1
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Smeeton M, Isaac G, Wilcox R, Anderson J, Board T, Van Citters DW, Williams S. A geometric assessment method for estimating dimensional change of retrieved dual mobility liners for total hip arthroplasty. Proc Inst Mech Eng H 2023:9544119231176112. [PMID: 37226516 DOI: 10.1177/09544119231176112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Despite their emerging use, the current understanding of the in-vivo functional mechanisms of Dual Mobility (DM) Total Hip Replacements (THRs) is poor, and current characterisation methodologies are not suitable for the unique function and design of these types of devices. Therefore, the aim of this study was to develop a geometric characterisation methodology to estimate dimensional change across the articulating surfaces of retrieved DM polyethylene liners so that their invivo function may be better understood. The method involves the acquisition of three-dimensional coordinate data from the internal and external surfaces of DM liners. The data is processed using a bespoke MATLAB script which approximates the unworn reference geometry of each surface, calculates geometric variance at each point and produces surface deviation heatmaps so that areas of wear and/or deformation may be visualised across the implant. One as-manufactured and five retrieved DM liners were assessed, which demonstrated the efficacy, repeatability and sensitivity of the developed method. This study describes an automated and non-destructive approach for assessing retrieved DM liners of any size and from any manufacturer, which may be used in future research to improve our understanding of their in-vivo function and failure mechanisms.
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Affiliation(s)
- Mackenzie Smeeton
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Graham Isaac
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Ruth Wilcox
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | | | - Tim Board
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Sophie Williams
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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2
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Ciolli G, Mesnard G, Deroche E, Gunst S, Batailler C, Servien E, Lustig S. Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Pers Med 2022; 13:jpm13010081. [PMID: 36675742 PMCID: PMC9867154 DOI: 10.3390/jpm13010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Instability is a common complication following total hip arthroplasty (THA). The dual mobility cup (DMC) allows a reduction in the dislocation rate. The goal of this systematic review was to clarify the different uses and outcomes according to the indications of the cemented DMC (C-DMC). Methods: A systematic review was performed using the keywords "Cemented Dual Mobility Cup" or "Cemented Tripolar Cup" without a publication year limit. Of the 465 studies identified, only 56 were eligible for the study. Results: The overall number of C-DMC was 3452 in 3426 patients. The mean follow-up was 45.9 months (range 12-98.4). In most of the cases (74.5%) C-DMC was used in a revision setting. In 57.5% DMC was cemented directly into the bone, in 39.6% into an acetabular reinforcement and in 3.2% into a pre-existing cup. The overall dislocation rate was 2.9%. The most frequent postoperative complications were periprosthetic infections (2%); aseptic loosening (1.1%) and mechanical failure (0.5%). The overall revision rate was 4.4%. The average survival rate of C-DMC at the last follow-up was 93.5%. Conclusions: C-DMC represents an effective treatment option to limit the risk of dislocations and complications for both primary and revision surgery. C-DMC has good clinical outcomes and a low complication rate.
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Affiliation(s)
- Gianluca Ciolli
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Sacred Heart Catholic University, 00168 Rome, Italy
| | - Guillaume Mesnard
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Correspondence:
| | - Etienne Deroche
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Stanislas Gunst
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- LIBM—EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69622 Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
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3
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Chisari E, Ashley B, Sutton R, Largoza G, Di Spagna M, Goyal N, Courtney PM, Parvizi J. Dual-Mobility Implants and Constrained Liners in Revision Total Hip Arthroplasty. Arthroplast Today 2022; 13:8-12. [PMID: 34934792 PMCID: PMC8661104 DOI: 10.1016/j.artd.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 09/15/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Instability remains the most common complication after revision total hip arthroplasty (THA). The purpose of this study was to determine whether there was a difference in aseptic revision rates and survivorship between dual-mobility (DM) and constrained liners (CL) in revision THA. METHODS We reviewed a consecutive series of 2432 revision THA patients from 2008 to 2019 at our institution and identified all patients who received either a CL or DM bearing. We compared demographics, comorbidities, indications, dislocations, and aseptic failure rates between the two groups. Bivariate and multivariate regression analyses were used to determine risk factors for failure, and a Kaplan-Meier survivorship analysis was performed with an aseptic re-revision as the endpoint. RESULTS Of the 191 patients, 139 (72%) received a DM bearing, and 52 (28%) had a CL. At a mean follow-up of 14.3 months, there was no statistically significant difference in rates of dislocation (10.4% vs 14.0%, P = .667), aseptic revision (30.9% vs 46.2%, P = .073), or time to revision (3.78 vs 6 months, P = .565) between the two groups. The multivariate analysis revealed CL had no difference in aseptic re-revision rates when compared with DM (odds ratio 1.47, 95% confidence interval 0.84-2.52, P = .177). The survivorship analysis found no difference in aseptic failure between the groups at 12 months (P = .059). CONCLUSION Both CL and DM bearings have high aseptic failure rates at intermediate term follow-up after revision THA. CL did show a higher risk of failure than DM bearings, but it was not statistically significant with the numbers available for this study. Further prospective studies are needed to determine the optimal treatment for recurrent instability.
