicated for patients demanding increased flexibility after surgery (Yoga) or were considered a higher risk for dislocation. RESULTS During a one-year follow-up there were eight dislocations out of 797 THA (1%) in the posterior group and none in the 690 THA (0%) in the anterior group (p-value of 0.008). Average time to dislocation was 7.5 weeks in the posterior group. Five of eight patients with dislocations needed revision surgery due to persistent instability. CONCLUSION Even in a higher-risk patient population, the direct anterior approach showed a lower dislocation rate compared to the posterior approach in the first year after surgery.
Collapse
Affiliation(s)
- Anna Jungwirth-Weinberger
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland
| | | | - Kilian Rueckl
- Julius-Maximilians-Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Germany
| | | | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| |
Collapse
|
18
|
Zügner R, Hjelmberg N, Rolfson O, Strömberg C, Saari T. Gluteus Maximus Transfer following Total Hip Arthroplasty Does Not Improve Abductor Moment: A Case-Control Gait Analysis Study of 15 Patients with Gluteus Medius Disruption. J Clin Med 2022; 11:jcm11113172. [PMID: 35683559 PMCID: PMC9181114 DOI: 10.3390/jcm11113172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Gluteus maximus flap transfer (GMT) is a surgical technique used to improve gait kinematics and kinetics, as well as to reduce and ameliorate the functional outcome in patients with hip abductor deficiency following total hip arthroplasty (THA). The purpose of this observational study was to evaluate the gait pre- and postoperatively and examine whether GMT increases the abduction moment. Materials and Methods: A gait analysis based on reflective markers and force plates was performed in 15 patients who underwent GMT and were examined using an optical tracking system before and at a minimum of 13 months after the operation. The median follow-up time was 24 (13−60) months. The primary outcome was hip abduction moment (Nm/kg) during gait. The control group consisted of 15 female subjects without any gait pathology. Results: The mean adduction moment was significantly higher compared with controls before the operation (p = 0.02), but this did not apply to the abduction moment (p = 0.60). At the group level, the abduction moment did not improve postoperatively (p = 0.30). Only six of fifteen patients slightly improved their hip abduction moment postoperatively. However, speed (0.74 to 0.80 m/s) and cadence (94 to 105 steps/min) were improved (p < 0.03). Discussion: The results of this study showed no improvement in the hip abduction moment after GMT surgery. In our experience, abduction deficiency following primary THA is still a difficult and unsolved problem.
Collapse
Affiliation(s)
- Roland Zügner
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Correspondence: ; Tel.: +46-703–101863
| | - Natalie Hjelmberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Christer Strömberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
| | - Tuuli Saari
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| |
Collapse
|
19
|
Accuracy and Reliability of Software Navigation for Acetabular Component Placement in THA: An In Vitro Validation Study. Medicina (B Aires) 2022; 58:medicina58050663. [PMID: 35630080 PMCID: PMC9147218 DOI: 10.3390/medicina58050663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Intraoperative fluoroscopy can be used to increase the accuracy of the acetabular component positioning during total hip arthroplasty. However, given the three-dimensional nature of cup positioning, it can be difficult to accurately assess inclination and anteversion angles based on two-dimensional imaging. The purpose of this study is to validate a novel method for calculating the 3D orientation of the acetabular cup from 2D fluoroscopic imaging. Materials and Methods: An acetabular cup was implanted into a radio-opaque pelvis model in nine positions sequentially, and the inclination and anteversion angles were collected in each position using two methods: (1) a coordinate measurement machine (CMM) was used to establish a digitalized anatomical coordinate frame based on pelvic landmarks of the cadaveric specimen, and the 3D position of the cup was then expressed with respect to the anatomical planes; (2) AP radiographic images were collected, and a mathematical formula was utilized to calculate the 3D inclination and anteversion based on the 2D images. The results of each method were compared, and interrater and intrarater reliably of the 2D method were calculated. Results: Interrater reliability was excellent, with an interclass correlation coefficient (ICC) of 0.988 (95% CI 0.975–0.994) for anteversion and 0.997 (95% CI 0.991–0.999) for inclination, as was intrarater reliability, with an ICC of 0.995 (95% CI 0.985–0.998) for anteversion and 0.998 (95% CI 0.994–0.999) for inclination. Intermethod accuracy was excellent with an ICC of 0.986 (95% CI: 0.972–0.993) for anteversion and 0.993 (95% CI: 0.989–0.995) for inclination. The Bland–Altman limit of agreement, which represents the error between the 2D and 3D methods, was found to range between 2 to 5 degrees. Conclusions: This data validates the proposed methodology to calculate 3D anteversion and inclination angles based on 2D fluoroscopic images to within five degrees. This method can be utilized to improve acetabular component placing intraoperatively and to check component placement postoperatively.
Collapse
|
20
|
Ogonda L, Cassidy RS, Beverland DE. A conservative approach to dislocation following total hip arthroplasty: a review of 8606 hips. Hip Int 2022; 32:291-297. [PMID: 32905705 DOI: 10.1177/1120700020959062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PATIENTS AND METHODS We present the data on 8606 total hip arthroplasty (THA) procedures carried out in 7818 patients through a posterior approach between 1998 and 2017. RESULTS 218 hips (2.5%) suffered at least 1 dislocation with dislocation rates declining from 6.2% from 1998 to 2002 to 1.5% from 2003 to 2017. Overall, 92 hips (1.06%) required revision surgery but of these, only 5 (0.06%) had a full revision of both components with the remaining 87 requiring intervention only on the acetabular side. None have had a pseudo-arthrosis; none were left dislocated and all remain stable to date. CONCLUSIONS In patients who have a second dislocation within 3 months of their primary surgery we recommend a spica or long leg cylinder cast to reduce the need for revision surgery. We propose an algorithm to manage instability with less aggressive operative treatment in this often-elderly patient population with the potential for less physiological insult and significant cost savings.
