1
|
Heckmann ND, Wang JC, Richardson MK, Biedermann BM, DiGiovanni RM, Christ AB, Longjohn DB, Oakes DA. Cemented Constrained Liners Used as an Articulating Hip Spacer for the Treatment of Chronic Prosthetic Joint Infection. Arthroplast Today 2024; 29:101422. [PMID: 39224754 PMCID: PMC11367267 DOI: 10.1016/j.artd.2024.101422] [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: 12/22/2023] [Revised: 03/25/2024] [Accepted: 04/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background Two-stage exchange arthroplasty remains the gold standard for treating chronic hip periprosthetic joint infections. However, controversy remains regarding the optimal spacer type, particularly among patients with increased dislocation risk. This study reports on the outcomes of articulating hip spacers utilizing a single constrained-liner design. Methods All patients who underwent treatment for hip periprosthetic joint infection at a single institution were screened. Patients were included if they received an articulating spacer utilizing a constrained liner of a single manufacturer design. Indications for constrained liner, demographic variables, and surgical variables were recorded. Patients were assessed for dislocation and component loosening prior to the second stage or at the final follow-up if the second stage was not undertaken. Comparative analysis was performed. Results Overall, 26 constrained liners were utilized in 25 patients. Indications for constrained liner included history of dislocation (n = 14), massive proximal femoral bone loss (n = 14), greater trochanteric deficiency (n = 12), and absent abductors (n = 7). Many patients had more than one indication. In total, 9 hips (34.6%) underwent a second stage at an average of 7.4 months, while 17 hips never underwent a second stage with an average follow-up of 27.6 months. One patient experienced failure of their constrained liner prior to the second stage due to pelvic discontinuity and massive acetabular bone loss. Conclusions Utilization of a constrained liner as an articulating spacer is a viable option for patients at high risk of instability. Meticulous cement technique, appropriate component position, and implant selection are crucial in achieving successful outcomes.
Collapse
Affiliation(s)
- Nathanael D. Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jennifer C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Mary K. Richardson
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Brett M. Biedermann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Ryan M. DiGiovanni
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alexander B. Christ
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Donald B. Longjohn
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Daniel A. Oakes
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
2
|
Kitamura T, Hayashi S, Matsumoto T, Hashimoto S, Nakano N, Kuroda Y, Niikura T, Kuroda R. Pseudarthrosis of Pelvic Fracture With Charcot Arthropathy Successfully Treated With Constrained Total Hip Arthroplasty. Cureus 2023; 15:e48295. [PMID: 38058331 PMCID: PMC10696913 DOI: 10.7759/cureus.48295] [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: 11/04/2023] [Indexed: 12/08/2023] Open
Abstract
Charcot arthropathy is a rapidly progressive and destructive form of arthropathy caused by various neurological diseases. Total hip arthroplasty (THA) is usually contraindicated in patients with Charcot arthropathy; however, recent studies have reported good results following THA in this patient population. Herein, we report a case of Charcot arthropathy secondary to syphilis in a patient who was successfully treated with constrained THA, a new type of THA. A 56-year-old man was injured in a car accident, and a displaced acetabular fracture was revealed three weeks later. He was treated conservatively but soon developed greater displacement of the fracture and femoral head destruction. The patient was referred to our hospital for further treatment. The patient had pelvic pseudarthrosis secondary to Charcot arthropathy at the time of the first visit to our hospital. First, THA was performed with the acetabular reconstruction of the deficient bone. However, the acetabular implant was displaced one week postoperatively. THA revision was performed using a constrained cup. Postoperatively, the patient exhibited good hip stability without dislocation. However, displacement of the acetabular cup occurred one year after the second surgery. We performed a re-revision of THA using a new type of constrained cup that offers a high level of constraint to maintain range of motion (ROM) and prevent dislocations. The patient was able to walk with a T-cane one year postoperatively. Herein, we report a difficult case of revision THA in a patient with Charcot arthropathy concomitant with syphilis. THA is usually contraindicated in patients with Charcot arthropathy; however, we propose that THA using constrained cups that offer a wider ROM may be a useful therapeutic strategy for the treatment of Charcot arthropathy.
Collapse
Affiliation(s)
- Toshiki Kitamura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Shingo Hashimoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Yuichi Kuroda
- Department of Orthopedics, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Takahiro Niikura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN
| |
Collapse
|
3
|
Rajeev A, Gravett E, Koshy G, Devalia K. The outcomes of constrained total hip arthroplasty for recurrent dislocation of hip hemiarthroplasty. Injury 2023; 54:110970. [PMID: 37595486 DOI: 10.1016/j.injury.2023.110970] [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: 04/07/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION The incidence of hemiarthroplasty dislocation for fracture neck of femurs ranges between 1 and 15% and the one-year mortality is 49- 70%. Revision of hemiarthroplasty to total hip replacement using a constrained liner has shown to improve the morbidity and mortality rates. The aim of the study was to assess whether conversion of dislocated hemiarthroplasty to total hip replacement improve functional and one year mortality. METHODS A retrospective analysis of the number of patients who had recurrent dislocations of hemiarthroplasty for fracture neck of femurs were carried out. The data were obtained from NHFD (National Hip Fracture Database) and internal hospital computer systems (Medway, Theatre notes and PACS) between Dec 2008 and Dec 2020. Patient demographics including age, sex, Abbreviated Mental Test Score (AMTS), functional assessment, mortality at one and two years were documented. The risk factors which led to dislocations such as Parkinsons disease, Cerebrovascular accidents, Musculo-neuropathies and Alzheimer`s disease was also noted. RESULTS A total of 3994 patients were admitted during the study period of which 1735 (43.4%) patients had hemiarthroplasty. Fifty-six (3.23%) patients had dislocation of hemiarthroplasty. The mean age was 81.4 years (range - 61 to 95). There were 40 (71.4%) females and 16 males (28.6%). The average AMTS score was 5.3. All 56 patients had closed manipulative reduction under anaesthesia within in 12 h of admission. Thirty-one patients (55.4%) went on to have recurrent dislocations of which 18 patients (58.4%) had total hip replacement using captive cup, 6 patients (19.4%) had open reduction,3 patients (9.7%) had excision arthroplasty procedure and four patients (12.5%) had no intervention, Eighteen patients who had total hip replacement with constrained captive for followed up to a minimum of two years (range2- 12 years). There were no intraoperative complications, dislocation or periprosthetic fractures in the follow up period. There was no mortality at the end of two years of follow up in this group, two-year mortality for the patients with alternative management for dislocated hemiarthroplasty was 76.67. CONCLUSION Treatment of recurrent hemiarthroplasty dislocation by revising to a total hip replacement with a constrained liner gives good functional and mortality outcomes.
