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Hidaka R, Matsuda K, Nakamura S, Nakamura M, Kawano H. Clinical effects of combined anteversion and offset on postoperative dislocation in total hip arthroplasty. ARTHROPLASTY 2024; 6:22. [PMID: 38704579 PMCID: PMC11070079 DOI: 10.1186/s42836-024-00245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Implant impingement and soft tissue tension are factors involved in dislocation after total hip arthroplasty (THA). Combined anteversion (CA) has been used as an indicator for implant placement. However, optimal implant placement remains a challenge. Moreover, the effect of changes in offset on dislocation is still unclear. In this study, we aimed to clarify the effects of postoperative CA and pre- and postoperative changes in offset on dislocation. METHODS Included were patients who underwent primary cementless THA between 2013 and 2020. The mean values of CA and offset in the dislocation and non-dislocation groups were compared. The CA values within ± 10% of the recommended values were defined as good CA, and those outside the range were rated as poor CA. The dislocation rates were compared between the good and poor CA groups and between the groups with and without increased offset. RESULTS A total of 283 hips were included. The mean values of CA in the dislocation and non-dislocation groups were significantly different (P < 0.05). The dislocation rate was significantly lower in the good CA group (P < 0.05). The dislocation rates in the groups with and without increased total offset were 0.5% and 4.3%, respectively (P = 0.004). There were no dislocations in patients with good CA and increased offset. CONCLUSIONS The dislocation rate was significantly lower when implants were placed within ± 10% of the recommended CA value. Our results suggest that dislocation can be avoided by placing the implant in the good CA range and considering the increase in total offset on the operative side.
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Affiliation(s)
- Ryo Hidaka
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Kenta Matsuda
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
| | - Shigeru Nakamura
- Department of Orthopedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19, Shibakubo-Cho, Nishitokyo, Tokyo, 188-0014, Japan
| | - Masaki Nakamura
- Department of Orthopedic Surgery, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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Xu Z, Chai S, Chen D, Wang W, Dai J, Zhang X, Qin J, Song K, Li X, Han J, Chang Q, Zhang M, Xue C, Lu J, Wu L, Yao Y, Li L, Jiang Q. The LANCET robotic system can improve surgical efficiency in total hip arthroplasty: A prospective randomized, multicenter, parallel-controlled clinical trial. J Orthop Translat 2024; 45:247-255. [PMID: 38601198 PMCID: PMC11004624 DOI: 10.1016/j.jot.2023.12.004] [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: 09/19/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 04/12/2024] Open
Abstract
Objective To evaluate the accuracy and safety of the LANCET robotic system, a robot arm assisted operation system for total hip arthroplasty via a multicenter clinical randomized controlled trial. Methods A total of 116 patients were randomized into two groups: LANCET robotic arm assisted THA group (N = 58) and the conventional THA group (N = 58). General information about the patients was collected preoperatively. Operational time and bleeding were recorded during the surgery. The position of the acetabular prosthesis was evaluated by radiographs one week after surgery and compared with preoperative planning. Harris score, hip mobility, prosthesis position and angle and complications were compared between the two groups at three months postoperatively. Results None of the 111 patients who ultimately completed the 3-month follow-up experienced adverse events such as hip dislocation and infection during follow-up. In the RAA group, 52 (92.9 %) patients were located in the Lewinnek safe zone and 49 (87.5 %) patients were located in the Callanan safe zone. In the control group were 47 (85.5 %) and 44 (80.0 %) patients, respectively. In the RAA group, 53 (94.6 %) patients had a postoperative acetabular inclination angle and 51 (91.1 %) patients had an acetabular version angle within a deviation of 5° from the preoperative plan. These numbers were significantly higher than those of the control group, which consisted of 42 (76.4 %) and 34 (61.8 %) patients respectively. There were no significant differences between the two groups of subjects in terms of general condition, intraoperative bleeding, hip mobility, and adverse complications. Conclusion The results of this prospective randomized, multicenter, parallel-controlled clinical study demonstrated that the LANCET robotic system leads conventional THA surgery in accuracy of acetabular cup placement and does not differ from conventional THA surgery in terms of postoperative hip functional recovery and complications. The translational potential of this article In the past, the success rate of total hip arthroplasty (THA) relied heavily on the surgeon's experience. As a result, junior doctors needed extensive training to become proficient in this technique. However, the introduction of surgical robots has significantly improved this situation. By utilizing robotic assistance, both junior and senior doctors can perform THA quickly and efficiently. This advancement is crucial for the widespread adoption of THA, as patients can now receive surgical treatment in local facilities instead of overwhelming larger hospitals and straining medical resources. Moreover, the development of surgical robots with fully independent intellectual property rights holds immense value in overcoming the limitations of high-end medical equipment. This aligns with the objectives outlined in the 14th Five Year Plan for National Science and Technology Strategy.
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Affiliation(s)
- Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Senlin Chai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Dongyang Chen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weijun Wang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jin Dai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaofeng Zhang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jianghui Qin
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kai Song
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinhua Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jing Han
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Chang
- Sports Medicine Center, Department of Orthopaedic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Miaofeng Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Chenxi Xue
- Department of Orthopedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jun Lu
- Sports Medicine Center, Department of Orthopaedic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Lidong Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yunfeng Yao
- Department of Orthopedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Lan Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Lin C, Chen W, Weng P, Huang Y, Liaw C. Liaw's Ellipse Anteversion Method for Distinguishing Acetabular Component Retroversion from Anteversion on Plain Radiographs. Orthop Surg 2024; 16:276-281. [PMID: 37986662 PMCID: PMC10782236 DOI: 10.1111/os.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 11/22/2023] Open
Abstract
Improper acetabulum component position is a significant risk factor for postoperative dislocation after total hip arthroplasty. Several radiographic two-dimensional methods exist for measuring acetabulum component anteversion, but they cannot distinguish between anteversion and retroversion. "Liaw's version," initially proposed as a simple mathematical standardized two-dimensional method, was modified to the computerized ellipse method, proving superior accuracy to traditional two-dimensional methods. In this article, we demonstrated its application in detecting and measuring retroverted acetabulum component. We obtained anteroposterior pelvis radiographs from a patient undergoing total hip arthroplasty on the day of surgery and 2 weeks postoperatively. The computerized ellipse method was used to measure the acetabulum component orientation. Upon comparison, the difference between θ assigned to be retroverted (9.52-8.56 = 0.96) is much smaller than the difference between θ assigned to be anteverted (23.81-18.86 = 4.95), leading us to determine retroversion. This was further confirmed by computed tomography at the 6-week follow-up. We propose that using the computerized ellipse method to measure Liaw's version can be a valuable tool in identifying acetabulum component retroversion on anteroposterior radiographs during routine postoperative follow-up and retrospective assessments of total hip arthroplasty patients.
