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Butler JT, Stegelmann SD, Butler JL, Bullock M, M Miller R. Comparing dislocation rates by approach following elective primary dual mobility total hip arthroplasty: a systematic review. J Orthop Surg Res 2023; 18:226. [PMID: 36945061 PMCID: PMC10032016 DOI: 10.1186/s13018-023-03724-6] [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: 11/30/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dual mobility components can be implanted during total hip arthroplasty (THA) for primary osteoarthritis via a direct anterior approach (DAA), anterolateral approach (ALA), direct lateral approach (DLA), or posterior/posterolateral approach (PLA). This review compares dual mobility hip dislocation rates using these approaches for elective primary THA. METHODS PubMed, Embase, and Cochrane databases were systematically searched for articles published after January 1, 2006 that reported dislocation rates for adult patients after primary THA with dual mobility implants. Articles were excluded if they reported revision procedures, nonelective THA for femoral neck fractures, acetabular defects requiring supplemental implants, prior surgery, or ≤ 5 patients. The primary outcome was hip dislocation rate. Secondary outcomes included infection, Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) score. RESULTS After screening 542 articles, 63 met inclusion criteria. Due to study heterogeneity, we did not perform a meta-analysis. Eight studies reported DAA, 5 reported ALA, 6 reported the DLA, and 56 reported PLA. Study size ranged from 41 to 2,601 patients. Mean follow-up time ranged from 6 months to 25 years. Rates of infection and dislocation were low; 80% of ALA, 87.5% of DAA, 100% of DLA, and 82.1% of PLA studies reported zero postoperative dislocations. Studies reporting postoperative HHS and PMA scores showed considerable improvement for all approaches. CONCLUSIONS Patients undergoing primary THA with dual mobility implants rarely experience postoperative dislocation, regardless of surgical approach. Additional studies directly comparing DAA, ALA, DLA, and PLA are needed to confirm these findings.
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Affiliation(s)
- Justin T Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA.
| | - Samuel D Stegelmann
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Johnathon L Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Matthew Bullock
- Department of Orthopedic Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Richard M Miller
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
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Ciolli G, Mesnard G, Deroche E, Gunst S, Batailler C, Servien E, Lustig S. Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Pers Med 2022; 13:jpm13010081. [PMID: 36675742 PMCID: PMC9867154 DOI: 10.3390/jpm13010081] [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] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Instability is a common complication following total hip arthroplasty (THA). The dual mobility cup (DMC) allows a reduction in the dislocation rate. The goal of this systematic review was to clarify the different uses and outcomes according to the indications of the cemented DMC (C-DMC). Methods: A systematic review was performed using the keywords "Cemented Dual Mobility Cup" or "Cemented Tripolar Cup" without a publication year limit. Of the 465 studies identified, only 56 were eligible for the study. Results: The overall number of C-DMC was 3452 in 3426 patients. The mean follow-up was 45.9 months (range 12-98.4). In most of the cases (74.5%) C-DMC was used in a revision setting. In 57.5% DMC was cemented directly into the bone, in 39.6% into an acetabular reinforcement and in 3.2% into a pre-existing cup. The overall dislocation rate was 2.9%. The most frequent postoperative complications were periprosthetic infections (2%); aseptic loosening (1.1%) and mechanical failure (0.5%). The overall revision rate was 4.4%. The average survival rate of C-DMC at the last follow-up was 93.5%. Conclusions: C-DMC represents an effective treatment option to limit the risk of dislocations and complications for both primary and revision surgery. C-DMC has good clinical outcomes and a low complication rate.