Collapse
Affiliation(s)
- Luke Ogonda
- Outcomes Unit, Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - Roslyn S Cassidy
- Outcomes Unit, Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | - David E Beverland
- Outcomes Unit, Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| |
Collapse
|
21
|
Hu Y, Zhou X, Qiao H, Zhu Z, Li H, Zhang J. Computer simulation of optimal lipped polyethylene liner orientation against prosthetic impingement. J Orthop Surg Res 2022; 17:204. [PMID: 35379266 PMCID: PMC8981617 DOI: 10.1186/s13018-022-03093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background Lipped or elevated acetabular liners are to improve posterior stability and are widely used in hip arthroplasty. However, concerns of increasing impingement exist when using such liners and optimal orientation of the elevated rim remains unknown. We aimed to identify the impact of lipped liner on the range of motion (ROM) before impingement and propose its optimal orientation. Methods An isochoric three-dimensional model of a general hip-replacement prosthesis was generated, and flex-extension, add-abduction and axial rotation were simulated on a computer. The maximum ROM of the hip was measured before the neck impinged on the liner. Different combinations of acetabular anteversion angles ranging from 5 to 30 degrees, and lipped liner orientations from posterior to anterior were tested. Results When acetabular anteversion was 10 or 15 degrees, placing the lip of the liner in the posterosuperior of the acetabulum allowed satisfactory ROM in all directions. When acetabular anteversion was 20 degrees, extension and external rotation were restricted. Adjusting the lip to the superior restored satisfactory ROM. When acetabular anteversion was 25 degrees, only placing the lip into the anterosuperior could increase extension and external rotation to maintain satisfactory ROM. Conclusions This study showed that optimal lipped liner orientation should depend on acetabular anteversion. When acetabular anteversion was smaller than 20 degrees, placing lip in the posterior allowed an optimally ROM. When acetabular anteversion was greater than 20 degrees, adjusting lip to the anterior allowed a comprehensive larger ROM to avoid early impingement. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03093-6.
Collapse
Affiliation(s)
- Yi Hu
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Xianhao Zhou
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Hua Qiao
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Zhenan Zhu
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Huiwu Li
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Jingwei Zhang
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| |
Collapse
|
22
|
Evaluation of the rate of post-operative dislocation in patients with ipsilateral valgus knee deformity after primary total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:1507-1514. [DOI: 10.1007/s00264-022-05372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
|
23
|
Combined Anteversion Technique for the Modified Hardinge Approach in Cementless Total Hip Arthroplasty. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
24
|
Castagnini F, Bordini B, Cosentino M, Ancarani C, Mariotti F, Biondi F, Faldini C, Traina F. The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:123. [PMID: 34524578 PMCID: PMC8443492 DOI: 10.1007/s10856-021-06598-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/29/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene. MATERIALS AND METHODS The regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included. RESULTS The rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2-2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models. CONCLUSION Bearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.
Collapse
Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Cristina Ancarani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Federica Mariotti
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Biondi
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- Head of Clinica Ortopedica e Traumatologica I, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Orthopaedics and Traumatology, University of Bologna DIBINEM, 40123, Bologna, Italy
| | - Francesco Traina
- Orthopaedics and Traumatology, University of Bologna DIBINEM, 40123, Bologna, Italy
- Head of Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
25
|
Klemt C, Bounajem G, Tirumala V, Xiong L, Padmanabha A, Kwon YM. Three-dimensional kinematic analysis of dislocation mechanism in dual mobility total hip arthroplasty constructs. J Orthop Res 2021; 39:1423-1432. [PMID: 32915465 DOI: 10.1002/jor.24855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/25/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
Dual mobility (DM) total hip arthroplasty (THA) is associated with reduced dislocation rates; however, the kinematic mechanism of dislocation in DM THA constructs is still not well understood. This study hypothesizes that the difference in kinematics between DM THA and conventional THA designs contributes to reduced dislocation rates of DM THA. In addition, this study aims to quantify and compare those kinematic parameters between DM THA and conventional THA using a validated dual fluoroscopy imaging system (DFIS) and finite element (FE) modelling. Fresh frozen cadavers were measured to compare the impingement-free range of motion and provocative subluxation kinematics among three THA constructs: (1) DM, (2) constrained liner (CS), and (3) 36 mm head diameter neutral liner (NL). The DFIS was used to measure the in vitro kinematics of the hip. Subject-specific FE models were developed to assess the horizontal dislocation distance and resistive torque at dislocation. The DM construct head exhibited increased provocative anterior and posterior subluxation range of motion before dislocation when compared to CS constructs (p = .05; p = .03), as well as NL constructs (p = .05). The DM THA showed a significantly larger posterior horizontal dislocation distance, as well as smaller resistive torque at dislocation, when compared to NL (p = .05; p = .03) and CS constructs (p = .04; p = .01). Our findings demonstrate there was increased provocative subluxation range of motion as well as normalized jump distance for the DM constructs compared to the NL and CS constructs, suggesting the DM THA may provide increased stability hip during at-risk functional hip positions.
Collapse
Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Georges Bounajem
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Venkatsaiakhil Tirumala
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Xiong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Padmanabha
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
26
|
Wiznia DH, Buchalter DB, Kirby DJ, Buckland AJ, Long WJ, Schwarzkopf R. Applying the hip-spine relationship in total hip arthroplasty. Hip Int 2021; 31:144-153. [PMID: 32787460 DOI: 10.1177/1120700020949837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty dislocations that occur inside Lewinnek's anatomical safe zone represent a need to better understand the hip-spine relationship. Unfortunately, the use of obtuse and redundant terminology to describe the hip-spine relationship has made it a relatively inaccessible topic in orthopaedics. However, with a few basic definitions and principles, the hip-spine relationship can be simplified and understood to prevent unnecessary dislocations following total hip arthroplasty.In the following text, we use common language to define a normal and abnormal hip-spine relationship, present an algorithm for recognising and treating a high-risk hip-spine patient, and discuss several common, high-risk hip-spine pathologies to apply these concepts. Simply, high-risk hip-spine patients often require subtle adjustments to acetabular anteversion based on radiographic evaluations and should also be considered for a high-offset stem, dual-mobility articulation, or large femoral head for additional protection against instability and dislocation.