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Affiliation(s)
- Chun‐Hao Lin
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Wei‐Cheng Chen
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Pei‐Wei Weng
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- International PhD Program in Biomedical Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DevicesTaipei Medical UniversityTaipeiTaiwan
| | - Yu‐min Huang
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Chen‐Kun Liaw
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DeviceCollege of Biomedical Engineering, Graduate Institute of Biomedical Optomechatronics, Taipei Medical UniversityTaipeiTaiwan
- TMU Biodesign CenterTaipei Medical UniversityTaipeiTaiwan
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Rebgetz P, McCarthy T, McLaren H, Wilson MJ, Whitehouse SL, Crawford RW. Achieving Target Cemented Femoral Stem Anteversion Using a 3-Dimensional Model. Arthroplast Today 2023; 19:101084. [PMID: 36688094 PMCID: PMC9852927 DOI: 10.1016/j.artd.2022.101084] [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: 10/23/2022] [Revised: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023] Open
Abstract
Background Total hip arthroplasty aims to provide patients with a pain-free and stable hip joint through optimization of biomechanics such as femoral anteversion. There are studies evaluating the limits of cementless stem version, however, none assessing the range of version achieved by a cemented collarless stem. A computed tomography (CT)-based study was performed, utilizing a contemporary robotic planning platform to assess the amount of rotation afforded by a cemented collarless stem, whilst maintaining native biomechanics. Methods The study utilized 36 cadaveric hips. All had CT scans of the pelvis and hip joints. The CT scans were then loaded into a contemporary robotic planning platform. A stem that restored the patients native femoral offset was selected and positioned in the virtual femur. The stem was rotated while checking for cortical contact at the level of the neck cut. Cortical contact was regarded as the rotation limit, assessed in both anteversion and retroversion. Target range for stem anteversion was 10°-20°. Failure to achieve target version triggered a sequence of adjustments to simulate surgical decisions. Results Native femoral offset and target version range was obtained in 29 of 36 (80.5%) cases. Following an adjustment sequence, 4 further stems achieved target anteversion with a compromise in offset of 2.3 mm. Overall 33 of 36 (91.7%) stems achieved the target anteversion range of 10°-20°. Conclusions Target femoral stem anteversion can be achieved using a cemented, collarless stem in a CT-based 3-dimensional model in 80.5% of hips. With a small compromise in offset (mean 2.3 mm), this can be increased to 91.7%.
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Affiliation(s)
- Paul Rebgetz
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | | | - Hamish McLaren
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Matthew J. Wilson
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Sarah L. Whitehouse
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia,Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Ross W. Crawford
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia,Corresponding author. Queensland University of Technology, Orthopaedic Research Unit, Level 5, CSB, The Prince Charles Hospital, Rode Rd, Brisbane, Queensland 4032, Australia. Tel.: +61 07 3139 4481.
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Rankin KA, Petit L, Nasreddine A, Minotti P, Leslie M, Wiznia DH. Computer-Assisted Navigation for Complex Revision of Unstable Total Hip Replacement in a Patient With Post-traumatic Arthritis. Arthroplast Today 2022; 15:153-158. [PMID: 35586609 PMCID: PMC9108506 DOI: 10.1016/j.artd.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/05/2022] Open
Abstract
Imageless computer-assisted navigation (CAN) excels in the post-traumatic arthritis and complex revision case setting when altered anatomy and landmarks are inaccurate references for cup positioning. We describe the case of an adult male patient who suffered an acetabular fracture which was treated nonoperatively. He subsequently developed post-traumatic arthritis and underwent an anterior approach total hip arthroplasty 25 years later. Postoperatively, he developed recurrent hip instability due to malpositioned components. We describe the use of imageless CAN during revision total hip arthroplasty to correct malpositioned components, with 3-year follow-up without dislocation. In these complex cases, CAN reduces the risk of component malpositioning and joint instability.
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Affiliation(s)
| | - Logan Petit
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Adam Nasreddine
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Phil Minotti
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Michael Leslie
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Daniel H. Wiznia
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
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Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation. INTERNATIONAL ORTHOPAEDICS 2022; 46:789-795. [DOI: 10.1007/s00264-021-05280-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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Flick TR, Ross BJ, Sherman WF. Instability After Total Hip Arthroplasty and the Role of Advanced and Robotic Technology. Orthop Clin North Am 2021; 52:191-200. [PMID: 34053564 DOI: 10.1016/j.ocl.2021.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Instability remains the leading cause of reoperation following total hip arthroplasty (THA). In this article, the risk factors for instability after THA are reviewed, including patient-related characteristics, surgical techniques, positioning of implants, and the role of advanced technology and robotics as a platform that may reduce the incidence of instability.
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Affiliation(s)
- Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - William F Sherman
- Adult Reconstruction Hip/Knee, Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
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Risk Factors for Dislocation and Re-revision After First-Time Revision Total Hip Arthroplasty due to Recurrent Dislocation - A Study From the Danish Hip Arthroplasty Register. J Arthroplasty 2021; 36:1407-1412. [PMID: 33423877 DOI: 10.1016/j.arth.2020.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Persistent instability after hip revision is a serious problem. Our aim was to analyze surgical and patient-related risk factors for both a new dislocation and re-revision after first-time hip revision due to dislocation. METHODS We included patients with a primary THA due to osteoarthritis and a first-time revision due to dislocation registered in the Danish Hip Arthroplasty Register (DHR) from 1996 to 2016. We identified dislocations in the Danish National Patient Register and re-revisions in the DHR. Risk factors were analyzed by a multivariable regression analysis adjusting for the competing risk of death. Results are presented as subdistribution hazard ratios (sHR). RESULTS We identified 1678 first-time revisions due to dislocation. Of these, 22.4% had a new dislocation. 19.8% were re-revised for any reason. With new dislocations treated by closed reduction as the endpoint, the sHR was 0.36 (95% CI, 0.27-0.48) for those who had a constrained liner (CL) during revision and 0.21 (0.08-0.58) for dual mobility cups (DMC), thereby lowering the risk of dislocation compared to regular liners. Changing only the head/liner increased the risk of dislocation (sHR = 2.65; 2.05-3.42) compared to full cup revisions. The protective effect of CLs and DMCs on dislocations vanished when re-revisions became the endpoint. The head/liner exchange was still found inferior compared to cup revision (sHR = 1.73; 1.34-2.23). CONCLUSION Patients revised with DMCs and CLs were associated with a lower risk of dislocation after a first-time revision but not re-revision, whereas only changing the head/liner was associated with a higher risk of dislocation and re-revision of any cause compared to cup revision.