Collapse
Affiliation(s)
- Aysha Rajeev
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom.
| | - Emma Gravett
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom
| | - George Koshy
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom
| | - Kailash Devalia
- Department of Trauma and Orthopaedics, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, Tyne and Wear, NE9 6SX, United Kingdom
| |
Collapse
|
4
|
Kenanidis E, Kakoulidis P, Anagnostis P, Potoupnis M, Tsiridis E. Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome. Hip Int 2023; 33:53-61. [PMID: 33896259 DOI: 10.1177/11207000211010712] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients' scores were assessed. Surgical tips to enhance outcomes were reviewed. METHODS 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient's age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. RESULTS There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1-84.5) and 80.5 months for dislocation (95% CI, 75.8-85.2). The mean postoperative functional scores were significantly improved (p < 0.001) at the latest follow-up. CONCLUSIONS CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs' offset relative to stem-neck impingement are necessary to maximise outcomes.
Collapse
Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Panagiotis Kakoulidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
| |
Collapse
|
5
|
Hoskins W, Rainbird S, Peng Y, Graves SE, Bingham R. Hip Hemiarthroplasty for Fractured Neck of Femur Revised to Total Hip Arthroplasty: Outcomes Are Influenced by Patient Age Not Articulation Options. J Arthroplasty 2021; 36:2927-2935. [PMID: 33941411 DOI: 10.1016/j.arth.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip hemiarthroplasty is the most common arthroplasty option for fractured neck of femur (FNOF). Revision to total hip arthroplasty (THA) is occasionally required. This study aimed to assess the outcome of hemiarthroplasty revised to THA and to assess the impact of femoral head size, dual mobility (DM), and constrained liners. METHODS All aseptic 1st revisions reported to the Australian Joint Replacement Registry after hemiarthroplasty performed for FNOF when a THA was used as the revision procedure were included from September 1999 to December 2019. The primary outcome measure was the cumulative percent revision for all-causes and dislocation. The impact of prosthesis factors on revision THA was assessed: standard head THA (≤32 mm), large head THA (≥36 mm), DM, and constrained liners. Outcomes were compared using Kaplan Meyer and competing risk. RESULTS There were 96,861 hemiarthroplasties performed, with 985 revised to THA. The most common reasons for 1st revision were loosening (49.3%), fracture (17.7%), and dislocation (11.0%). Of the hemiarthroplasty procedures revised to THA, 76 had a 2nd revision. The most common reasons for 2nd revision were fracture (27.6%), dislocation (26.3%), loosening (23.7%), and infection (18.4%). Femoral head size, DM, or constrained liner use did not alter the incidence of all-cause 2nd revision. This did not change when solely looking at patients still alive. A 2nd revision was more likely in patients aged <75 years. CONCLUSION The outcome of hemiarthroplasty performed for FNOF revised to THA is influenced by patient age, not by the articulation used.
Collapse
Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Traumaplasty.Melbourne, East Melbourne, Victoria, Australia
| | - Sophia Rainbird
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Yi Peng
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Roger Bingham
- Traumaplasty.Melbourne, East Melbourne, Victoria, Australia; Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia
| |
Collapse
|
6
|
Mancino F, Jones CW, Sculco TP, Sculco PK, Maccauro G, De Martino I. Survivorship and Clinical Outcomes of Constrained Acetabular Liners in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Arthroplasty 2021; 36:3028-3041. [PMID: 34030877 DOI: 10.1016/j.arth.2021.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several studies have evaluated the survivorship and clinical outcomes of constrained acetabular liners (CALs) in complex primary and revision total hip arthroplasty with hip instability; however, there remains no consensus on the overall performance of this constrained implant. We therefore performed a systematic review of the literature to examine survivorship and complication rate of CAL usage. METHODS A systematic review of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords. RESULTS In all, 37 articles met the inclusion criteria. A total of 4152 CALs were implanted. The all-cause reoperation-free survivorship was 79.9%. The overall complication rate was 22.2%. Dislocation was the most common complications observed and the most frequent reason for reoperation with an incidence of 9.4% and 9.2%, respectively. Infection after CAL placement had an incidence of 4.6%. The reoperation rate for aseptic acetabular component loosening was 2.9%. Overall, patients had improved outcomes as documented by postoperative hip scores. CONCLUSION CALs usage have a relatively high complication rate, particularly when compared with current bearing alternatives (dual mobility cups and large diameter femoral heads), however, it remains a valuable salvage procedure in complex patients affected by recurrent dislocation and implant instability. Newer designs have shown reduced impingement and higher survivorship free from dislocation. However, CALs should only be used when the reasons of instability have been correctly recognized and optimized.