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Affiliation(s)
- Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Blair Ashley
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Garrett Largoza
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marco Di Spagna
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nitin Goyal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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4
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Pai FY, Ma HH, Chou TFA, Huang TW, Huang KC, Tsai SW, Chen CF, Chen WM. Risk factors and modes of failure in the modern dual mobility implant. A systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:541. [PMID: 34126990 PMCID: PMC8204435 DOI: 10.1186/s12891-021-04404-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background The aims of this meta-analysis were to: (1) validate the outcome of modern dual mobility (DM) designs in patients who had undergone primary and revision total hip arthroplasty (THA) procedures and (2) to identify factors that affect the outcome. Methods We searched for studies that assessed the outcome of modern DM-THA in primary and revision procedures that were conducted between January, 2000 to August, 2020 on PubMed, MEDLINE, Cochrane Reviews and Embase. The pooled incidence of the most common failure modes and patient reported outcomes were evaluated in patients who have received: (1) primary THA, (2) revision THA for all causes or (3) for recurrent dislocation. A meta-regression analysis was performed for each parameter to determine the association with the outcome. The study design of each study was assessed for potential bias and flaws by using the quality assessment tool for case series studies. Results A total of 119 studies (N= 30016 DM-THAs) were included for analysis. The mean follow-up duration was 47.3 months. The overall implant failure rate was 4.2% (primary: 2.3%, revision for all causes: 5.5%, recurrent dislocation: 6.0%). The most common failure modes were aseptic loosening (primary: 0.9%, revision for all causes: 2.2%, recurrent dislocation: 2.4%), septic loosening (primary:0.8%, revision for all causes: 2.3%, recurrent dislocation: 2.5%), extra-articular dislocation (primary:0.6%, revision for all causes:1.3%, recurrent dislocation:2.5%), intra-prosthetic dislocation (primary:0.8%, revision for all causes:1.0%, recurrent dislocation:1.6%) and periprosthetic fracture (primary:0.9%, revision for all causes:0.9%, recurrent dislocation:1.3%). The multi-regression analysis identified younger age (β=-0.04, 95% CI -0.07 – -0.02) and female patients (β=3.34, 95% CI 0.91–5.78) were correlated with higher implant failure rate. Age, gender, posterolateral approach and body mass index (BMI) were not risk factors for extra-articular or intra-prosthetic dislocation in this cohort. The overall Harris hip score and Merle d’Aubigné score were 84.87 and 16.36, respectively. Level of evidence of this meta-analysis was IV. Conclusion Modern dual-mobility designs provide satisfactory mid-term implant survival and clinical performance. Younger age and female patients might impact the outcome after DM-THA. Future research directions should focus on, (1) long-term outcome of modern dual-mobility design, including specific concerns such as intra-prosthetic dislocation and elevated metal ion, and (2) cost-effectiveness analysis of dual-mobility implant as an alternative to conventional THA for patients who are at high risk of dislocation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04404-4.