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St Mart JP, Goh EL, Shah Z. Robotics in total hip arthroplasty: a review of the evolution, application and evidence base. EFORT Open Rev 2020; 5:866-873. [PMID: 33425375 PMCID: PMC7784137 DOI: 10.1302/2058-5241.5.200037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Robotic systems used in orthopaedics have evolved from active systems to semi-active systems. Early active systems were associated with significant technical and surgical complications, which limited their clinical use. The new semi-active system Mako has demonstrated promise in overcoming these limitations, with positive early outcomes. There remains a paucity of data regarding long-term outcomes associated with newer systems such as Mako and TSolution One, which will be important in assessing the applicability of these systems. Given the already high satisfaction rate of manual THA, further high-quality comparative studies are required utilizing outcome scores that are not limited by high ceiling effects to assess whether robotic systems justify their additional expense.
Cite this article: EFORT Open Rev 2020;5:866-873. DOI: 10.1302/2058-5241.5.200037
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Affiliation(s)
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Zameer Shah
- Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Innmann MM, Weishorn J, Beaule PE, Grammatopoulos G, Merle C. Pathologic spinopelvic balance in patients with hip osteoarthritis : Preoperative screening and therapeutic implications. DER ORTHOPADE 2020; 49:860-869. [PMID: 32940740 DOI: 10.1007/s00132-020-03981-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recently spinopelvic balance and mobility, i.e. the dynamic interaction of the spine, pelvis and the femur in the sagittal plane between different postures, has been identified as a relevant factor influencing the outcome of primary total hip arthroplasty (THA). Individual spinopelvic balance and mobility seem to affect patient reported outcome and the risk of impingement and dislocation following THA. The aim of this article is to provide a concise overview of normal and pathologic spinopelvic alignment, to characterize relevant spinopelvic parameters and the diagnostic assessment in patients with hip OA and to discuss potential implications for THA with respect to implant selection and component orientation.Spinopelvic characteristics are highly variable. Patients with stiff lumbar spines and mobile hips seem to be at an increased risk of impingement and dislocation and can be screened with single lateral standing radiographs of the spinopelvic complex before THA. In patients with hip and spine pathology, particular attention should be paid to evaluate the individual pathoanatomy of the hip and established clinical measurements should be diligently taken with respect to the reconstruction of the center of rotation, hip offset, leg length and soft tissue tension in order to minimize the risk of impingement and dislocation. No evidence-based recommendations for novel target zones concerning implant position can currently be made. In patients at risk 36 mm heads should be used whenever possible. In high risk patients, such as the combination of a stiff unbalanced lumbar spine ("flatback") and a mobile hip or in the presence of long spinal fusions or fusions involving the sacrum, dual mobility cups offer additional stability.
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Affiliation(s)
- Moritz M Innmann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Johannes Weishorn
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Paul E Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, University of Ottawa, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital-General Campus, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian Merle
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
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Goldman AH, Osmon DR, Hanssen AD, Pagnano MW, Berry DJ, Abdel MP. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Aseptic Reoperations Within One Year of Primary Total Hip Arthroplasty Markedly Increase the Risk of Later Periprosthetic Joint Infection. J Arthroplasty 2020; 35:S10-S14. [PMID: 32192836 DOI: 10.1016/j.arth.2020.02.054] [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: 11/27/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the success of primary total hip arthroplasties (THAs), some patients will require an aseptic reoperation within 1 year of the index THA. The goal of this study is to evaluate the risk of subsequent periprosthetic joint infection (PJI) in patients undergoing an aseptic reoperation within 1 year of a primary THA. METHODS A retrospective review utilizing our institutional joint registry identified 211 primary THAs requiring aseptic reoperation within 1 year following index arthroplasty. A control group of 15,357 primary THAs not requiring reoperation within 1 year was identified. Patients were divided into groups based on time from primary THA to reoperation: (1) within 90 days (n = 112 THAs; 40% for dislocation, 34% for periprosthetic fracture) or (2) 91-365 days (n = 99 THAs; 37% for dislocation, 29% for periprosthetic fracture). Mean follow-up was 7 years. RESULTS Patients undergoing an aseptic reoperation within 90 days had a PJI rate of 4.8% at 2 years, while the 91-365 day group had a PJI rate of 3.2% at 2 years. The control group had a PJI rate of 0.2% at 2 years. Employing a multivariate analysis, reoperation within 90 days of index arthroplasty had an elevated risk of PJI (hazard ratio 8, P < .001) as did a reoperation between 91 and 365 days (hazard ratio 13, P < .001). CONCLUSION Aseptic reoperations within 1 year following primary THA resulted in an 8- to 13-fold increased risk of subsequent PJI. The risk was similar whether the aseptic reoperation was early (within 90 days) or later (91-365 days). LEVEL OF EVIDENCE Level III (Prognostic).
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Affiliation(s)
| | - Douglas R Osmon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Saiz AM, Lum ZC, Pereira GC. Etiology, Evaluation, and Management of Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2019; 7:e7. [DOI: 10.2106/jbjs.rvw.18.00165] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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A Geometric Model to Determine Patient-Specific Cup Anteversion Based on Pelvic Motion in Total Hip Arthroplasty. Adv Orthop 2019; 2019:4780280. [PMID: 31186967 PMCID: PMC6521545 DOI: 10.1155/2019/4780280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Cup position is critical to stability in total hip arthroplasty and is affected by pelvis motion during positions of daily life. The purpose of this study was to explicitly define the relationship between sagittal pelvic motion and resultant cup functional anteversion and create a tool to guide the surgeon to a patient-specific intra-operative anteversion. Materials and Methods 10,560 combinations of inclination, anteversion, and pelvic tilt were generated using a geometric model. Resultant functional anteversion was calculated for each iteration and variables were correlated. An electronic mobile tool was created that compares inputted patient-specific values to population-based averages to determine pelvic positions and dynamics that may lead to instability. Results A third-degree polynomial equation was used to describe the relationship between variables. The freely downloadable mobile tool uses input from pre-operative plain radiographic measurements to provide the surgeon a quantitative correction to intra-operative cup anteversion based on differences in functional anteversion compared to population-based averages. Conclusion This study provides a geometric relationship between planned cup position, pelvic position and motion, and the resultant functional anteversion. This mathematical model was applied to an electronic tool that seeks to determine an individualized intra-operative cup anteversion based on measured patient-specific pelvic dynamics.