Collapse
Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christopher W Jones
- Department of Orthopaedics, The Orthopaedic Research Foundation of Western Australia (ORFWA), Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy; Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| |
Collapse
|
7
|
Do All Rigid and Unbalanced Spines Present the Same Risk of Dislocation After Total Hip Arthroplasty? A Comparison Study Between Patients With Ankylosing Spondylitis and History of Spinal Fusion. J Arthroplasty 2020; 35:3594-3600. [PMID: 32660797 DOI: 10.1016/j.arth.2020.06.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Spines with ankylosis or with a history of lumbosacral fusions have been collectively classified as rigid and unbalanced, and associated with an increased rate of dislocation after total hip arthroplasty (THA). It remains unknown whether the cause of spinal arthrodesis influences the dislocation rate. METHODS A retrospective study was conducted from January 2000 to December 2017, with an institutional review board's approval to identify 2 cohorts with a history of THA: one with ankylosing spondylitis (AS) involving the lumbosacral spine and another cohort with a history of lumbosacral spinal fusion (SF). A chart review was performed to collect demographic and surgical variables. Lumbar lordosis angle (LLA), acetabular anteversion, and inclination angle measurements were taken for each patient. Kaplan-Meier survivorship curves were constructed and multivariable Cox regression was performed for analysis. RESULTS The AS and SF cohorts consisted of 142 and 135 patients, respectively. The SF group had a greater mean LLA (34.18°) than the AS group (21°). A total of 16 patients (11.85%) suffered from dislocation after primary elective THA in the SF group, whereas 4 patients (2.82%) in the AS group. After multivariable Cox regression analysis, increasing LLA and hips outside of the Lewinnek safe zone were found to be associated with a higher hazard of dislocation after THA. CONCLUSION We found that the degree of lumbar spine curvature is more associated with dislocation after THA than the history of SF itself; specifically, an increase in lumbar lordosis angle of 1º increases the probability of dislocation by 13% among AS and SF patients.
Collapse
|
8
|
Crawford DA, Adams JB, Brown KW, Morris MJ, Berend KR, Lombardi AV. Mid-Term Survivorship of a Novel Constrained Acetabular Device. J Arthroplasty 2020; 35:859-863. [PMID: 31668696 DOI: 10.1016/j.arth.2019.09.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/29/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recurrent instability after total hip arthroplasty is a difficult complication. In certain cases, a constrained acetabular device is needed to address these issues. The purpose of this study is to report the midterm outcomes and survivorship of a single novel constrained liner device. METHODS A retrospective review as performed on all procedures (except first stage exchange for infection) in which a Freedom Constrained (Zimmer Biomet, Warsaw, IN) liner was used between December 2003 and November 2016. Patients with 2-year minimum follow-up or failure were included, yielding a cohort of 177 patients. Procedures were 130 aseptic revisions, 40 reimplantations following infection eradication, and 7 complex primaries. The constrained mechanism was implanted in 46 hips (26%) to treat active instability and 131 hips (74%) for increased risk of instability and intraoperative instability. Patients had on average 3.4 previous surgeries. RESULTS With an average 7.1-year follow-up, 11 hips dislocated (6.2%), and 13 hips (7.3%) were revised for acetabular aseptic loosening, resulting in an overall constrained aseptic or mechanical failure rate of 13.6%. Nineteen hips (10.7%) failed from infection with 58% of these having had a previous infection. Patients with active instability had significantly higher failure for dislocation than patients who were at risk (15.2% vs 3%, P = .01). All-cause survival rate at 7 years was 74.8%, aseptic survival was 83.6%, and survival for instability was 91.8%. CONCLUSION Revision for instability remains challenging as many patients have had numerous previous surgeries and at-risk anatomy. Constrained inserts are one option to manage instability, but a high rate of recurrence can still occur.
Collapse
Affiliation(s)
| | | | | | - Michael J Morris
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
9
|
Lack of early dislocation for dual mobility vs. fixed bearing total hip arthroplasty: A multi-center analysis of comparable cohorts. J Orthop 2020; 21:1-5. [PMID: 32071524 DOI: 10.1016/j.jor.2020.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background Dislocation is a major cause of morbidity and revision surgery following total hip arthroplasty (THA). To address such issues, dual mobility (DM) bearings were introduced as a more stable alternative to fixed-bearing (FB) prostheses. As such, we compared DM and FB systems in a cohort study in terms of dislocations, readmissions, and revisions. Methods A 27 multi-center retrospective review was performed of 664 DM and 218 FB cases from the same manufacturer with mean follow-up of 2.09 years and 1.83 years, respectively. Patient reported outcome measures (PROMs) including Harris Hip Score (HHS), SF12, EQ5D, and Lower Extremity Activity Score (LEAS) were evaluated as well as dislocation rates, readmissions, and revisions rates. We also performed a survivorship analysis through Kaplan-Meier estimator. Students t-test was used for normally distributed continuous data and Fisher exact test (P < 0.05) was used for discrete data. Results There were 0 dislocations in the DM (0%) group and 2 dislocations in the FB (0.92%) group (p = 0.06). Latest follow up HHS revealed a significant difference between groups (91.44 DM and 87.81 FB; p = 0.006). In addition, there was significant difference between DM and FB on SF12 Physical Component Score (PCS) (46.83 and 44.55, respectively, p = 0.015). Also, readmission rates at 30, 60 and 90 days remained lower for DM than for FB at each time point (1.05% vs. 2.75%, 1.81% vs. 2.75%, and 1.81% vs. 2.75, respectively). Overall, DM had a lower revision rate at 1.51% compared to 2.29% for FB (p = 0.24). The revision breakdown for DM revealed 0 (0%) for both Anatomic Dual Mobility (ADM) and Modular Dual Mobility (MDM) due to the acetabular component.) There was a difference, 14 (87.5%) for ADM and 2 (12.5%) due to the femoral component. The survivorship analysis revealed no significance difference between DM and FB at 4 years (97.90% and 97.26%, respectively). Conclusion In comparison to patients who undergo FB THA, DM bearings have improved PROMs and a lower rate of dislocation, readmission, and revision.