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Affiliation(s)
- Gianluca Ciolli
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Sacred Heart Catholic University, 00168 Rome, Italy
| | - Guillaume Mesnard
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Correspondence:
| | - Etienne Deroche
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Stanislas Gunst
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- LIBM—EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69622 Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
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Yang J, Bryan AJ, Drabchuk R, Tetreault MW, Calkins TE, Della Valle CJ. Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation. Hip Int 2022; 32:648-655. [PMID: 33566709 DOI: 10.1177/1120700020988469] [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
INTRODUCTION Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA. METHODS A total of 155 primary THAs with a monoblock, cementless dual-mobility acetabular component were performed in patients at high risk for dislocation. Two patients died prior to their two-year follow-up. The remaining 153 THAs were followed for a mean of 5.1 years (range: 2.1 to 9.3). RESULTS There were no dislocations; however, four patients underwent revision surgery: one for an early periprosthetic acetabular fracture, one for an early periprosthetic femoral fracture, one for a late periprosthetic femoral fracture, and one for leg-length discrepancy. Intraoperative complications included one periprosthetic acetabular fracture treated with protected weight-bearing and one intraoperative proximal femoral fracture treated with cerclage wiring. Harris Hip Scores improved from a mean of 42.4 points preoperatively to a mean of 82.4 points postoperatively (p < 0.001). No cups were radiographically loose. At a mean follow-up of 5.1 years, survivorship of the acetabular component was 99.3% (95% CI, 98.1-100%) and survivorship without any reoperation was 97.4% (95% CI, 95.9-100%). DISCUSSION Although there were no dislocations in this high-risk population, periprosthetic fractures of the femur and acetabulum were common with the implants utilised.
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Affiliation(s)
- JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew J Bryan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Roman Drabchuk
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Castiello E, Moghnie A, Tigani D, Affatato S. Dual mobility cup in hip arthroplasty: an in-depth analysis of joint registries. Artif Organs 2021; 46:804-812. [PMID: 34153137 DOI: 10.1111/aor.14015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/23/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
Although total hip arthroplasty (THA) has shown successful results, instability remains a major complication. In recent years, dual mobility cups (DMC) have gained interest among clinicians thanks to its low rate of dislocation and good clinical results. The main aim of this work was to describe the accuracy of data on DMC from national and regional joint registries (JRs) and the available worldwide literature. We identified topics on DMC among JRs to propose a new harmonized and standardized section for DMC with the aim to understand its surveillance over the time. We extracted survival and implant data for a separate analysis. After performing a critical exclusion process, nine joint registries were considered eligible and included for final synthesis; these were the results from the available worldwide data from Joints Registries (JRs). In our study, eight analysed JRs reported a slight increase in DMC use in the last decade. In all the JRs evaluated and the available articles, dislocation remains one of the main reasons for revision and re-revision in hip arthroplasties. DMC is considered a valid construct increasingly used worldwide in primary and revision THA with the primary aim of reducing dislocation rates. Annual reports from JRs collect heterogeneous and low-quality information about outcomes and surveillance of DMC, creating a burden for clinicians to extract comparable data from different JR. Longer follow-up and a systematic registering of DMCs with international registry harmonization are needed to monitor DMC outcomes.
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Affiliation(s)
| | | | - Domenico Tigani
- Department of Orthopaedic Surgery, Ospedale Maggiore, Bologna, Italy
| | - Saverio Affatato
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Godoy-Monzon D, Garcia-Mansilla A, Buljubasich M, Cid-Casteulani A, Valentini R. Dual mobility system. The French solution in elderly patients with intracapsular hip fracture and high risk of dislocation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Godoy-Monzon D, Garcia-Mansilla A, Buljubasich M, Cid-Casteulani A, Valentini R. Dual mobility system. The French solution in elderly patients with intracapsular hip fracture and high risk of dislocation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:335-341. [PMID: 32493649 DOI: 10.1016/j.recot.2020.03.003] [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: 12/08/2019] [Revised: 03/11/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Actually there is a controversy about the treatment of hip fractures on older patients with high risk of dislocation. Our study is focused on report clinico-functional and radiographic results in this population treated with total hip replacement using a dual mobility system after a minimum follow up of 2 years. MATERIALS AND METHODS In the period from January 2015 to January 2016 patients assisted at the Emergency Unit at the participant hospital were recluted for participation. A total of 137 patients were assisted and 41 fulfilled the inclusion criteria and accepted to participate. All patients received a total hip replacement with a dual mobility system (cemented or uncemented). The patients were evaluated with the Mini-Mental State Examination, walking distance test, preop and postop at 3 and 6 weeks, 3 months, 6 months, one year and subsequent years. Radiographic evaluation was scheduled with clinico-functional review. RESULTS Forty-one patients included, follow up average 2.4 years (range 2 to 3.2 years). Mean age 85.2 (range 80 to 96 years). Four patients died during follow up due to causes not related to the total hip replacement and the implant was functioning. One case have an infection and was revised in one stage procedure. One case have an infection at 8 months follow-up and was revised in one stage procedure. There were no dislocations. CONCLUSION The use of dual mobility system in this high dislocation risk population has shown good clinical and functional results, and support the sistematic indication in our services.