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Soft tissue tension is four times lower in the unstable primary total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 42:2059-2065. [DOI: 10.1007/s00264-018-3908-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/16/2018] [Indexed: 01/25/2023]
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Sutter EG, McClellan TR, Attarian DE, Bolognesi MP, Lachiewicz PF, Wellman SS. Outcomes of Modular Dual Mobility Acetabular Components in Revision Total Hip Arthroplasty. J Arthroplasty 2017; 32:S220-S224. [PMID: 28413142 DOI: 10.1016/j.arth.2017.03.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/18/2017] [Accepted: 03/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a high rate of dislocation after revision total hip arthroplasty. This study evaluated the outcomes of 1 modular dual mobility component in revision total hip arthroplasty in patients at high risk of dislocation. METHODS We reviewed 64 revisions performed in 27 (42%) patients for recurrent dislocation, 16 (25%) for adverse local tissue reaction, 11 (17%) for reimplantation infection, and 10 (16%) for aseptic loosening, malposition, or fracture. Complications, reoperations, and survivorship were evaluated. RESULTS Three-year survival was 98% with failure defined as aseptic loosening and 91% with failure as cup removal for any reason. With mean follow-up time of 38 months, there were 14 complications, including 2 dislocations treated with closed reduction, 9 infections, and 12 reoperations. All complications occurred in patients revised for instability, adverse local tissue reaction, or infection. CONCLUSION The early results of this component are promising, with good overall survival and low rate of dislocation.
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Affiliation(s)
- E Grant Sutter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Taylor R McClellan
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - David E Attarian
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Paul F Lachiewicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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De Martino I, D'Apolito R, Soranoglou VG, Poultsides LA, Sculco PK, Sculco TP. Dislocation following total hip arthroplasty using dual mobility acetabular components: a systematic review. Bone Joint J 2017; 99-B:18-24. [PMID: 28042114 DOI: 10.1302/0301-620x.99b1.bjj-2016-0398.r1] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this systematic review was to report the rate of dislocation following the use of dual mobility (DM) acetabular components in primary and revision total hip arthroplasty (THA). MATERIALS AND METHODS A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed. A comprehensive search of Pubmed/Medline, Cochrane Library and Embase (Scopus) was conducted for English articles between January 1974 and March 2016 using various combinations of the keywords "dual mobility", "dual-mobility", "tripolar", "double-mobility", "double mobility", "hip", "cup", "socket". The following data were extracted by two investigators independently: demographics, whether the operation was a primary or revision THA, length of follow-up, the design of the components, diameter of the femoral head, and type of fixation of the acetabular component. RESULTS In all, 59 articles met our inclusion criteria. These included a total of 17 908 THAs which were divided into two groups: studies dealing with DM components in primary THA and those dealing with these components in revision THA. The mean rate of dislocation was 0.9% in the primary THA group, and 3.0% in the revision THA group. The mean rate of intraprosthetic dislocation was 0.7% in primary and 1.3% in revision THAs. CONCLUSION Based on the current data, the use of DM acetabular components are effective in minimising the risk of instability after both primary and revision THA. This benefit must be balanced against continuing concerns about the additional modularity, and the new mode of failure of intraprosthetic dislocation. Longer term studies are needed to assess the function of these newer materials compared with previous generations. Cite this article: Bone Joint J 2017;99-B(1 Supple A):18-24.
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Affiliation(s)
- I De Martino
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - R D'Apolito
- Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - V G Soranoglou
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - L A Poultsides
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - P K Sculco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - T P Sculco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Ezquerra L, Quilez MP, Pérez MÁ, Albareda J, Seral B. Range of Movement for Impingement and Dislocation Avoidance in Total Hip Replacement Predicted by Finite Element Model. J Med Biol Eng 2017; 37:26-34. [PMID: 28286463 PMCID: PMC5325855 DOI: 10.1007/s40846-016-0210-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/18/2016] [Indexed: 11/25/2022]
Abstract
Dislocation is a serious complication in total hip replacement (THR). An inadequate range of movement (ROM) can lead to impingement of the prosthesis neck on the acetabular cup; furthermore, the initiation of subluxation and dislocation may occur. The objective of this study was to generate a parametric three-dimensional finite element (FE) model capable of predicting the dislocation stability for various positions of the prosthetic head, neck, and cup under various activities. Three femoral head sizes (28, 32, and 36 mm) were simulated. Nine acetabular placement positions (abduction angles of 25°, 40° and 60° combined with anteversion angles of 0°, 15° and 25°) were analyzed. The ROM and maximum resisting moment (RM) until dislocation were evaluated based on the stress distribution in the acetabulum component. The analysis allowed for the definition of a “safe zone” of movement for impingement and dislocation avoidance in THR: an abduction angle of 40°–60° and anteversion angle of 15°–25°. It is especially critical that the anteversion angle does not fall to 10°–15°. The sequence of the RM is a valid parameter for describing dislocation stability in FE studies.