Collapse
Affiliation(s)
- Daniel H Wiznia
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Daniel B Buchalter
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - David J Kirby
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Aaron J Buckland
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - William J Long
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| |
Collapse
|
27
|
3D Printed Guides and Preoperative Planning for Uncemented Stem Anteversion Reconstruction during Hip Arthroplasty: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6621882. [PMID: 33681357 PMCID: PMC7910057 DOI: 10.1155/2021/6621882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/16/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
Objective To investigate if 3D printed guides and preoperative planning can accurately control femoral stem anteversion. Methods A prospective comparative study was carried out from 2018 to 2020, including 53 patients who underwent hip arthroplasty for femoral neck fracture. The target rotation center of the femoral head is determined by three-dimensional planning. In group A, planning was made by 2D templates. In group B, preoperative 3D planning and 3D printed osteotomy/positioning guides were performed. After the operation, 3D model registration was performed to calculate the accuracy of anteversion restoration. Results We screened 60 patients and randomized a total of 53 to 2 parallel study arms: 30 patients to the group A (traditional operation) and 23 patients to the group B (3D preoperative planning and 3D printed guide). There were no significant differences in demographic or perioperative data between study groups. The restoration accuracy of group A was 5.42° ± 3.65° and of group B was 2.32° ± 1.89°. The number and rate of abnormal cases was 15 (50%) and 2 (8.7%), respectively. Significant statistical differences were found in angle change, restoration accuracy, and number of abnormal cases. Conclusion Three-dimensional preoperative planning and 3D printed guides can improve the accuracy of the restoration of femoral anteversion during hip arthroplasty.
Collapse
|
28
|
Shareghi B, Mohaddes M, Kärrholm J. Pelvic tilt between supine and standing after total hip arthroplasty an RSA up to seven years after the operation. J Orthop Res 2021; 39:121-129. [PMID: 32484957 DOI: 10.1002/jor.24759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 02/04/2023]
Abstract
The pose of the prosthetic components after total hip arthroplasty (THA) is commonly evaluated on conventional radiographs. Any change of the pelvic position after the operation in supine and between supine and standing position with time will influence validity of the measurements. We evaluated the changed pelvic tilt angle (PTA) in supine and standing position up to 7 years after operation. The aims of our study were (a) to evaluate if the PTA change over time after THA, (b) to assess any difference in PTA between supine and standing positions, and (c) to investigate whether factors such as gender, the condition of the opposite hip or low-back pain have any influence on PTA after THA. Repeated radiostereophotogrammetric radiographs of 106 patients were studied. Patients had been examined in the supine position postoperatively, and in both supine and standing positions at 6 months and 7-year follow-up. Measurements of supine patients showed an increasing mean posterior pelvic tilt over time. From supine to standing, the pelvis tilted in the opposite direction. At 6 months, the mean anterior tilt was 3.6° ± 3.8° (confidence interval [CI]: 2.8° to 4.3°) which increased to 6.4° ± 3.9° (CI: 5.7° to 7.2°) at 7 years. The mean changes in pelvic rotations around the longitudinal and sagittal axis were less than 1 degree, in both positions. In individual patients, this change reached about 11.0 degrees in supine and 18.0 degrees when standing.
Collapse
Affiliation(s)
- Bita Shareghi
- Department of Orthopaedics, The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Maziar Mohaddes
- Department of Orthopaedics, The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Johan Kärrholm
- Department of Orthopaedics, The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
29
|
Moreta J, Uriarte I, Foruria X, Urra I, Aguirre U, Martínez-de Los Mozos JL. Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty. Hip Int 2021; 31:97-102. [PMID: 31601128 DOI: 10.1177/1120700019873617] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. METHODS A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. RESULTS At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively (p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5).Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. CONCLUSION Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.
Collapse
Affiliation(s)
- Jesús Moreta
- Department of Orthopaedic Surgery and Trauma, Hospital Galdakao-Usansolo, Galdakao, Spain.,Lower Limb Reconstruction Group. Biocruces Bizkaia Health Research Institute, Hospital Galdakao- Usansolo. Osakidetza. (Bizkaia, Spain)
| | - Iker Uriarte
- Department of Orthopaedic Surgery and Trauma, Hospital Galdakao-Usansolo, Galdakao, Spain.,Lower Limb Reconstruction Group. Biocruces Bizkaia Health Research Institute, Hospital Galdakao- Usansolo. Osakidetza. (Bizkaia, Spain)
| | - Xabier Foruria
- Department of Orthopaedic Surgery and Trauma, Hospital Galdakao-Usansolo, Galdakao, Spain.,Lower Limb Reconstruction Group. Biocruces Bizkaia Health Research Institute, Hospital Galdakao- Usansolo. Osakidetza. (Bizkaia, Spain)
| | - Ioar Urra
- Department of Orthopaedic Surgery and Trauma, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Urko Aguirre
- Research Unit, Hospital Galdakao-Usansolo, Bizkaia, Spain. Health Services Research on Chronic Diseases Network - REDISSEC
| | | |
Collapse
|
30
|
Wang PH, Tsai SW, Chen CF, Wu PK, Chen CM, Chang MC, Chen WM. Cementation of the highly cross-linked polyethylene liner into a well-fixed acetabular shell to treat patients with recurrent dislocation after total hip arthroplasty. Artif Organs 2020; 45:E136-E145. [PMID: 33277711 DOI: 10.1111/aor.13852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023]
Abstract
Cementation of a highly cross-linked polyethylene liner into a well-fixed acetabular shell provided a good durability for liner wear. However, its efficacy in treating recurrent instability due to malposition cup is less reported. The aim of this study is to evaluate the outcome of this surgical technique to treat hip instability. From 2009 to 2019, we have identified 38 patients who had been surgically treated for recurrent instability, including cementation liner (N = 20) and revision cup (N = 18) procedures. Patients were followed for a mean of 45.66 months. We have recorded and analyzed all causes of implant failure including recurrent instability. Clinical outcomes were assessed including complication and Harris Hip Score (HHS) preoperatively and at the latest follow-up. Revision-free survivorship for any cause was 95.0% at 1 year, and 84.4% at 5 years in cementation liner group and 88.9% at 1 year and 5 years in revision cup group. Mean Harris hip score improved from 48.3 points preoperatively to 79.5 points at the last follow-up in cementation liner group and mean HHS improved from 43.3 points preoperatively to 77.2 points in revision cup group. There were two implant failures in each group, including one is due to persistent hip instability and the other is due to periprosthetic joint infection in the cementation liner group and two implant failure are due to persistent hip instability in the revision cup group. Functional scores and implant survival were similar in both groups. We demonstrated that orientation correction via the cementation of the polyethylene liner into well-fixed acetabular shell is a promising option to treat and prevent instability. Level of Evidence: Therapeutic Level IV.