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Affiliation(s)
- D Godoy-Monzon
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - A Garcia-Mansilla
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Buljubasich
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Cid-Casteulani
- Servicio de Ortopedia y Traumatología, Centro Médico Fitz Roy, Buenos Aires, Argentina
| | - R Valentini
- Servicio de Ortopedia y Traumatología, Centro de Educación Médica e Investigación Clínicas (CEMIC), Buenos Aires, Argentina
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Abstract
Hip dislocation remains a major concern following total hip arthroplasty due to its high frequency and economic burden. This article evaluates the cost-effectiveness regarding dual mobility as an alternative to standard implant designs. A review of literature analyzing the PubMed Central database was undertaken using the following terms in the primary query: dual mobility, cost-effectiveness, cost-analysis, or economic analysis. Dual mobility systems may be a cost-effective alternative when the price of the implant does not exceed the traditional system by $1023. Dual mobility cups may be an essential component for the future success of value-based total hip arthroplasty.
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Jones CW, De Martino I, D'Apolito R, Nocon AA, Sculco PK, Sculco TP. The use of dual-mobility bearings in patients at high risk of dislocation. Bone Joint J 2019; 101-B:41-45. [PMID: 30648492 DOI: 10.1302/0301-620x.101b1.bjj-2018-0506.r1] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years. MATERIALS AND METHODS We performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum. RESULTS There were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation; there were no other dislocations. CONCLUSION At mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.
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Affiliation(s)
- C W Jones
- University of Sydney, Sydney, Australia
| | - I De Martino
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - R D'Apolito
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - A A Nocon
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - P K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - T P Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
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9
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Elbuluk AM, Slover J, Anoushiravani AA, Schwarzkopf R, Eftekhary N, Vigdorchik JM. The cost-effectiveness of dual mobility in a spinal deformity population with high risk of dislocation: a computer-based model. Bone Joint J 2018; 100-B:1297-1302. [PMID: 30295522 DOI: 10.1302/0301-620x.100b10.bjj-2017-1113.r3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS The routine use of dual-mobility (DM) acetabular components in total hip arthroplasty (THA) may not be cost-effective, but an increasing number of patients undergoing THA have a coexisting spinal disorder, which increases the risk of postoperative instability, and these patients may benefit from DM articulations. This study seeks to examine the cost-effectiveness of DM components as an alternative to standard articulations in these patients. PATIENTS AND METHODS A decision analysis model was used to evaluate the cost-effectiveness of using DM components in patients who would be at high risk for dislocation within one year of THA. Direct and indirect costs of dislocation, incremental costs of using DM components, quality-adjusted life-year (QALY) values, and the probabilities of dislocation were derived from published data. The incremental cost-effectiveness ratio (ICER) was established with a willingness-to-pay threshold of $100 000/QALY. Sensitivity analysis was used to examine the impact of variation. RESULTS In the base case, patients with a spinal deformity were modelled to have an 8% probability of dislocation following primary THA based on published clinical ranges. Sensitivity analysis revealed that, at its current average price ($1000), DM is cost-effective if it reduces the probability of dislocation to 0.9%. The threshold cost at which DM ceased being cost-effective was $1180, while the ICER associated with a DM THA was $71 000 per QALY. CONCLUSION These results indicate that under specific clinical and economic thresholds, DM components are a cost-effective form of treatment for patients with spinal deformity who are at high risk of dislocation after THA. Cite this article: Bone Joint J 2018;100-B:1297-1302.