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Affiliation(s)
- Laura Ezquerra
- Department of Orthopaedic Surgery, University Hospital Lozano Blesa, San Juan Bosco, 15, 50009 Saragossa, Spain
- C/El Greco, 150, Urbanización Virgen de la Columna, 50730 El Burgo de Ebro, Saragossa, Spain
| | - María Paz Quilez
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Maria de Luna s/n, Campus Río Ebro, Edificio “Agustín de Betancourt”, 50018 Saragossa, Spain
| | - María Ángeles Pérez
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, Maria de Luna s/n, Campus Río Ebro, Edificio “Agustín de Betancourt”, 50018 Saragossa, Spain
| | - Jorge Albareda
- Department of Orthopaedic Surgery, University Hospital Lozano Blesa, San Juan Bosco, 15, 50009 Saragossa, Spain
| | - Belén Seral
- Department of Orthopaedic Surgery, University Hospital Lozano Blesa, San Juan Bosco, 15, 50009 Saragossa, Spain
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Risk factors for dislocation after revision total hip arthroplasty: A systematic review and meta-analysis. Int J Surg 2016; 38:123-129. [PMID: 28043927 DOI: 10.1016/j.ijsu.2016.12.122] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND No formal systematic review or meta-analysis was performed up to now to summarize the risk factors of dislocation after revision total hip arthroplasty(THA). AIMS The present study aimed to quantitatively and comprehensively conclude the risk factors of dislocation after revision total hip arthroplasty. METHODS A search was applied to CNKI, Embase, Medline, and Cochrane central database (all up to October 2016). All studies assessing the risk factors of dislocation after revision THA without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale. Data were pooled and a meta-analysis completed. RESULTS A total of 8 studies were selected, which altogether included 4656 revision THAs. 421 of them were cases of dislocation occurred after surgery, suggesting the accumulated incidence of 9.04%. Results of meta-analyses showed that age at surgery (standardized mean difference -0.222; 95% CI -0.413-0.031), small-diameter femoral heads (≤28 mm) (OR 1.451; 95%CI 1.056-1.994), history of instability (OR 2.739; 95%CI 1.888-3.974), number of prior revisions ≥ 3 (OR, 2.226; 95% CI, 1.569-3.16) and number of prior revisions ≥ 2 (OR 1.949; 95% CI 1.349-2.817), acetabular components with elevated rim liner were less likely to develop dislocation after revision THA (OR 0.611; 95% CI 0.415-0.898). CONCLUSIONS Related prophylaxis strategies should be implemented in patients involved with above-mentioned risk factors to prevent dislocation after revision THA.
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Falez F, Papalia M, Favetti F, Panegrossi G, Casella F, Mazzotta G. Total hip arthroplasty instability in Italy. INTERNATIONAL ORTHOPAEDICS 2016; 41:635-644. [PMID: 27999925 DOI: 10.1007/s00264-016-3345-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/09/2016] [Indexed: 01/25/2023]
Abstract
Hip dislocation is a major and common complication of total hip arthroplasty (THA), which appears with an incidence between 0.3% and 10% in primary total hip arthroplasties and up to 28% in revision THA. The hip dislocations can be classified into three groups: early, intermediate and late. Approximately two-thirds of cases can be treated successfully with a non-operative approach. The rest require further surgical intervention. The prerequisite to developing an appropriate treatment strategy is a thorough evaluation to identify the causes of the dislocation. In addition, many factors that contribute to THA dislocation are related to the surgical technique, mainly including component orientation, femoral head diameter, restoration of femoral offset and leg length, cam impingement and condition of the soft tissues. The diagnosis of a dislocated hip is relatively easy because the clinical situation is very typical. Having identified a dislocated hip, the first step is to perform a closed reduction of the implant. After reduction you must perform a computed tomography scan to evaluate the surgical options for treatment of recurrent dislocation that include: revision arthroplasty, modular components exchange, dual-mobility cups, large femoral heads, constrained cups, elimination of impingement and soft tissue procedures. The objective is to avoid further dislocation, a devastating event which is increasing the number of operations on the hip. To obtain this goal is useful to follow an algorithm of treatment, but the best treatment remains prevention.
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Affiliation(s)
- Francesco Falez
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia,1, Rome, Italy.
| | - Matteo Papalia
- Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy
| | - Fabio Favetti
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia,1, Rome, Italy
| | - Gabriele Panegrossi
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia,1, Rome, Italy
| | - Filippo Casella
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia,1, Rome, Italy
| | - Gianluca Mazzotta
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia,1, Rome, Italy
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Single-component revisions are associated with dislocation after revision total hip arthroplasty at intermediate-term follow-up. Hip Int 2016; 26:233-6. [PMID: 27132533 DOI: 10.5301/hipint.5000332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Dislocation is the most frequent complication following revision total hip arthroplasty (THA). Although several risk factors for dislocation in revision THA have been described, many cannot be modified at the time of surgery. Identifying modifiable risk factors for subsequent dislocation after revision THA provides opportunity for orthopedic surgeons to decrease instability. METHODS A retrospective analysis of 203 consecutive revision THA procedures performed by a single surgeon with a minimum 2-year follow-up between May 2003 and June 2012 was performed. 2 (1.0%) died and 14 (6.9%) were lost to follow-up leaving 187 (92%) revision procedures in 123 men and 64 women. Univariate and multivariate logistic regression was used to identify risk factors for dislocation. RESULTS 9 (4.8%) of all patients reviewed experienced a dislocation episode. Of those, 8 (89%) had a single component revised, 6 (67%) were women, and 4 (44%) had a history of recurrent dislocation. 2 of 14 (14%) patients with a constrained liner dislocated. Univariate analysis demonstrated that single-component revisions were at higher risk for dislocation after the surgery (p value = 0.033). CONCLUSIONS Identifying modifiable risk factors for dislocation after revision THA provide opportunity to decrease rates of instability. Based on our data, single-component revision THA is a risk factor for subsequent dislocation.
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Lack of early dislocation following total hip arthroplasty with a new dual mobility acetabular design. Hip Int 2015; 25:34-8. [PMID: 25655740 DOI: 10.5301/hipint.5000186] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2014] [Indexed: 02/04/2023]
Abstract
Dual mobility implant designs minimise the risk of dislocation without sacrificing range of motion. Between 1st September 2008 and 31st July 2011, 5 institutions examined early clinical outcomes of a new dual mobility bearing hip system implanted in 485 primary THAs in 452 patients. Patient demographics were 46% female, a mean age of 67 years and a mean BMI of 30. Complications at a minimum of 2 years after surgery included 1 femur fracture, 1 DVT and 4 unrelated deaths. There were no dislocations. For functional outcomes, Harris Hip Scores increased from 41 to 86 (p<0.001), while VAS pain scores decreased from 5.9 to 0.7 (p<0.001). Minimal complications, excellent early clinical outcomes and the absence of early dislocations demonstrate the improved stability of this dual mobility implant system.