Collapse
Affiliation(s)
- Pai-Han Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chao-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| |
Collapse
|
31
|
Hoskins W, Bingham R, Hatton A, de Steiger RN. Standard, Large-Head, Dual-Mobility, or Constrained-Liner Revision Total Hip Arthroplasty for a Diagnosis of Dislocation: An Analysis of 1,275 Revision Total Hip Replacements. J Bone Joint Surg Am 2020; 102:2060-2067. [PMID: 33264216 DOI: 10.2106/jbjs.20.00479] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dislocation remains a leading cause of revision following primary and revision total hip arthroplasty (THA). The aim of the present study was to compare the rate of second revision THA following a major first revision for the treatment of dislocation using an implant with a standard, large head, dual-mobility, or constrained acetabular liner. METHODS Data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry from September 1999 through December 2018. All primary THAs that had been performed for the treatment of osteoarthritis and subsequently revised for dislocation were included. All revision THA prostheses with a standard head (≤32 mm), large head (≥36 mm), dual-mobility, or constrained acetabular liner that were used for the first revision procedure were identified. The primary outcome measures were the cumulative rates of second revisions for all causes and for a subsequent diagnosis of dislocation for the 4 different constructs used in the first revision. RESULTS A total of 1,275 hips underwent a major first revision because of prosthesis dislocation, with 203 of these hips going on to have a second revision. The rate of all-cause second revision was significantly higher in the standard-head group compared with the constrained-acetabular-liner group (hazard ratio [HR], 1.53 [95% confidence interval (CI), 1.01 to 2.30]; p = 0.044). There was no difference in the rates of revision between other articulations. The most common cause of second revision for all implants was dislocation. There were a total of 91 second revisions for a diagnosis of dislocation. Standard heads had a higher rate of second revision compared with constrained acetabular liners (HR, 2.44 [95% CI, 1.30 to 4.60]; p = 0.005), dual-mobility implants (HR, 2.04 [95% CI, 1.03 to 4.01]; p = 0.039), and large heads (HR, 1.80 [95% CI, 1.09, 2.99]; p = 0.022). There was no difference in the rates of second revision between other articulations. CONCLUSIONS Surgeons have a number of options for prostheses when performing a first revision for the treatment of dislocation following a primary THA. The most common cause of a second revision is recurrent dislocation. The use of constrained acetabular liners, dual-mobility liners, and large heads (≥36 mm) are options for reducing subsequent dislocation. Standard head sizes have a higher rate of second revision for further dislocation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, Parkville, Victoria, Australia.,Traumaplasty Melbourne, East Melbourne, Victoria, Australia
| | - Roger Bingham
- Traumaplasty Melbourne, East Melbourne, Victoria, Australia.,Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alesha Hatton
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Richard N de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.,Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Victoria, Australia
| |
Collapse
|
32
|
D'Apolito R, Bandettini G, Jacquot FMP, Zagra L. Modular dual-mobility cups using ceramic liners: an original solution for selected indications? Hip Int 2020; 30:59-65. [PMID: 33267689 DOI: 10.1177/1120700020964976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dual mobility (DM) has been shown to improve stability both in primary and revision total hip arthroplasty (THA) and is increasingly used in patients at high risk of dislocation and in the treatment of THA instability. The introduction of modular liners has helped to overcome some of the limitations of monoblock DM cups. In this context, the use of a ceramic liner would avoid the conventional cobalt-chromium liner in the titanium shell, which can be problematic in some situations. The aim of this paper is to report the outcomes of a consecutive series of patients undergoing revision THA using a modular DM cup with a ceramic liner instead of the conventional metal one, and to clarify the rationale for this currently "off-label" use. PATIENTS AND METHODS This is a retrospective series of patients who received this new DM bearing in a single institution. Patients were followed up clinically and radiologically at 1 month, 3 months, 6 months and yearly thereafter. RESULTS 5 patients received the ceramic liner in the study period (2014-2019). The indications were instability or high risk of dislocation in ceramic liner fracture and ARMD with soft tissue damage after MoM THA. The mean age at surgery was 74 (63-82) years, the mean follow-up was 36 (12-72) months. No dislocation occurred, and no adverse events related to the implant were recorded. CONCLUSIONS The use of a ceramic liner in a modular DM cup offers several advantages in selected patients, and the results of our cohort are encouraging. However, caution is needed in introducing this new bearing because knowledge is currently limited. Further studies on a larger number of patients and with longer follow-ups are needed to confirm these findings and before widespread use of the device.
Collapse
Affiliation(s)
- Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | - Guido Bandettini
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| |
Collapse
|
33
|
Shoji T, Ota Y, Saka H, Murakami H, Takahashi W, Yamasaki T, Yasunaga Y, Iwamori H, Adachi N. Factors affecting impingement and dislocation after total hip arthroplasty - Computer simulation analysis. Clin Biomech (Bristol, Avon) 2020; 80:105151. [PMID: 32836081 DOI: 10.1016/j.clinbiomech.2020.105151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies on the causes and factors affecting dislocation after total hip arthroplasty have revealed conflicting results. The purpose of this study was to evaluate the factors affecting impingement and dislocation after total hip arthroplasty, using a 3-dimensional dynamic motion analysis. METHODS The CT data of 53 patients (53 hips: anterior dislocation; 11 cases, and posterior dislocation; 42 cases) who experienced hip dislocation after total hip arthroplasty with posterior approach, and 120 control patients (120 hips) without dislocation were analyzed. Parameters related to implant alignment, offset and leg length were evaluated. The impingement type was also analyzed using a software. FINDINGS Considering implant settings affecting dislocation, patients at risk for posterior dislocation had decreased stem anteversion, combined anteversion, femoral offset, and leg length. Nevertheless, patients at risk for anterior dislocation had only lower leg length, and these patients may also be at risk for a higher incidence of recurrent dislocation. Bony impingement occurred in almost half of the cases with posterior dislocation, while implant impingement was associated with anterior dislocation. Importantly, anterior dislocation was not as common as posterior dislocation even in cases with occurrence of posterior impingement. INTERPRETATION Bony impingement substantially affects dislocation even in the situation where the implant position and alignment are determined by the so-called "safe zone", especially on the anterior side, while implant impingement affects anterior dislocation. The restoration of anterior offset (i.e., prescribed by the stem anteversion and femoral offset) and combined anteversion is critical for avoidance of posterior dislocation after total hip arthroplasty.