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Affiliation(s)
- A M Elbuluk
- Hospital for Special Surgery, New York, New York, USA
| | - J Slover
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - A A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - N Eftekhary
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - J M Vigdorchik
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
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Lazennec JY, Kim Y, Pour AE. Total Hip Arthroplasty in Patients With Parkinson Disease: Improved Outcomes With Dual Mobility Implants and Cementless Fixation. J Arthroplasty 2018; 33:1455-1461. [PMID: 29276118 DOI: 10.1016/j.arth.2017.11.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Parkinson disease (PD) results in severe limitation in ambulation caused by abnormality of gait and posture. The rate of complications, including fractures and dislocation after total hip arthroplasty (THA), can be higher among these patients. The goal of this study was to investigate the long-term outcomes of primary and revision THAs with cementless dual mobility implants. METHODS This retrospective study examines 59 PD patients who had surgery between 2002 and 2012. All the primary cases were performed for osteoarthritis and all patients received cementless acetabular implants with dual mobility bearing surface. The femoral stem was cemented in 4 patients who underwent revision surgery. The mean follow-up time was 8.3 years (4-14 years). RESULTS Good to excellent pain relief was achieved in 53 of 57 patients at the 2-year follow-up and in 40 of 47 patients at their latest follow-up. The most common medical complication was cognitive impairment (12 of 57 patients). One patient sustained an intraprosthetic hip dislocation 9 years after surgery, which required revision. Four patients sustained periprosthetic femoral fractures with well-fixed stem, requiring open reduction and internal fixation. The disability had increased in 68% of the patients in the latest follow-up visit. DISCUSSION Our study shows that elective primary or revision THA using cementless implants with dual mobility bearing surface in patients with PD provides satisfactory long-term outcomes, although many of these patients may see a general worsening of their activities over time due to PD.
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Affiliation(s)
- Jean Y Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Anatomy Department Faculté Pitie Salpetriere UPMC, Paris, France
| | - Youngwoo Kim
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, France; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Paris Tech, Paris, France; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Assi C, Kheir N, Samaha C, Kouyoumjian P, Yammine K. Early results of total hip arthroplasty using dual-mobility cup in patients with osteonecrosis of the femoral head. SICOT J 2018; 4:4. [PMID: 29469804 PMCID: PMC5822877 DOI: 10.1051/sicotj/2018001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/28/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Osteonecrosis of the femoral head (ONFH) remains a therapeutic challenge for patients undergoing total hip arthroplasty (THA). The majority of these patients are young with high functional demand, and show an increased risk of dislocation following surgery than patients with osteoarthritis. The use of double mobility cup (DMC) has been linked with lower rates of complications when compared to conservative cups; however, the literature is scarce over DMC results in patients with ONFH. The aim of the study is to report the early outcomes of patients with ONFH treated with THA-DMC. MATERIALS A retrospective analysis of patients suffering from ONFH who underwent THA using DMC (THA-DMC) from 2006 to 2015 were evaluated for functional status and risk of post-operative complications. Thirty THA-DMC in 26 patients with a mean follow-up of 51 months were evaluated clinically (modified Hip Harris Score) and radiologically. RESULTS The mean age of the included patients was 54.9 years. At final follow-up, the mean modified Hip Harris score was 98.7 ± 2.7 and no dislocation episodes or revision surgeries were recorded. The radiological assessment revealed no signs of migration/tilting, radiolucent lines, periprosthetic osteolysis or heterotopic ossification over the DMC component and the femoral stem. The survival rate over 51 months of follow-up was 100%. DISCUSSION The use of the new generation of dual mobility cup in patients with ONFH showed excellent functional early results with no major complications such as dislocation.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Nadim Kheir