Collapse
|
10
|
Karvonen M, Laaksonen I, Pulkkinen P, Eskelinen A, Haapakoski J, Puhto AP, Kettunen J, Manninen M, Mäkelä KT. Implant Survival of Constrained Acetabular Device in Primary Total Hip Arthroplasty Based on Data From the Finnish Arthroplasty Register. J Arthroplasty 2020; 35:219-223. [PMID: 31526699 DOI: 10.1016/j.arth.2019.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Constrained acetabular devices were developed to prevent dislocations after total hip arthroplasty (THA). However, the data on their success have been contradictory. In this study, we aimed to assess implant survival of the constrained acetabular device in primary THA based on the Finnish Arthroplasty Register data. METHODS A total of 373 primary THAs with constrained acetabular devices inserted from 2006 to 2017 were included. A reference group was formed on a 1:3 basis and matched for age, sex, and diagnosis, consisting of 1118 conventional THAs. Implant survival estimates using death as a competing risk were assessed with revision for any reason and for any aseptic reason as the endpoints. The Cox multiple regression models were adjusted for age, sex, and diagnosis. The mean follow-up time was 3.3 (0-12.4) years for the constrained device group and 3.8 (0-12.0) years for the reference group. RESULTS Overall, there were 21 revisions in the constrained device group and 49 in the reference group. The 8-year survivorship for any reason was 94% (confidence interval [CI]: 91-96) for the constrained device group and 93% (CI: 89-97) for the reference group. With revision for any aseptic reason as the endpoint, the 8-year survivorships were 97% (CI: 95-99) and 94% (CI: 90-98), respectively. During the first 1.5 years, the constrained acetabular device group had a similar revision risk (hazard ratio: 1.09 [CI: 0.57-2.07], P = .8) to that of the reference group. CONCLUSION The constrained acetabular device had good survival in primary THA, and our results support its continued use even in high-risk patients.
Collapse
Affiliation(s)
- Mikko Karvonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Pulkkinen
- Department of Biostatistics, University of Helsinki, Helsinki, Finland
| | | | | | - Ari-Pekka Puhto
- Department of Orthopaedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Jukka Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | | | - Keijo T Mäkelä
- Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
11
|
Statz JM, Sierra RJ, Trousdale RT, Milbrandt TA. Total Hip Arthroplasty in Patients with Spasticity: A Critical Analysis Review. JBJS Rev 2019; 7:e10. [PMID: 31045687 DOI: 10.2106/jbjs.rvw.18.00115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph M Statz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | |
Collapse
|
12
|
Abstract
Hip instability after total joint arthroplasty is a devastating complication. Appropriate management of instability is a challenge. Three components that are commonly used in these challenging scenarios are constrained liners, constrained tripolar components, and nonconstrained tripolar components. The biomaterials and biomechanics of these devices vary. Surgeons must take into account the risks associated with each of these components and some surgical pearls for their use. A thorough review of the recent literature allows comparison of results addressing the short-, medium-, and long-term survival of each component. Constraining devices are a good option when used in salvage procedures in elderly and/or low-demand patients with hip instability. However, constraining devices should not be used to correct deficiencies in surgical technique or implant placement.
Collapse
|
13
|
Abstract
Neck of femur fractures are occurring at an increased incidence. Functionally independent patients without cognitive impairment can expect reasonable life expectancy. This indicates the need for a durable surgical option that optimises the chance to return to pre-injury functional status, with minimal risk of complications and reoperation. Most fractures are displaced. Surgical options include internal fixation, hemiarthroplasty or total hip arthroplasty (THA). Evidence is conclusive that arthroplasty options outperform internal fixation in terms of function, quality of life and reoperation rates. In anyone other than young patients where head preserving surgery is required, arthroplasty is the standard of care. Hemiarthroplasty is the heavily favoured arthroplasty option for surgeons. However, in patients other than the extreme elderly, medically infirm, neurologically impaired, or with little or no ambulatory capacity, the evidence to support hemiarthroplasty is lacking. In functionally independent patients without cognitive impairment, THA should be considered the gold standard, producing better functional and quality of life outcomes, lower reoperation rates and better cost effectiveness, with no difference in complications or mortality. An increased risk of dislocation does exist. This may be reduced with modern surgical technique and implant options. Low amounts of research have been afforded to undisplaced fractures. For this fracture type, surgery is the standard of care. Despite a higher risk of reoperation, internal fixation is the preferred option for all age groups. Further study is required to identify the difference between internal fixation and THA, in particular, for unstable fracture patterns in elderly patients.
Collapse
|
14
|
Yassin M, Garti A, Khatib M, Weisbrot M, Robinson D. Retentive Cup Arthroplasty in Selected Hip Fracture Patients-A Prospective Series With a Minimum 3-Year Follow-Up. Geriatr Orthop Surg Rehabil 2016; 7:178-182. [PMID: 27847676 PMCID: PMC5098687 DOI: 10.1177/2151458516661384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the efficacy of the use of retentive cup primary total hip replacement (THR) in high-dislocation risk subcapital fracture patients. Methods: During the years 2008 to 2012, 354 patients with displaced subcapital fracture were operated at our institute. The patients were selected to undergo primary constrained THR according to the following criteria: (1) a preinjury grade 4 or more on the Functional Independence Measure mobility item “5. Locomotion: walking/wheelchair” and grade 4 is defined as “4. Minimal assistance Requiring incidental hands-on help only” (patient performs >75% of the task) and (2) a disease leading to poor motor control. Exclusion criteria were normal muscular control and known infection of the involved joint. Results: Of the 354 patients, 87 fulfilled the inclusion criteria and underwent constrained total hip. Average age was 78 years with a female predominance (73%). Fifteen patients had prior hemiparesis, 19 had Parkinson disease, and 35 had generalized sarcopenia. Eighty-five patients had an uneventful recovery, with an average Hip Disability and Osteoarthritis Outcome Score (HOOS) of 76 ± 7 at 2 years. In 2 patients, the prostheses dislocated. In both cases, the dislocation was due to ring displacement and the inner head dislocated. One case was infected and the patient was treated by a Girdlestone procedure. In the other case, the prosthetic head was revised. The patient remained asymptomatic and at 4-year follow-up had an HOOS of 85. Discussion: It appears that constrained prosthesis is a suitable treatment for patients with poor muscular control having subcapital fractures. The functional results appear to be superior to those of bipolar arthroplasty and similar to the results of primary total hip arthroplasty while the dislocation risk is <3%. Conclusion: Semielective total hip arthroplasty using a retentive cup liner appears to offer good functional results with a low dislocation rate in patients with poor muscular control.