Collapse
Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroaki Murakami
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Wakan Takahashi
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama town, Kure city, Hiroshima 737-0023, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Hiroshi Iwamori
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| |
Collapse
|
34
|
Waters G, D'Alessandro P, Yates P. Functional navigation in hip resurfacing. ANZ J Surg 2020; 91:168-173. [PMID: 33164345 DOI: 10.1111/ans.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acetabular malpositioning in total hip arthroplasty (THA) can result in edge loading, leading to increased wear, pseudotumours and bearing failure. Historically Lewinnek's safe zone has been the goal for optimal THA cup positioning; however, research indicates that one generic safe zone is not ideal. In hip resurfacing (HR) there is a lack of data regarding optimal position, and studies indicate that edge loading is related to increased inclination. METHODS We used a functional positioning protocol to produce patient-specific (PS) dynamic analyses, identifying individual functional ideal acetabular zones. We hypothesized that identifying and implanting into PS functional ideal zones would result in decreased edge loading and improved clinical outcomes. Fifteen adept HRs were implanted using a PS functional positioning protocol. As plans were created for standard THA acetabular position, adjustments were made intra-operatively. RESULTS Dynamic post-operative analyses showed 80% of implants were appropriately positioned. The remaining 20% had edge loading, where implants had inclination ≤5° of planned positioning and 10° of planned anteversion. 60% were ≤10° of planned inclination and anteversion. No pre-operative planned positions were within 'Lewinneks's zone', indicating its questionable relevance, especially in HR. A total of 20% of patients developed pain; however, at 1 year post-operatively all patients recorded improved Oxford hip scores. CONCLUSION This study confirms that functional positioning in HR consistently results in improved precision and accuracy in achieving the functional acetabular ideal zone, leading to improved clinical outcomes and prevention of edge loading.
Collapse
Affiliation(s)
- Georgina Waters
- Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia
| | - Peter D'Alessandro
- Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Piers Yates
- Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
35
|
Stevenson KL, Fryhofer G, Hasenauer M, Lee GC. Instability After All-Cause Acetabular-Only Revision Total Hip Arthroplasty Remains a Clinical Problem. J Arthroplasty 2020; 35:3249-3253. [PMID: 32622714 DOI: 10.1016/j.arth.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/25/2020] [Accepted: 06/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to (1) evaluate the rate of instability and reoperation after acetabular component-only revision, (2) compare instability rates across various head sizes, and (3) determine patient factors correlating with postoperative instability. METHODS We retrospectively reviewed all isolated acetabular component revisions (n = 200) at our institution between 2007 and 2017. Patients with less than one-year follow-up were excluded. Patients were subdivided into 4 head size groups: (1) 32 mm or less, (2) 36 mm or more, (3) dual mobility, and (4) constrained liners. Factors including the body mass index, cup position, prior revision(s), and subsequent reoperation were compared across groups. RESULTS 189 patients (200 hips) met the inclusion criteria. The overall rate of instability was 12% (n = 24), and 37 (18.5%) cases underwent subsequent revision, including 11 cases for recurrent instability. There was no significant difference in postoperative dislocation or reoperation for instability across the various groups. The use of a constrained liner trended toward the highest rate of postoperative instability (36.4%, P = .090). History of preoperative instability was a significant risk factor for postoperative instability with or without history of prior revision (P = .011 and P = .001, respectively). CONCLUSION Contemporary isolated acetabular revision is still associated with significant rates of instability. Surprisingly, the head size was not a predictive factor for postoperative dislocation or reoperation, but a prior history of instability was associated with postoperative instability. Patients revised to a constrained liner experienced highest rates of failure and remain an unsolved clinical problem.
Collapse
Affiliation(s)
- Kimberly L Stevenson
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - George Fryhofer
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mark Hasenauer
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
36
|
Graulich T, Graeff P, Jaiman A, Nicolaides S, Omar Pacha T, Örgel M, Macke C, Omar M, Krettek C, Liodakis E. Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case-control study of patients with CT data. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:627-633. [PMID: 33098004 PMCID: PMC8053145 DOI: 10.1007/s00590-020-02819-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/15/2020] [Indexed: 01/07/2023]
Abstract
Purpose Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p < 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p < 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty
Collapse
Affiliation(s)
- Tilman Graulich
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Pascal Graeff
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Ashish Jaiman
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Stine Nicolaides
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tarek Omar Pacha
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| |
Collapse
|
37
|
Hannon CP, Cotter EJ, Cooper HJ, Deirmengian CA, Rodriguez JA, Urban RM, Paprosky WG, Jacobs JJ. Adverse Local Tissue Reaction due to Mechanically Assisted Crevice Corrosion Presenting as Late Instability Following Metal-on-Polyethylene Total Hip Arthroplasty. J Arthroplasty 2020; 35:2666-2670. [PMID: 32389403 DOI: 10.1016/j.arth.2020.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mechanically assisted crevice corrosion (MACC) at modular junctions can cause a spectrum of adverse local tissue reactions (ALTRs) in patients who have undergone total hip arthroplasty (THA). The purpose of this study is to describe the presentation, treatments, and related complications of a cohort of patients presenting with late instability following metal-on-polyethylene THA due to underlying MACC and ALTR. METHODS This multicenter retrospective case series presents 17 patients (12 women, mean age 62.6, range 42-73) presenting with late instability secondary to ALTR and MACC. All patients had a metal (Cobalt Chrome)-on-polyethylene bearing surface. Patients experienced a mean 2.7 dislocations (range 1-6) at mean 4.3 years (range 0.4-17.0) following their index surgery. Serum metal levels (n = 12) demonstrated a greater elevation of cobalt (mean 6.9, range 0.13-20.88 ng/mL) than chromium (mean 1.9, range 0.13-3.23 ng/mL). RESULTS Patients were revised for instability at a mean of 6.8 years (range 2.1-19.4) following their index surgery. ALTR was encountered in every case and the modular head-neck junction demonstrated visible corrosion. An exchange of the CoCr head to a ceramic head with a titanium sleeve and placement of a constrained liner was performed for a majority of patients (n = 15, 88.2%). Five patients (29.4%) had complications postoperatively including peroneal palsy (n = 2), periprosthetic joint infection (n = 2), and ALTR recurrence (n = 1). CONCLUSION Recurrent instability in the setting of otherwise well-positioned THA components and without another obvious cause should raise concern for ALTR as a potential underlying etiology.