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon - Department of Orthopedic Surgery, Middle East Institute of Health, Bsalim, Lebanon
| | - Pascal Kouyoumjian
- Department of orthopedic Surgery, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital, Beirut, Lebanon - Center for Evidence-based Anatomy, Sports & Orthopedic Research, Jdeideh, Lebanon
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Ukaj S, Gjyshinca B, Podvorica V, Ukaj F, Molliqaj G, Boshnjaku A, Gamulin A. Primary hemiarthroplasty for treatment of unstable pertrochanteric femoral fractures (AO/OTA Type 31 A2.3) in elderly osteoporotic patients. SICOT J 2017; 3:31. [PMID: 28387197 PMCID: PMC5384320 DOI: 10.1051/sicotj/2017013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/13/2017] [Indexed: 12/13/2022] Open
Abstract
Introduction: The aim of this study was to prospectively analyze the role of primary hemiarthroplasty in unstable osteoporotic pertrochanteric fractures (AO/OTA Type 31 A2.3), with emphasis given to postoperative Functional Independent Measure (FIM) and Harris Hip Score (HHS). Methods: Fifty-six consecutive patients (average age 78.25 ± 5.45), out of which 24 males (79.29 ± 4.99) and 32 females (77.47 ± 5.72), with unstable pertrochanteric femoral fractures, operated with primary hemiarthroplasty procedure from 2012 to 2014 were included in this prospective study with a follow-up of two years. Primary outcomes were FIM and HHS. Secondary outcomes included duration of surgery, estimated intraoperative blood loss, time to first postoperative full weight-bearing, time to walking ability with and without crutches, average hospital stay, postoperative complications, and mortality. Results: The FIM score at 3 months was 85.9 ± 5.7. HHS at two years was excellent for 41 patients (73, 2%), good for eight (14.3%), fair for four (7.1%), and poor for three (5.4%). The mean duration of surgery was 62.6 min, estimated intraoperative blood loss 175.5 mL, time to first postoperative full weight-bearing 2.2 ± 0.4 days, ability to walk with crutches 6.3 ± 1.8 days and without crutches 44.2 ± 12.7 days, and the average hospital stay was 9.6 ± 2.7 days. Conclusion: This study highlighted good clinical postoperative outcome scores for primary hemiarthroplasty for the treatment of unstable pertrochanteric femoral fractures in elderly osteoporotic patients. This procedure seems to be secure and effective, and offers a good quality of life in terms of FIM and HHS.
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Affiliation(s)
- Skender Ukaj
- Department of Orthopedics and Osteo-Muscular Trauma, University Clinical Center of Kosovo, 10000 Pristina, Kosovo - Faculty of Medicine, University of Gjakova Fehmi Agani, 50000 Gjakove, Kosovo
| | - Bahri Gjyshinca
- Department of Orthopedics and Osteo-Muscular Trauma, University Clinical Center of Kosovo, 10000 Pristina, Kosovo
| | - Vlora Podvorica
- Department of Orthopedics and Osteo-Muscular Trauma, University Clinical Center of Kosovo, 10000 Pristina, Kosovo
| | - Fatime Ukaj
- Department of Orthopedics and Osteo-Muscular Trauma, University Clinical Center of Kosovo, 10000 Pristina, Kosovo
| | - Granit Molliqaj
- Neurosurgical Department, University Hospital of Geneva, 1200 Geneva, Switzerland
| | - Arben Boshnjaku
- Faculty of Medicine, University of Gjakova Fehmi Agani, 50000 Gjakove, Kosovo
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 1200 Geneva, Switzerland
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