Collapse
Affiliation(s)
- Mustafa Yassin
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Avraham Garti
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Muhammad Khatib
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Moshe Weisbrot
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| | - Dror Robinson
- Department of Orthopedic Surgery, Rabin Medical Center, Hasharon Hospital, Tel Aviv University Medical School, Petah Tikva, Israel
| |
Collapse
|
15
|
Karvonen M, Karvonen H, Seppänen M, Liukas A, Koivisto M, Mäkelä KT. Freedom Constrained Liner for the Treatment and Prevention of Dislocation in Total Hip Arthroplasty. Scand J Surg 2016; 106:165-172. [PMID: 27456021 DOI: 10.1177/1457496916660035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Dislocation is one of the most common complications following total hip arthroplasty. The aim of our study was to assess failure rate of the Biomet Freedom constrained liner (Biomet, Warsaw, IN, USA) either in revision surgery for recurrent dislocation, or as a preventive method in high dislocation risk patients. PATIENTS AND METHODS We assessed retrospectively 105 consecutive surgical procedures in 103 patients where a Freedom constrained liner or cup was used in Turku University Hospital over a 7-year period from 2007 to 2014. The mechanical failure rate of the device was assessed based on medical records. The average age of the patients was 73.4 years. The number of male patients was 53 (51%). Mean follow-up time was 2.5 years. The association between failure of the device and potential risk factors-age, gender, indication, and approach-was analyzed with logistic regression. Results were expressed by odd ratios and 95% confidence intervals. RESULTS The mechanical failure rate of the Freedom device was 6 out of 105 (5.7%). None of the 11 preventive primary THAs against dislocation failed, 4 out of 52 (7.7%) preventive revision THAs against dislocation failed, and 2 out of 42 (4.8%) of the treated dislocation cases failed. Four out of six failures were dislocations due to impingement and failure of the locking mechanism. Two liners failed because of loosening. The risk factors assessed were not associated with failure of the device. INTERPRETATION We found out that the mechanical failure rate of a Freedom constrained device was low. These results encourage us to continue using the device.
Collapse
Affiliation(s)
- M Karvonen
- 1 Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - H Karvonen
- 1 Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - M Seppänen
- 1 Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| | - A Liukas
- 2 Department of Anesthesiology, Turku University Hospital, Turku, Finland
| | - M Koivisto
- 3 Faculty of Science, University of Turku, Turku, Finland
| | - K T Mäkelä
- 1 Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
| |
Collapse
|
16
|
Rajeev A, Banaszkiewicz P. Constrained captive acetabular cup for recurrent dislocation of hemiarthroplasty in elderly: A case series. Int J Surg Case Rep 2016; 23:141-5. [PMID: 27129135 PMCID: PMC4855749 DOI: 10.1016/j.ijscr.2016.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/15/2016] [Accepted: 04/16/2016] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Hemiarthroplasty of the hip is one of the commonest procedures done for intracapsular fractures of the neck of femur in elderly. Dislocation of the hemiarthroplasty is a recognised and significant complication. This is associated with considerable morbidity and mortality. The treatment options include closed manipulation, skin and skeletal traction, conversion to total hip replacement, exploration and open reduction and leaving it out of the acetabulum. PRESENTATION OF CASE A retrospective review of ten patients with recurrent and failed closed manipulative reduction of hemiarthroplasty who underwent revision using a cemented captive acetabular cup and cement to cement revision of femoral component with Exeter CDH stem was carried out. The follow up period was two years and the functional outcomes were assessed using Harris hip scores. DISCUSSION The management of recurrent dislocations of hemiarthroplasty in elderly patient are very challenging. Even though various treatment options are described most of them are associated with increased morbidity and mortality and prevent these patients from early mobilisation. The use of captive acetabular avoid repeated dislocations, prolonged bed rest, wearing of a brace and all the complications associated with sustained immobilization. The drawbacks of using constrained cups are hip pain, limited hip movements and loosening. CONCLUSION We describe a new method of treatment of this difficult condition with a cemented constrained acetabular captive cup and cement to cement revision using a CDH femoral stem. This method prevents further dislocations and will give good functional outcomes thus reducing the high morbidity and mortality.
Collapse
Affiliation(s)
- Aysha Rajeev
- Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, NE9 6SX, UK.
| | - Paul Banaszkiewicz
- Trauma and Orthopaedics, Queen Elizabeth Hospital, Gateshead Health Foundation NHS Trust, Sheriff Hill, Gateshead, NE9 6SX, UK
| |
Collapse
|
17
|
Pace T, Finley S, Snider R, Looper J, Tanner S. Short-Term Results of Novel Constrained Total Hip Arthroplasty. Orthop Rev (Pavia) 2015; 7:5779. [PMID: 26330992 PMCID: PMC4508557 DOI: 10.4081/or.2015.5779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/14/2015] [Accepted: 06/05/2015] [Indexed: 12/02/2022] Open
Abstract
Constrained acetabular components have only been recommended as a salvage option for the persistently unstable total hip arthroplasty (THA), due to limited range of motion and less than satisfactory component failure rates. This is a retrospective review of 137 patients with 154 consecutive primary constrained THAs performed between November 2003 and August 2007. We reviewed serial radiographs, postoperative complications, groin/thigh pain, and compared preoperative and postoperative Harris Hip Scores. With a mean follow-up of 6 years, there was 1.9% dislocation rate, 0% component failure rate, and 2.6% infection rate. Seven patients reported continued groin pain, and three had continued thigh pain. One patient showed radiographic evidence of 1 mm polyethylene wear. Radiographic review showed no evidence of osteolysis or stem subsidence. Harris Hip Scores improved from a mean of 68.8 (range 58-87) preoperatively to 98.9 (range 65-100) at final clinical assessment. This constrained acetabular prosthesis had a dislocation rate of less than 2%, with 0% component failure rate at a minimum of 2 years of follow-up suggesting this prosthesis may be a viable alternative for patients at risk for instability or those known to have recurrent instability.