Collapse
Affiliation(s)
- Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Eric J Cotter
- Department of Orthopaedic Surgery, University of Wisconsin-Madison, Madison, WI
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY
| | - Carl A Deirmengian
- Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Rodriguez
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Robert M Urban
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Joshua J Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| |
Collapse
|
38
|
Novel Constrained Dual Mobility Hip Prosthesis to Combat Instability in Revision Total Hip Arthroplasty whilst Preserving Normal Function. Case Rep Orthop 2020; 2020:6390310. [PMID: 32724692 PMCID: PMC7364194 DOI: 10.1155/2020/6390310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 12/04/2022] Open
Abstract
We present the case of a male patient with sepsis and a chronic discharging sinus in a multirevised total hip replacement. Following extensive debridement, the reimplanted hip became unstable. With the patient's long-term desire to return to work and ride a bicycle with his children, the patient agreed to proceed with a novel, custom-designed, constrained dual mobility liner which allowed unrestricted movement. In 2017, the patient underwent revision surgery with this novel dual mobility constrained prosthesis. The patient was very quickly able to regain independence. After 16 years of unemployment, he managed to return to gainful employment as a cleaner rapidly regaining function as well as finally being able to ride a bike with his children for the first time.
Collapse
|
39
|
Scanaliato JP, Eckhoff M, Schneider PR, Reich MS. Reducing the "Irreducible" Total Hip Arthroplasty Dislocation with a Fracture Table: A Case Report. JBJS Case Connect 2020; 9:e0162. [PMID: 31850959 DOI: 10.2106/jbjs.cc.19.00162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Reduction of dislocated total hip arthroplasty components is a challenging clinical scenario. Although component revision is recommended as a definitive treatment for those with recurrent instability, immediate reduction is required after an acute dislocation. We describe the case of a dislocated total hip arthroplasty and present a novel method for obtaining reduction after other closed techniques had failed. CONCLUSIONS Based on this case, utilization of a fracture table to generate adequate axial traction can aid orthopedic surgeons in obtaining reduction of a challenging dislocated hip prosthesis.
Collapse
Affiliation(s)
- John P Scanaliato
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas.,Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Michael Eckhoff
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas.,Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Phillip R Schneider
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas.,Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Michael S Reich
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center, El Paso, Texas
| |
Collapse
|
40
|
Van Eecke E, Vanbiervliet J, Dauwe J, Mulier M. Comparison of Constrained Acetabular Components and Dual Mobility Cups in Revision Total Hip Arthroplasty: A Literature Review. Hip Pelvis 2020; 32:59-69. [PMID: 32566536 PMCID: PMC7295616 DOI: 10.5371/hp.2020.32.2.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022] Open
Abstract
Recurrent instability remains a common cause of failure after revision total hip arthroplasty (THA). Dual mobility (DM) cups and designs with constrained acetabular liners (CAL) have both been developed to help overcome this challenge. The aim of this report is to compare safety and efficacy outcomes of both designs based on the literature. A comprehensive literature review including published evidence on the results of DM and CAL in revision THA was performed and summarized. Available literature focusing on overall survival, dislocation, loosening, intra-prosthetic dislocation (IPD), and functional outcomes were analysed. Forty-six reports including an evaluation of 5,617 total hips were evaluated were included in the review. The included studies were divided into two distinct groups based on implantation approach: i) CAL (n=15) and ii) DM (n=31). The DM group had higher overall survival rates (94.7% vs. 81.0%), lower dislocation rates (2.6% vs. 11.0%), and lower acetabular loosening rates (1.0% vs. 2.0%) compared to the CAL group. IPDs were reported in 6 studies (mean rate, 0.6%). No differences in functional outcomes were identified due to incomplete reports. Our observations reveal that designs with CAL have poorer outcomes as compared to DM cups in revision THA. Currently, the use of DM seems more appropriate since they offer lower rates of dislocations, loosening and re-revisions in the short- and mid-term. Concerns regarding the potential of increased wear in a younger, high-demand population require additional data and evaluation by long-term studies for the DM design.
Collapse
Affiliation(s)
- Eduard Van Eecke
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jens Vanbiervliet
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Dauwe
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michiel Mulier
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
41
|
Abstract
PURPOSE OF REVIEW Advances in technology, implant design, and surgical technique have lowered the dislocation rate in primary total hip arthroplasty (THA). Despite these advances, there remain a large number of instability episodes without a known etiology. Recent research suggests that the pelvic and lumbar spine interrelationship may be the explanation in prosthetic dislocations without a known cause. In this review, we describe the biomechanics, measurements, diagnoses, classification, management, and outcomes of total hip and revision total hip instability as it relates to spinopelvic alignment. RECENT FINDINGS As a person goes from standing to sitting, lumbar lordosis decreases, and the sacrum and entire pelvis tilts posteriorly with sacrum and coccyx rotating posterior-inferiorly, resulting in increased acetabular cup anteversion to accommodate femoral flexion. A fused spine and associated fixed acetabulum can result in abnormal pelvic femoral motion, impingement, and dislocation. Classifying the spinopelvic mechanics by sacral motion based on sitting and standing lateral radiographs provides an understanding of how the acetabulum behaves in space. This information helps appropriate cup positioning, reducing the risk of femoral side impingement and subsequent dislocation. Surgical techniques to consider in the spinopelvic at-risk patient are positioning considerations in acetabular cup inclination and anteversion, high offset femoral stems, high offset acetabular liners, dual mobility articulations, and removal of impinging structures. Future research is needed to define the safest order of operation in concomitant hip and spine pathology, the effects on pelvic femoral biomechanics in spine surgery, and whether preoperative and intraoperative management strategies have a long-term beneficial effect on the dislocation rate.
Collapse
Affiliation(s)
- Zachary C Lum
- Adult Reconstruction Division, Department of Orthopaedic Surgery, University of California: Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA.
| | - Mauro Giordani
- Adult Reconstruction Division, Department of Orthopaedic Surgery, University of California: Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA
| | - John P Meehan
- Adult Reconstruction Division, Department of Orthopaedic Surgery, University of California: Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA
| |
Collapse
|
42
|
Ding ZC, Zeng WN, Mou P, Liang ZM, Wang D, Zhou ZK. Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip. Orthop Surg 2020; 12:589-600. [PMID: 32227469 PMCID: PMC7189031 DOI: 10.1111/os.12665] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 02/05/2023] Open
Abstract
Objective To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients. Methods This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips. Results A total of 131 Crowe type IV hips were followed up for a mean of 76.5 ± 28.1 months. Three hundred and ninety‐three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 ± 28.2 months. No significant difference was observed in follow‐up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non‐operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22‐mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901–291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037–1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982–77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips. Conclusions Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.