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Clarke A, Pulikottil-Jacob R, Grove A, Freeman K, Mistry H, Tsertsvadze A, Connock M, Court R, Kandala NB, Costa M, Suri G, Metcalfe D, Crowther M, Morrow S, Johnson S, Sutcliffe P. Total hip replacement and surface replacement for the treatment of pain and disability resulting from end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44): systematic review and economic evaluation. Health Technol Assess 2015; 19:1-668, vii-viii. [PMID: 25634033 DOI: 10.3310/hta19100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Total hip replacement (THR) involves the replacement of a damaged hip joint with an artificial hip prosthesis. Resurfacing arthroplasty (RS) involves replacement of the joint surface of the femoral head with a metal surface covering. OBJECTIVES To undertake clinical effectiveness and cost-effectiveness analysis of different types of THR and RS for the treatment of pain and disability in people with end-stage arthritis of the hip, in particular to compare the clinical effectiveness and cost-effectiveness of (1) different types of primary THR and RS for people in whom both procedures are suitable and (2) different types of primary THR for people who are not suitable for hip RS. DATA SOURCES Electronic databases including MEDLINE, EMBASE, The Cochrane Library, Current Controlled Trials and UK Clinical Research Network (UKCRN) Portfolio Database were searched in December 2012, with searches limited to publications from 2008 and sample sizes of ≥ 100 participants. Reference lists and websites of manufacturers and professional organisations were also screened. REVIEW METHODS Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of different types of THR and RS for people with end-stage arthritis of the hip. Included randomised controlled trials (RCTs) and systematic reviews were data extracted and risk of bias and methodological quality were independently assessed by two reviewers using the Cochrane Collaboration risk of bias tool and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A Markov multistate model was developed for the economic evaluation of the technologies. Sensitivity analyses stratified by sex and controlled for age were carried out to assess the robustness of the results. RESULTS A total of 2469 records were screened of which 37 were included, representing 16 RCTs and eight systematic reviews. The mean post-THR Harris Hip Score measured at different follow-up times (from 6 months to 10 years) did not differ between THR groups, including between cross-linked polyethylene and traditional polyethylene cup liners (pooled mean difference 2.29, 95% confidence interval -0.88 to 5.45). Five systematic reviews reported evidence on different types of THR (cemented vs. cementless cup fixation and implant articulation materials) but these reviews were inconclusive. Eleven cost-effectiveness studies were included; four provided relevant cost and utility data for the model. Thirty registry studies were included, with no studies reporting better implant survival for RS than for all types of THR. For all analyses, mean costs for RS were higher than those for THR and mean quality-adjusted life-years (QALYs) were lower. The incremental cost-effectiveness ratio for RS was dominated by THR, that is, THR was cheaper and more effective than RS (for a lifetime horizon in the base-case analysis, the incremental cost of RS was £11,284 and the incremental QALYs were -0.0879). For all age and sex groups RS remained clearly dominated by THR. Cost-effectiveness acceptability curves showed that, for all patients, THR was almost 100% cost-effective at any willingness-to-pay level. There were age and sex differences in the populations with different types of THR and variations in revision rates (from 1.6% to 3.5% at 9 years). For the base-case analysis, for all age and sex groups and a lifetime horizon, mean costs for category E (cemented components with a polyethylene-on-ceramic articulation) were slightly lower and mean QALYs for category E were slightly higher than those for all other THR categories in both deterministic and probabilistic analyses. Hence, category E dominated the other four categories. Sensitivity analysis using an age- and sex-adjusted log-normal model demonstrated that, over a lifetime horizon and at a willingness-to-pay threshold of £20,000 per QALY, categories A and E were equally likely (50%) to be cost-effective. LIMITATIONS A large proportion of the included studies were inconclusive because of poor reporting, missing data, inconsistent results and/or great uncertainty in the treatment effect estimates. This warrants cautious interpretation of the findings. The evidence on complications was scarce, which may be because of the absence or rarity of these events or because of under-reporting. The poor reporting meant that it was not possible to explore contextual factors that might have influenced study results and also reduced the applicability of the findings to routine clinical practice in the UK. The scope of the review was limited to evidence published in English in 2008 or later, which could be interpreted as a weakness; however, systematic reviews would provide summary evidence for studies published before 2008. CONCLUSIONS Compared with THR, revision rates for RS were higher, mean costs for RS were higher and mean QALYs gained were lower; RS was dominated by THR. Similar results were obtained in the deterministic and probabilistic analyses and for all age and sex groups THR was almost 100% cost-effective at any willingness-to-pay level. Revision rates for all types of THR were low. Category A THR (cemented components with a polyethylene-on-metal articulation) was more cost-effective for older age groups. However, across all age-sex groups combined, the mean cost for category E THR (cemented components with a polyethylene-on-ceramic articulation) was slightly lower and the mean QALYs gained were slightly higher. Category E therefore dominated the other four categories. Certain types of THR appeared to confer some benefit, including larger femoral head sizes, use of a cemented cup, use of a cross-linked polyethylene cup liner and a ceramic-on-ceramic as opposed to a metal-on-polyethylene articulation. Further RCTs with long-term follow-up are needed. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003924. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Aileen Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Amy Grove
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Martin Connock
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Matthew Costa
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gaurav Suri
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Metcalfe
- Warwick Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Michael Crowther
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Morrow
- Oxford Medical School, University of Oxford, Oxford, UK
| | - Samantha Johnson
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry, UK
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Heffernan C, Banerjee S, Nevelos J, Macintyre J, Issa K, Markel DC, Mont MA. Does dual-mobility cup geometry affect posterior horizontal dislocation distance? Clin Orthop Relat Res 2014; 472:1535-44. [PMID: 24464508 PMCID: PMC3971207 DOI: 10.1007/s11999-014-3469-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 01/10/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dual-mobility acetabular cups have been marketed with the purported advantages of reduced dislocation rates and improvements in ROM; however, the relative efficacies of these designs in terms of changing joint stability via ROM and dislocation distance have not been thoroughly evaluated. QUESTIONS/PURPOSES In custom computer simulation studies, we addressed the following questions: (1) Do variations in component geometry across dual-mobility designs (anatomic, modular, and subhemispheric) affect the posterior horizontal dislocation distances? (2) How do these compare with the measurements obtained with standard hemispheric fixed bearings? (3) What is the effect of head size on posterior horizontal dislocation distances for dual-mobility and standard hemispheric fixed bearings? (4) What are the comparative differences in prosthetic impingement-free ROM between three modern dual-mobility components (anatomic, modular, and subhemispheric), and standard hemispheric fixed bearings? METHODS CT scans of an adult pelvis were imported into computer-aided design software to generate a dynamic three-dimensional model of the pelvis. Using this software, computer-aided design models of three dual-mobility designs (anatomic, modular, and subhemispheric) and standard hemispheric fixed bearings were implanted in the pelvic model and the posterior horizontal dislocation distances measured. Hip ROM simulator software was used to compare the prosthetic impingement-free ROMs of dual-mobility bearings with standard hemispheric fixed-bearing designs. RESULTS Variations in component design had greater effect on posterior horizontal dislocation distance values than increases in head size in a specific design (p < 0.001). Anatomic and modular dual-mobility designs were found to have greater posterior horizontal dislocation distances than the subhemispheric dual-mobility and standard hemispheric fixed-bearing designs (p < 0.001). Increasing head sizes increased posterior horizontal dislocation distances across all designs (p < 0.001). The subhemispheric dual-mobility implant was found to have the greatest prosthetic impingement-free ROM among all prosthetic designs (p < 0.001; R(2) = 0.86). CONCLUSIONS The posterior horizontal dislocation distances differ with the individual component geometries of dual-mobility designs, with the anatomic and modular designs showing higher posterior horizontal dislocation distances compared with subhemispheric dual-mobility and standard hemispheric fixed-bearing designs. CLINICAL RELEVANCE Static, three-dimensional computerized simulation studies suggest differences that may influence the risk of dislocation among components with varying geometries, favoring anatomic and modular dual-mobility designs. Clinical studies are needed to confirm these observations.