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Affiliation(s)
- Fu-Yuan Pai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsan-Wen Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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5
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Giacomo P, Giulia B, Valerio P, Vincenzo S, Pierluigi A. Dual mobility for total hip arthroplasty revision surgery: A systematic review and metanalysis. SICOT J 2021; 7:18. [PMID: 33749588 PMCID: PMC7984151 DOI: 10.1051/sicotj/2021015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Revision THA (R-THA) is thought to have a higher complication rate if compared to primary THA. Dual Mobility (DM) implants have been designed aiming for achieving greater stability, with good clinical results. However, scarce material can be found about the real improvements provided by this type of implant compared to traditional implant in Revisions of Total Hip Arthroplasties. METHODS A systematic review and meta-analysis of comparative studies were performed in December 2019. This was in accordance with the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Our primary outcome measure was overall survivorship and dislocation rate, either treated with a conservative method or requiring surgery. RESULTS Regarding the overall implant survival, we found a slight significant risk ratio, with a statistically meaningful difference between the two groups in questions in favour of the DM implant. A statistically significant difference in favour of the DM group turned out considering only the Dislocation rate Risk ratio and the aseptic loosening risk as well. No statistical difference was found between the two groups about the risk ratio of infection. DISCUSSION A steady increase of evidence is demonstrating the efficacy of using a DM cup system in THA revisions with low dislocation rates, but currently there is no study in the literature that demonstrates with statistically significant evidence. The main finding of the present study is that implant's Survivor and prevention of dislocation at medium follow-up showed better results with a DM if compared to a fixed-bearing cup, for Revision THA.
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Affiliation(s)
- Placella Giacomo
- Hospital San Raffaele - Orthopaedic Department, Milan 20132, Italy
| | | | - Pace Valerio
- Università degli Studi di Perugia, Perugia 06123, Italy
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6
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Nessler JM, Nessler JP. The Patient With Chronic Total Hip Arthroplasty Dislocations: A Case Series of Five Patients Who Underwent Revision THA Using Polypropylene Mesh for Capsular Reconstruction. Arthroplast Today 2020; 6:655-661. [PMID: 32875015 PMCID: PMC7451887 DOI: 10.1016/j.artd.2020.07.031] [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: 05/18/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 11/18/2022] Open
Abstract
We report a case series of 5 patients who underwent revision total hip arthroplasty (THA) using a polypropylene mesh for capsular reconstruction for chronic THA instability. The average follow-up is 16.6 months (range, 9-20 months). There were no postoperative dislocations in our series. Three patients had previous infections with two-stage revisions before final revision surgery and were infection free at their most recent follow-up. One patient developed a prosthetic joint infection 2 months postoperatively. The use of a polypropylene mesh appears to be another tool that surgeons can use when dealing with the difficult dilemma on how to treat the patient with chronic THA instability and severe abductor and capsular tissue loss.
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Affiliation(s)
- Joseph M. Nessler
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA
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7
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Vajapey SP, Fideler KL, Lynch D, Li M. Use of dual mobility components in total hip arthroplasty: Indications and outcomes. J Clin Orthop Trauma 2020; 11:S760-S765. [PMID: 32999552 PMCID: PMC7503159 DOI: 10.1016/j.jcot.2020.07.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022] Open
Abstract
Instability after total hip arthroplasty (THA) can be a problematic complication and remains one of the leading causes of revision surgery in the early post-operative period. Dual mobility (DM) implants decrease dislocation risk after THA but they come with their own set of complications. Selective use of DM implants for THA in high risk groups can confer the advantages of this construct while mitigating the risks. In this paper, we review the current literature to examine the evidence for or against use of DM implants in various clinical scenarios and provide an algorithm for when to consider using DM design construct in THA.
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Affiliation(s)
- Sravya P. Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Kathryn L. Fideler
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Daniel Lynch
- School of Medicine, The Ohio State University Wexner Medical Center, United States
| | - Mengnai Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States,Corresponding author. Adult Reconstructive Surgery, Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall Columbus, Ohio, 43210, United States.