Collapse
Affiliation(s)
- Zi-Chuan Ding
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei-Nan Zeng
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Ping Mou
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhi-Min Liang
- Clinic Research Management Department, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Duan Wang
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| |
Collapse
|
43
|
Mishra A, Verma T, Agarwal G, Sharma A, Maini L. 3D Printed Patient-Specific Acetabular Jig for Cup Placement in Total Hip Arthroplasty. Indian J Orthop 2020; 54:174-180. [PMID: 32257035 PMCID: PMC7096340 DOI: 10.1007/s43465-020-00061-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Acetabular cup placement is an important modifiable factor determining complication rates like aseptic loosening and hip dislocation related to faulty cup placement, which by standard method is largely dependent upon eyeballing and surgeon's judgment. We evaluated a self-designed, low-cost, patient-specific acetabular jig to guide cup placement in total hip arthroplasty in comparison to conventional technique. METHODS It was a prospective randomized control study. Thirty-six patients were categorized into group-A & group-B. In group-A, virtually designed acetabular jig was 3 Dimensional (3D) printed and used intra-operatively to guide cup placement. In group-B, the standard method of cup placement was used. Acetabular cup placement was evaluated on post-operative x-rays and compared between two groups. RESULTS In group-A, angle of anteversion were significantly in centre of range of safe zone as compared to group B in which hip is maximally stable with more precision in creating hip centre as compared to group-B without any significant(p = 0.325) increase in surgical time or blood loss. CONCLUSION Computed tomography (CT) scan based virtual pre-operative templating and cup placement guided by virtually designed, patient-specific acetabular jig is a low-cost tool with a short learning curve which can be designed and made available easily. It is a useful tool in decreasing chances of malpositioning of cup and recreates hip centre close to anatomical one especially in cases where anatomy has been distorted such as bony ankylosis and developmental dysplasia of hip.
Collapse
Affiliation(s)
- Abhishek Mishra
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- Plot no. 60, Vivek Nagar Colony, Nasirpur, Varanasi, Uttar Pradesh India
| | - Tarun Verma
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Gaurang Agarwal
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Amit Sharma
- Lady Hardinge Medical College, New Delhi, India
| | - Lalit Maini
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| |
Collapse
|
44
|
Elbuluk AM, Coxe FR, Schimizzi GV, Ranawat AS, Bostrom MP, Sierra RJ, Sculco PK. Abductor Deficiency-Induced Recurrent Instability After Total Hip Arthroplasty. JBJS Rev 2020; 8:e0164. [DOI: 10.2106/jbjs.rvw.18.00164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
45
|
Herman A, Masri BA, Duncan CP, Greidanus NV, Garbuz DS. Multivariate analysis of risk factors for re-dislocation after revision for dislocation after total hip arthroplasty. Hip Int 2020; 30:93-100. [PMID: 30887851 DOI: 10.1177/1120700019831628] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment for recurrent dislocation of a total hip arthroplasty is surgical using varied techniques and technologies to reduce the chances of re-dislocation and re-revision. The goal of this study is to compare operative techniques to reduce re-dislocation and re-revision in revision hip arthroplasty due to recurrent dislocations. METHODS A retrospective study of revision hip arthroplasties done due to recurrent dislocation prior to 01 January 2014. Electronic physician and provincial health records were used to collect patients' initial and follow-up data. Treatment failure was defined as either aseptic re-revision or re-dislocation without revision. Time to event was considered as the re-revision date or the date of second dislocation when the latter endpoint was used. RESULTS Of 379 operations, 88 (23.2%) had aseptic repeat revision or recurrent dislocation. Of these: 66 (75.0%) due to dislocation with re-revision; 10 (11.4%) due to dislocation with no re-revision surgery; 5 (5.7%) due to aseptic loosening of components; 3 (3.4%) due to osteolysis; 3 (3.4%) due to pseudotumour; and 1 (1.1%) due to periprosthetic fracture. The following factors increase risk of failure: the use of augmented-liners (lipped, oblique and high-offset liners; HR = 1.68, 95% CI, 1.05-2.69), periprosthetic femur fracture (HR = 2.80, 95% CI, 1.39-8.21) and pelvic discontinuity (HR = 3.69, 95% CI, 1.66-8.21). Femur head sizes 36-40 mm are protective (HR = 0.54, 95% CI, 0.31-0.86). In abductor dysfunction the use of focal constrained liners decreases the risk of failure (HR = 0.13, 95% CI, 0.018-0.973). CONCLUSIONS Larger head sizes and focal constrained liners (abductors dysfunction) should be used and fully constrained liners and augmented-liners should be avoided in a revision hip arthroplasty due to recurrent dislocations.
Collapse
Affiliation(s)
- Amir Herman
- Department of Orthopaedic Surgery, Assuta Ashdod Medical Centre, Ashdod, Israel
- Ben-Guriun University Faculty of Medicine, Be'er-Sheva, Israel
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Clive P Duncan
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Nelson V Greidanus
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Donald S Garbuz
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
46
|
Vigdorchik J, Eftekhary N, Elbuluk A, Abdel MP, Buckland AJ, Schwarzkopf RS, Jerabek SA, Mayman DJ. Evaluation of the spine is critical in the workup of recurrent instability after total hip arthroplasty. Bone Joint J 2019; 101-B:817-823. [PMID: 31256675 DOI: 10.1302/0301-620x.101b7.bjj-2018-1502.r1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS While previously underappreciated, factors related to the spine contribute substantially to the risk of dislocation following total hip arthroplasty (THA). These factors must be taken into consideration during preoperative planning for revision THA due to recurrent instability. We developed a protocol to assess the functional position of the spine, the significance of these findings, and how to address different pathologies at the time of revision THA. PATIENTS AND METHODS Prospectively collected data on 111 patients undergoing revision THA for recurrent instability from January 2014 to January 2017 at two institutions were included (protocol group) and matched 1:1 to 111 revisions specifically performed for instability not using this protocol (control group). Mean follow-up was 2.8 years. Protocol patients underwent standardized preoperative imaging including supine and standing anteroposterior (AP) pelvis and lateral radiographs. Each case was scored according to the Hip-Spine Classification in Revision THA. RESULTS Survival free of dislocation at two years was 97% in the protocol group (three dislocations, all within three months of surgery) versus 84% in the control group (18 patients). Furthermore, 77% of the inappropriately positioned acetabular components would have been unrecognized by supine AP pelvis imaging alone. CONCLUSION Using the Hip-Spine Classification System in revision THA, we demonstrated a significant decrease in the risk of recurrent instability compared with a control group. Without the use of this algorithm, 77% of inappropriately positioned acetabular components would have been unrecognized and incorrect treatment may have been instituted. Cite this article: Bone Joint J 2019;101-B:817-823.