Collapse
Affiliation(s)
- Thomas Pace
- Department of Orthopedic Surgery, Greenville Health System , SC, USA ; University of South Carolina School of Medicine , West Columbia, SC, USA
| | - Stephen Finley
- Department of Orthopedic Surgery, Greenville Health System , SC, USA
| | - Rebecca Snider
- Department of Orthopedic Surgery, Greenville Health System , SC, USA
| | - Jayme Looper
- Department of Orthopedic Surgery, Greenville Health System , SC, USA
| | - Stephanie Tanner
- Department of Orthopedic Surgery, Greenville Health System , SC, USA
| |
Collapse
|
18
|
A second generation constrained acetabular component for treatment of complex hip replacement instability. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Gallart X, Gomez J, Fernández-Valencia J, Combalía A, Bori G, García S, Rios J, Riba J. Analysis of the failures of a cemented constrained liner model in patients with a high dislocation risk. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
20
|
Gallart X, Gomez JC, Fernández-Valencia JA, Combalía A, Bori G, García S, Rios J, Riba J. [Analysis of the failures of a cemented constrained liner model in patients with a high dislocation risk]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:274-82. [PMID: 24999273 DOI: 10.1016/j.recot.2014.04.002] [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: 02/24/2014] [Revised: 03/30/2014] [Accepted: 04/01/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the short-term results of an ultra high molecular weight polyethylene retentive cup in patients at high risk of dislocation, either primary or revision surgery. MATERIAL AND METHOD Retrospective review of 38 cases in order to determine the rate of survival and failure analysis of a constrained cemented cup, with a mean follow-up of 27 months. We studied demographic data, complications, especially re-dislocations of the prosthesis and, also the likely causes of system failure analyzed. RESULTS In 21.05% (8 cases) were primary surgery and 78.95% were revision surgery (30 cases). The overall survival rate by Kaplan-Meier method was 70.7 months. During follow-up 3 patients died due to causes unrelated to surgery and 2 infections occurred. 12 hips had at least two previous surgeries done. It wasn't any case of aseptic loosening. Four patients presented dislocation, all with a 22 mm head (P=.008). Our statistical analysis didn't found relationship between the abduction cup angle and implant failure (P=.22). CONCLUSIONS The ultra high molecular weight polyethylene retentive cup evaluated in this series has provided satisfactory short-term results in hip arthroplasty patients at high risk of dislocation.
Collapse
Affiliation(s)
- X Gallart
- Unidad de Cadera, Servicio de Cirugía Ortopédica y Traumatología, ICEMEQ, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - J C Gomez
- Unidad de Cadera, Servicio de Cirugía Ortopédica y Traumatología, ICEMEQ, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - J A Fernández-Valencia
- Unidad de Cadera, Servicio de Cirugía Ortopédica y Traumatología, ICEMEQ, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - A Combalía
- Unidad de Cadera, Servicio de Cirugía Ortopédica y Traumatología, ICEMEQ, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - G Bori
- Unidad de Cadera, Servicio de Cirugía Ortopédica y Traumatología, ICEMEQ, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - S García
- Unidad de Cadera, Servicio de Cirugía Ortopédica y Traumatología, ICEMEQ, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - J Rios
- Laboratory of Biostatistics & Epidemiology, Universitat Autònoma de Barcelona, Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clínic, Barcelona, España
| | - J Riba
- Unidad de Cadera, Servicio de Cirugía Ortopédica y Traumatología, ICEMEQ, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| |
Collapse
|
21
|
Munro JT, Vioreanu MH, Masri BA, Duncan CP. Acetabular liner with focal constraint to prevent dislocation after THA. Clin Orthop Relat Res 2013; 471:3883-90. [PMID: 23423623 PMCID: PMC3825877 DOI: 10.1007/s11999-013-2858-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dislocation continues to commonly cause failure after primary and revision total hip arthroplasty (THA). Fully constrained liners intended to prevent dislocation are nonetheless associated with a substantial incidence of failure by redislocation, mechanical failure, aseptic loosening, or a combination. Constrained liners with cutouts of the elevated rims can theoretically increase range of movement and therefore decrease the risk dislocation, but it is unclear if they do so in practice and whether they are associated with early wear or loosening. QUESTIONS/PURPOSES We therefore determined (1) occurrence or recurrence of dislocation and (2) rate of complications associated with constrained implants with cutouts; and (3) assessed for early cup loosening. METHODS We retrospectively reviewed the records of 81 patients at high risk for dislocation who had 82 constrained liners inserted for primary (n = 10) or revision (n = 72) THA between 2008 and 2010. From the records we extracted demographic and implant data and instances of recurrent dislocation, implant failure, osteolysis, loosening, or construct failure. The minimum followup was 24 months (mean, 34 months; range, 24-49 months). RESULTS Three liners failed as a result of further dislocation (3%). Three deep infections occurred. One patient had progressive loosening at the shell-bone interface. CONCLUSIONS Our observations suggest this liner is associated with a relatively low risk of dislocation in patients at high risk for dislocation and those with recurrent dislocation.