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Affiliation(s)
| | - Samik Banerjee
- />Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
| | | | | | - Kimona Issa
- />Seton Hall University School of Health and Medical Sciences, South Orange, NJ USA
| | - David C. Markel
- />Providence Hospital, DMC-Providence Residency, Detroit, MI USA
| | - Michael A. Mont
- />Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215 USA
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Itokawa T, Nakashima Y, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y. Late dislocation is associated with recurrence after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2013; 37:1457-63. [PMID: 23677511 DOI: 10.1007/s00264-013-1921-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/26/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was conducted to examine the risk factors for recurrent dislocation after total hip arthroplasty (THA) and test the hypothesis that late dislocations are associated with recurrence. METHODS A total of 1,250 hips in 1,017 patients were retrospectively reviewed. All operations were performed through the posterolateral approach with posterior soft tissue repair. An early or late dislocation was defined as a dislocation occurring before or after one year postoperatively, respectively. RESULTS Dislocation occurred in 36 hips (2.9 %) and 20 of them experienced recurrence. Recurrent dislocations were observed in ten out of 25 hips (40.0 %) with early dislocation; however, ten out of 11 hips (90.9 %) with late dislocation experienced recurrence (p = 0.0046). Multivariate analysis revealed that late dislocation was significantly associated with recurrence with odds ratio of 5.94 per year. Seven in 20 hips with recurrent dislocation required surgical treatment. CONCLUSION Late dislocation significantly contributed to the development of recurrent dislocations.
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Affiliation(s)
- Takashi Itokawa
- Department of Orthopaedic Surgery, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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26
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Reprint of “Hip arthroplasty”. Int J Orthop Trauma Nurs 2013. [DOI: 10.1016/j.ijotn.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Miki H, Sugano N, Yonenobu K, Tsuda K, Hattori M, Suzuki N. Detecting cause of dislocation after total hip arthroplasty by patient-specific four-dimensional motion analysis. Clin Biomech (Bristol, Avon) 2013; 28:182-6. [PMID: 23219052 DOI: 10.1016/j.clinbiomech.2012.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 11/07/2012] [Accepted: 11/12/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dislocation is a major complication after total hip arthroplasty. Prosthesis impingement is considered to be an important cause of dislocation because impingement marks are more frequently found on retrieved cups or liners in patients who have undergone revision surgery because of dislocation (80%-94%) than in those who have undergone reoperation for other reasons (51%-56%). However, it remains a question whether impingement marks are the cause of dislocation or are instead its result. To clarify the issue, it is necessary to confirm noninvasively whether the point of impingement matches the patient's hip position when dislocation occurs. METHODS Using four-dimensional patient-specific analysis, we recorded prosthesis impingement in 10 hips with instability after primary total hip arthroplasty when the patients reproduced the dislocation-causing motion. FINDINGS We found prosthesis impingement to be related to at least instability in 6 of 10 hips with dislocation after primary total hip arthroplasty and in 4 of 4 hips that underwent revision surgery for recurrent dislocation. All impingements occurred between the anterior wall of the liner and the stem neck in posterior dislocation and between the posterior wall of the liner and the stem neck in anterior dislocation. Revision surgery in 1 of those 4 hips revealed 2 impingement marks on the retrieved liner that closely matched the prosthesis impingement point and the dislocation pathway of the metal head on the liner that were detected earlier during motion analysis. INTERPRETATION Prosthesis impingement is an important factor in dislocation after total hip arthroplasty.
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Affiliation(s)
- Hidenobu Miki
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
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28
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Abstract
Total hip arthroplasty is a cost-effective surgical procedure undertaken to relieve pain and restore function to the arthritic hip joint. More than 1 million arthroplasties are done every year worldwide, and this number is projected to double within the next two decades. Symptomatic osteoarthritis is the indication for surgery in more than 90% of patients, and its incidence is increasing because of an ageing population and the obesity epidemic. Excellent functional outcomes are reported; however, careful patient selection is needed to achieve best possible results. The present economic situation in many developed countries will place increased pressure on containment of costs. Future demand for hip arthroplasty, especially in patients younger than 65 years, emphasises the need for objective outcome measures and joint registries that can track lifetime implant survivorship. New generations of bearing surfaces such as metal-on-metal, ceramic-on-ceramic, and metal-on-ceramic, and techniques such as resurfacing arthroplasty have the potential to improve outcomes and survivorship, but findings from prospective trials are needed to show efficacy. With the recall of some metal-on-metal bearings, new bearing surfaces have to be monitored carefully before they can be assumed to be better than traditional bearings.
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Affiliation(s)
- Robert Pivec
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
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29
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Werner BC, Brown TE. Instability after total hip arthroplasty. World J Orthop 2012; 3:122-30. [PMID: 22919568 PMCID: PMC3425631 DOI: 10.5312/wjo.v3.i8.122] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 07/01/2012] [Accepted: 08/07/2012] [Indexed: 02/06/2023] Open
Abstract
Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. Non-operative management is often successful if the components are well-fixed and correctly positioned in the absence of neurocognitive disorders. If conservative management fails, surgical options include revision of malpositioned components; exchange of modular components such as the femoral head and acetabular liner; bipolar arthroplasty; tripolar arthroplasty; use of a larger femoral head; use of a constrained liner; soft tissue reinforcement and advancement of the greater trochanter.