Collapse
Affiliation(s)
- J Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - N Eftekhary
- NYU Langone Orthopaedic Hospital, New York, New York, USA
| | - A Elbuluk
- Hospital for Special Surgery, New York, New York, USA
| | - M P Abdel
- Mayo Clinic, Rochester, Minnesota, USA
| | - A J Buckland
- NYU Langone Orthopaedic Hospital, New York, New York, USA
| | | | - S A Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - D J Mayman
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
47
|
Saiz AM, Lum ZC, Pereira GC. Etiology, Evaluation, and Management of Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2019; 7:e7. [DOI: 10.2106/jbjs.rvw.18.00165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
48
|
Plummer D, Passen E, Alexander J, Vajapey S, Frantz T, Niedermeier S, Pettit R, Scharschmidt T. Rapid return to function and stability with dual mobility components cemented into an acetabular reconstructive cage for large osseous defects in the setting of periacetabular metastatic disease. J Surg Oncol 2019; 119:1155-1160. [PMID: 30908659 DOI: 10.1002/jso.25463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Large acetabular defects secondary to metastatic disease frequently require extensive acetabular reconstruction. Techniques of acetabular reconstruction have been described, but no consensus for the management of these defects has been reached so far. We present our technique and patient outcomes for acetabular reconstruction by cementing a dual mobility cup into an acetabular cage. METHODS We reviewed 152 total hip arthroplasties and identified 19 patients with periacetabular metastatic disease and large defects who required acetabular reconstruction utilizing a dual mobility cup cemented into an acetabular reconstructive cage. The following outcomes were evaluated: pain relief, functional improvement, postoperative complications. RESULTS Mean follow-up was 3 years, with 13 of the 19 patients eligible for 2-year follow-up. Patients reported a significant improvement in both pain and functional outcomes. There were no dislocations or signs of loosening. Two patients developed postoperative infections. One patient required hemipelvectomy 16 months postop due to recurrence of metastatic disease. CONCLUSIONS Cementing a dual mobility cup into an acetabular cage provides a highly stable and durable option for patients with periacetabular metastatic disease and large defects. Patients are able to return to immediate full weight bearing with significant improvement in both function and pain at 2 years.
Collapse
Affiliation(s)
- Darren Plummer
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | - Edward Passen
- Department of Orthopaedic Surgery, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
| | - John Alexander
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | - Sravya Vajapey
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | - Travis Frantz
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | - Steven Niedermeier
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | - Robert Pettit
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | - Thomas Scharschmidt
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| |
Collapse
|
49
|
[Revision total hip arthroplasty : Significance of instability, impingement, offset and gluteal insufficiency]. DER ORTHOPADE 2019; 48:315-321. [PMID: 30868208 DOI: 10.1007/s00132-019-03704-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Instability is a common cause of failure in primary and, especially, revision total hip arthroplasty. The reasons for instability include implant malpositioning, impingement, inadequate offset reconstruction, and gluteal insufficiency. Impingement following THA and revision THA is divided into prosthetic and bony impingement, and in addition to instability also causes pain in the area of the hip joint. Offset reconstruction during revision THA is of particular biomechanical importance, since insufficient reconstruction leads not only to instability and pain but also to dislocation. Abductor deficiency often occurs after revision THA and leads to a change in gait pattern, instability and pain. AIM Current diagnostic and treatment procedures for instability, impingement, insufficient offset reconstruction and abductor deficiency after THA and revision THA are summarized. RESULTS AND DISCUSSION Diagnosis of an instable THA and painful THA includes patient history, physical examination and medical imaging. Thus, in almost all cases, the cause can be determined and treated. Dislocation after primary THA in the early postoperative period can often be treated conservatively if accurate component placement is observed, while a late-onset and recurrent dislocation after primary and revision THA usually needs surgical procedures. To avoid bony and prosthetic THA impingement intraoperative control is absolutely necessary. If possible, the offset reconstruction is based on the condition of the native hip joint and can be achieved by using modular prostheses, neck adapters and different head lengths. Abductor deficiency also occurs frequently after revision THA and can be treated surgically if severe clinical symptoms and fatty degeneration of the abductors have been diagnosed.
Collapse
|
50
|
Neil Wheelton A, Myatt D, Helm AT. Outcomes for cemented dual mobility cup to treat recurrent instability; A UK case series. J Orthop 2019; 16:220-223. [PMID: 30906127 DOI: 10.1016/j.jor.2019.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 02/17/2019] [Indexed: 01/26/2023] Open
Abstract
Objectives Recurrent dislocation of Total Hip Replacement (THR) is often multifactorial and remains a significant surgical challenge with a significant risk of further instability. Dual Mobility Cups (DMC) have been used widely with good long term results in France with few studies in the British literature, especially assessing their use for recurrent instability. We set out to assess whether recurrent instability can be successfully treated solely with revision of acetabular component to a dual mobility cup. Methods We retrospectively reviewed a prospectively collected electronic database for all consecutive dual mobility cups implanted to address recurrently instability in THR. Radiological and clinical data have been analysed. Results From September 2013 to September 2017 54 dual mobility cups have been implanted, mean age 78 (range 49-97). 47 were 1st time revision procedures, 7 were following previous revisions including 5 failed PLADs. Average time post primary was 10 years (range 8 months-23 years). Twenty cases are cement in cement revisions which has become our primary technique for revision of cemented cups. Mean follow up is 1.9 years (range 6 months-5 years), 37 cases have 2 year follow up available. 8 patients have died. There have been no episodes of further instability. One patient has had reoperation for infection (1st stage revision). Conclusions This series demonstrates satisfactory early to mid-term results for the use of dual mobility cups to treat recurrent instability. The technique is particularly useful when femoral components are well fixed and can be used with monoblock implants such as the Charnley stem. Cement in cement revision is a convenient technique and potentially reduces complications and cost. Further analysis of longer term data is required but these results suggests this could be a valid solution to a complex problem.
Collapse
Affiliation(s)
- Andrew Neil Wheelton
- Lancashire Teaching Hospitals NHS Foundation Trust, PR2 9HT, United Kingdom
- Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, M4Y 1H1, Canada
| | - Darren Myatt
- Lancashire Teaching Hospitals NHS Foundation Trust, PR2 9HT, United Kingdom
| | | |
Collapse
|