Collapse
Affiliation(s)
- Jacob T. Munro
- Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3 Canada
| | - Mihai H. Vioreanu
- Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3 Canada
| | - Bassam A. Masri
- Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3 Canada
| | - Clive P. Duncan
- Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3 Canada
| |
Collapse
|
22
|
Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res 2012; 470:1907-16. [PMID: 22179979 PMCID: PMC3369098 DOI: 10.1007/s11999-011-2212-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Failure rates of constrained cups for treating recurrent dislocation in revision THA range from 40% to 100%. Although constrained liners are intended to stabilize the hip by mechanically preventing dislocation, the resulting loss of range of motion may lead to impingement and, ultimately, implant failure. QUESTIONS/PURPOSES We therefore documented the mechanisms of failure of constrained acetabular cups in revision THA and determined the type and severity of damage (wear, fracture, and impingement) that occurs in situ. METHODS We retrieved 57 constrained components of four different designs at revision THA and examined for the presence of rim impingement, oxidation, cracks within the liner, backside wear, pitting, scratching, abrasion, burnishing, and the presence of embedded particles. Articular wear was calculated from the volume of the concave articular bearing surface, which was measured using the fluid displacement method. RESULTS Failure of the locking ring was responsible for 51% of failures, whereas 28% of revisions were the result of acetabular cup loosening, 6% backside wear, and 22% infection. Impingement damage of the rim of the polyethylene liner was seen in all retrievals with moderate or severe damage in 54%. The average volumetric wear rate of the articular surface was 95 mm(3)/year. CONCLUSIONS Failure of the locking liner ring and loosening of the acetabular cup are the primary causes of mechanical failure with constrained liners; polyethylene is an inadequate material for restricting motion of the hip to prevent instability. The durability of these devices is unlikely to improve unless the mechanical demands are modified through increased range of motion leading to less frequent rim impingement.
Collapse
Affiliation(s)
- Philip C. Noble
- The Institute of Orthopedic Research and Education, Baylor College of Medicine, 6550 Fannin Street, Suite 2501, Houston, TX 77030 USA
- The Methodist Hospital, Houston, TX USA
| | - Salim K. Durrani
- The Institute of Orthopedic Research and Education, 6550 Fannin Street, Suite 2501, Houston, TX 77030 USA
| | - Molly M. Usrey
- The Institute of Orthopedic Research and Education, 6550 Fannin Street, Suite 2501, Houston, TX 77030 USA
| | - Kenneth B. Mathis
- The Methodist Hospital, Houston, TX USA
- Orthopedic Surgery, Weill Cornell Medical College of Cornell University, New York, NY USA
| | - Nikolaos V. Bardakos
- The South West London Elective Orthopaedic Centre, Epsom and St. Helier University Hospitals NHS Trust, Dorking Road, Epsom, KT18 7EG Surrey UK
| |
Collapse
|
23
|
Saragaglia D, Ruatti S, Refaie R. Relevance of a press-fit dual mobility cup to deal with recurrent dislocation of conventional total hip arthroplasty: a 29-case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:431-6. [DOI: 10.1007/s00590-012-1002-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/11/2012] [Indexed: 11/29/2022]
|
24
|
Fernández-Fairen M, Hernández-Vaquero D, Murcia-Mazón A, Querales-Leal V, Torres-Pérez A, Murcia-Asensio A. Inestabilidad de la artroplastia total de cadera. Una aproximación desde los criterios de la evidencia científica. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
25
|
Instability of total hip arthroplasty: An approach using the scientific evidence. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recote.2011.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
26
|
Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: a 59 cases series with a mean 8 years' follow-up. Orthop Traumatol Surg Res 2011; 97:8-13. [PMID: 21273156 DOI: 10.1016/j.otsr.2010.08.003] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 07/15/2010] [Accepted: 08/26/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Instability is one of the most feared complications following total hip replacement (THR). In France, dual-mobility cups are widely used in acetabular revision for instability; few studies, however, have focused on this type of implant. HYPOTHESIS The gain in stability provided by the dual-mobility implant allows the risk of dislocation to decrease by the sole revision of the acetabular component in case of recurrent instability. OBJECTIVES This hypothesis was tested over medium-term follow-up of a series of cementless dual-mobility cups implanted during isolated acetabular revision for recurrent dislocation. PATIENTS AND METHODS A series of THR revision for instability was analyzed retrospectively. Inclusion criteria were: recurrent THR dislocation treated by cementless dual-mobility cup, between 1995 and 2001. Radiological analysis used Imagika™ software. Fifty-nine patients were included; nine died before radioclinical follow-up could be performed; none of the survivors were lost to follow-up. Mean follow-up was 8 years (range, 6-11 years). RESULTS There was one early dislocation without recurrence; the dislocation rate was 1.7%. At follow-up, mean PMA score was 16.5 (12-18) and mean Harris score 86.7 (49-99). Radiologically, there was no loosening or migration, but 19% of X-ray views showed less than 1mm wide peri-acetabular radiolucency. With dislocation as censoring criterion, 8-year survivorship was 98% (95% CI: 95-100%). DISCUSSION The dislocation rate (1.7%) and clinical results were better than in most series of revision by constrained cup for recurrent dislocation. The high rate of peri-acetabular radiolucency would seem to relate to the external coating of the cup: aluminum oxide in the Novae-1 implant and aluminum oxide/hydroxyapatite in the Novae-E. CONCLUSION The use of dual-mobility cups to treat THR instability gave satisfactory results. We recommend dual-mobility cups with hydroxyapatite surface treatment over a porous metallic substrate, rather than with an aluminum oxide or an aluminum oxide/hydroxyapatite bilayer coating. LEVEL OF EVIDENCE Level IV. Retrospective Study.