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30
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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
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31
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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
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32
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Carter AH, Sheehan EC, Mortazavi SMJ, Purtill JJ, Sharkey PF, Parvizi J. Revision for recurrent instability: what are the predictors of failure? J Arthroplasty 2011; 26:46-52. [PMID: 21550768 DOI: 10.1016/j.arth.2011.03.021] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 03/10/2011] [Indexed: 02/01/2023] Open
Abstract
Dislocation is a common complication following total hip arthroplasty (THA). In this study, we evaluated treatment strategies in patients undergoing revision THA for instability. A total of 156 hips in 154 patients underwent revision THA for instability between 2000 and 2007 at our institution. Demographic data and surgical treatment used were analyzed to determine risk factors for failure. Revision treatments included acetabular components in 100 hips, liner exchange in 56 hips, and femoral and acetabular components in 13 hips. Thirty-three (21.2%) had further dislocation. Isolated liner revision (P = .004), previous revision arthroplasty (P < .05), and the use of a 28-mm femoral head were associated with higher failure rates. A total of 20.3% (12/59) of constrained liners failed. Isolated liner exchange, history of revision, and use of a 28-mm head were associated with failure in revision THA for instability.
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Affiliation(s)
- Aaron H Carter
- Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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34
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Wong K, Sivan M, Matthews G. Flexion reminder device to discourage recurrent posterior dislocation of a total hip replacement: a case report. J Med Case Rep 2008; 2:250. [PMID: 18657276 PMCID: PMC2503994 DOI: 10.1186/1752-1947-2-250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Accepted: 07/25/2008] [Indexed: 11/26/2022] Open
Abstract
Introduction Recurrent dislocation of a total hip replacement prosthesis is a frustrating complication for both the surgeon and the patient. For positional dislocations with no indications for revision surgery, the current best treatment is physiotherapy, the use of abduction braces and avoidance of unsafe hip positions. Abduction braces can be cumbersome and have poor compliance. We report the successful use of a new lightweight flexion reminder device that can be used to treat people with this condition. Case presentation A 64-year-old British woman experienced recurrent positional posterior dislocation after primary hip replacement, particularly when involved in activities involving unsafe flexion of the operated hip. She disliked using an abduction brace and hence was given a simple 'flexion reminder device' that could be strapped to the thigh. Beyond the safe flexion limit, the padded top end of the device hitched against the groin crease and reminded her not to flex further, to avoid dislocation. She experienced no discomfort in wearing the device continuously throughout the day and was very satisfied. She has had no further dislocations in the 2 years since she began using it. Conclusion In cases of arthroplasty dislocation caused mainly by an unsafe hip position, and with no indication for revision surgery, this new lightweight and easily worn flexion reminder device may be a good option for avoiding such positional dislocations, particularly those caused by unsafe flexion.
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Affiliation(s)
- King Wong
- Department of Orthopaedics, Wycombe General Hospital, High Wycombe, Buckinghamshire, UK.
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35
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Abstract
BACKGROUND Dislocation is one of the most common complications of total hip arthroplasty with a reported dislocation rate of 3.2%. Despite increased experience with hip replacement, the overall rate has not yet changed. The aim of this paper is to review the most recent literature published on this topic and indexed in Medline, in order to clarify the main risk factors, and to standardize a treatment protocol of such an important complication of prosthetic surgery. MATERIALS AND METHODS Medline database was searched using key words: "hip dislocation", "hip instability" from 1980-2007. Studies were eligible for review and included if they met the following criteria: (1) publication in English, (2) clinical trials (3) review papers. RESULTS The risk of first-time dislocation as a function of time after the surgery is not well understood. Most, but not all, series have demonstrated that the risk of dislocation is highest during the first few months after hip arthroplasty; however, first-time late dislocation can also occur many years after the procedure. Several risk factors were described, including the surgical approach, the diameter of the head, impingement, component malposition, insufficient abductor musculature. In addition, there are also many treatment options, such as long-term bracing after closed reduction, component reorientation, capsulorraphy, trochanteric advancement, increasing offset, exchange of the modular head and the polyethylene liner, insertion of constrained liner. CONCLUSION Preventing hip dislocation is obviously the best strategy. Surgeons must take into account patient and surgical risk factors. For patients at high risk for dislocation the surgeon should accurately restore leg length and femoral offset; the use of larger femoral heads, posterior transosseous repair of the capsulotendinous envelope if posterior approach is chosen or the use of a lateral approach should be considered. Proper patient education and postoperative care are very important.
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Affiliation(s)
- F D'Angelo
- Department of Orthopedics and Traumatology, University of Insubria, Varese - Italy,Correspondence: Fabio D'Angelo, Department of Orthopedics and Traumatology, University of Insubria, Viale Borri 57, 21100 Varese, Italy. E-mail:
| | - L Murena
- Department of Orthopedics and Traumatology, University of Insubria, Varese - Italy
| | - G Zatti
- Department of Orthopedics and Traumatology, University of Insubria, Varese - Italy
| | - P Cherubino
- Department of Orthopedics and Traumatology, University of Insubria, Varese - Italy
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36
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Patel PD, Potts A, Froimson MI. The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty 2007; 22:86-90. [PMID: 17570285 DOI: 10.1016/j.arth.2006.12.111] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 12/24/2006] [Indexed: 02/01/2023] Open
Abstract
The dislocating hip is functionally impairing and leads to patient dissatisfaction. The etiology is multifactorial and may include component malpositioning, soft tissue laxity, and component or anatomical impingement. Initial treatment of dislocation usually consists of closed reduction followed by the use of an abduction pillow or brace or a knee immobilizer, although evidence to support these actions is limited. Operative intervention is generally reserved for patients with more than 2 dislocations and should aim to correct the cause of dislocation using a simple algorithm. Proper component positioning is key to prevention of further dislocation, but other tools include modular implants, jumbo heads, and increased offset. Finally, constrained acetabular components may be considered if a patient fails one of the above surgical options.
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Affiliation(s)
- Preetesh D Patel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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