Collapse
|
27
|
Abstract
Dislocation after total hip arthroplasty (THA) is a potentially devastating complication that can be difficult to manage. Many patient and mechanical factors have been associated with an increased risk of dislocation. Conservative treatments such as abduction bracing have not proven effective at treating this difficult problem. Surgical options include the use of larger femoral heads, unconstrained tripolar femoral heads, and constrained devices. While each device has its merits, there is no one-size-fits-all solution to this problem. With the development of highly cross-linked polyethylene and its superior wear characteristics and mechanical properties, the use of larger femoral heads is now available. Twenty-six hips in 25 patients who underwent revision surgery for recurrent dislocation were treated with a femoral head =/>36 mm in diameter. The direct lateral surgical approach was used in 24 hips, and the posterior and anterior supine intermuscular approaches were used in 1 hip each. One patient died 5 years after revision surgery, and 3 patients have not returned for clinical follow-up over the past 2 years. Four hips subsequently suffered a repeat dislocation, for a dislocation rate of 17%. Two patients underwent a subsequent surgery: 1 irrigation and debridement and 1 hardware removal. There have been no other revisions to date. Mean time to follow-up is 17.2 months. While the use of large femoral heads for the treatment of dislocation is warranted, continued follow-up is necessary.
Collapse
Affiliation(s)
- Michael D Skeels
- Joint Implant Surgeons Inc., the Ohio State University, Mount Carmel Health Systems, New Albany, Ohio, USA
| | | | | |
Collapse
|
28
|
Mont MA, McGrath MS, Bonutti PM, Ulrich SD, Marker DR, Seyler TM, Suda AJ. Anatomic and physiologic rationale for various technologies for primary total hip arthroplasty. Expert Rev Med Devices 2009; 6:169-86. [PMID: 19298164 DOI: 10.1586/17434440.6.2.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A number of patients have anatomic or physiologic variations that may adversely affect the performance of a primary total hip arthroplasty. Various technologies have been utilized in an attempt to improve the outcomes for these patients; however, some of these potential solutions are controversial. The authors examined the complete body of literature for scientific evidence regarding the use of these new technologies. The anatomic and physiologic anomalies that were studied include extra-articular deformities, developmental dysplasia, Perthes disease, Type C femoral bone, acetabular bone deficiency, femoral rotational abnormalities, variations that increase the risk of hip dislocation, sickle cell anemia, and extremely small or large bone sizes. This article presents the current scientific evidence and imparts an unbiased view of the use of various technologies to provide individualized solutions for patients who have anatomic or physiologic variations.
Collapse
Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopaedics, Baltimore, MD 21215, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Kotwal RS, Ganapathi M, John A, Maheson M, Jones SA. Outcome of treatment for dislocation after primary total hip replacement. ACTA ACUST UNITED AC 2009; 91:321-6. [DOI: 10.1302/0301-620x.91b3.21274] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We have studied the natural history of a first episode of dislocation after primary total hip replacement (THR) to clarify the incidence of recurrent dislocation, the need for subsequent revision and the quality of life of these patients. Over a six-year period, 99 patients (101 hips) presented with a first dislocation of a primary THR. A total of 61 hips (60.4%) had dislocated more than once. After a minimum follow-up of one year, seven patients had died. Of the remaining 94 hips (92 patients), 47 underwent a revision for instability and one awaits operation (51% in total). Of these, seven re-dislocated and four needed further surgery. The quality of life of the patients was studied using the Oxford Hip Score and the EuroQol-5 Dimension (EQ-5D) questionnaire. A control group of patients who had not dislocated was also studied. At a mean follow-up of 4.5 years (1 to 20), the mean Oxford Hip Score was 26.7 (15 to 47) after one episode of dislocation, 27.2 (12 to 45) after recurrent dislocation, 34.5 (12 to 54) after successful revision surgery, 42 (29 to 55) after failed revision surgery and 17.4 (12 to 32) in the control group. The EuroQol-5 dimension questionnaire revealed more health problems in patients undergoing revision surgery.
Collapse
Affiliation(s)
- R. S. Kotwal
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - M. Ganapathi
- Department of Orthopaedics, Ysbyty Gwynedd, Bangor LL57 2PW, UK
| | - A. John
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - M. Maheson
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - S. A. Jones
- Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff CF14 4XW, UK
| |
Collapse
|
30
|
Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res 2008; 466:389-95. [PMID: 18196422 PMCID: PMC2505133 DOI: 10.1007/s11999-007-0047-9] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 11/01/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED THA revisions using standard cups are at risk of dislocation (5.1% to 14.4% incidence), especially in patients over 70 years of age. Constrained tripolar cups have reduced this risk (6% incidence) but are associated with substantial loosening rates (9%). The nonconstrained dual mobility cup was designed to improve prosthetic stability (polyethylene head >or= 40 mm diameter) without increasing loosening rates by reducing wear and limiting impingement (rotation range of 108 degrees). We implanted 88 cemented dual mobility cups for THA revisions in 82 patients at high risk of dislocation. Average patient age was 72 years (range, 65-86 years). Eighty-five of the 88 hips were reviewed at 2 to 5 years followup. One patient (1.1%) had a traumatic dislocation at 2 years postoperatively. Two patients (2.3%) had asymptomatic early loosening and three patients (3.5%) had localized radiographic lucencies. These results confirm those with press-fit dual mobility cups suggesting a low dislocation rate at 5 years and a cup survival of 94.6%. At middle term followup, cemented dual mobility cup achieved better results than constrained cups in cases at risk of dislocation and recurrent loosening. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | - Mickaël Ropars
- University Hospital, 16 boulevard de Bulgarie, 35203 Rennes, France
| | - François Gaucher
- University Hospital, 16 boulevard de Bulgarie, 35203 Rennes, France
| | - Thierry Musset
- University Hospital, 16 boulevard de Bulgarie, 35203 Rennes, France
| | - Olivier Chaix
- University Hospital, 16 boulevard de Bulgarie, 35203 Rennes, France
| |
Collapse
|