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8
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Chouteau J, Rollier JC, Bonnin MP, Saffarini M, Nover L, Chatelet JC, Jacquot L. Absence of instabilities and intra-prosthetic dislocations at 7 to 11 years following THA using a fourth-generation cementless dual mobility acetabular cup. J Exp Orthop 2020; 7:51. [PMID: 32661747 PMCID: PMC7359208 DOI: 10.1186/s40634-020-00265-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/16/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Dual-mobility (DM) cups are increasingly used in total hip arthroplasty (THA) but there lacks literature on their long-term results. We aimed to investigate outcomes of a fourth-generation cementless DM acetabular cup at 7-11 years. METHODS We retrospectively evaluated 240 consecutive hips that received cementless THA using the same dual mobility cup (Novae Sunfit TH) and femoral stem (Corail). Patients were recalled at ≥7 years to collect Oxford hip scores (OHS), Harris hip scores (HHS), and inspect for radiolucent lines and granulomas. Multi-variable analyses were performed to determine whether HHS or OHS were associated with pre- or intra-operative variables. RESULTS At 8.4 ± 0.8 years (range, 7-11), 6 hips were revised (2.5%), 54 deceased (22.5%), and 14 could not be reached (5.8%). Four revisions (2 cup+stem, 2 liners only) were due to sepsis (1.7%), one (cup and stem) for trauma (0.4%), and one (stem) due to aseptic loosening (0.4%). For the remaining 166 hips, HHS was 83.6 ± 13.2 and OHS was 20.3 ± 6.7. Multi-variable analysis confirmed that HHS (β = - 0.38; p = 0.039) and OHS (β = 0.36; p < 0.001) worsened with age, and that OHS was worse for Charnley C patients (β = 3.17; p = 0.009). Neither granulomas nor radiolucenies were observed around any cups, but radiolucenies were seen around 25 stems (20.3%). CONCLUSIONS This fourth-generation DM cup demonstrated satisfactory outcomes at 7-11 years, with no instabilities or cup revisions due to aseptic loosening. Better OHS was observed for younger patients and those presenting higher Charnley grade. LEVEL OF EVIDENCE Level IV, retrospective case study.
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Affiliation(s)
- Julien Chouteau
- Artro Group Institute, Lyon, France.,Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Jean-Charles Rollier
- Artro Group Institute, Lyon, France.,Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Michel P Bonnin
- Artro Group Institute, Lyon, France.,Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | | | | | - Jean-Christophe Chatelet
- Artro Group Institute, Lyon, France.,Centre de Chirurgie Orthopédique du Beaujolais, Ramsay Santé, Arnas, France
| | - Laurent Jacquot
- Artro Group Institute, Lyon, France.,Clinique d'Argonay, Ramsay Santé, Annecy, France
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9
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Di Martino A, Geraci G, Stefanini N, Perna F, Mazzotti A, Ruffilli A, Faldini C. Surgical repair for abductor lesion after revision total hip arthroplasty: a systematic review. Hip Int 2020; 30:380-390. [PMID: 31777283 DOI: 10.1177/1120700019888863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abductor mechanism lesions represent a severe complication after revision total hip arthroplasty (rTHA). The resulting abductor insufficiency can cause limping, pain, instability, and a higher rate of failure, thus requiring further revision surgery. In case of severe degeneration and retraction of the abductor mechanism, several different surgical treatments are needed. AIM To systematically review all studies reporting on surgical treatment of severe abductor lesion after rTHA, focusing on surgical techniques, and clinical and functional results. METHOD Scientific databases were accessed in December 2018 to identify studies addressing the surgical management of severe abductor disruption after rTHA. The PRISMA guidelines were followed. Data were extracted from the identified articles and summarised. Only data about patients with symptoms of abductor insufficiency after rTHA were included in the database. RESULTS 9 retrospective studies were included, all being retrospective case series reporting on a total of 92 patients. Several surgical strategies have been described and performed: a repair using a synthetic mesh was reported in 1 study; 2 studies reported on local muscle transfer (gluteus maximus transfer or advancement); vastus lateralis advancement was described in 4 studies while in 2 studies the injury was repaired with the use of an allograft. Overall positive results have been reported in terms of pain reduction, while poor to mild functional scores with persistent limping have often been observed in the postoperative period. CONCLUSIONS The short follow-up time of the reviewed studies is inadequate to uncover any late dislocation, implant failure or different complications related to abductor mechanism reconstruction.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy.,Sidney Kimmel Medical College of Thomas Jefferson University (SKMC), Philadelphia, PA, USA
| | - Giuseppe Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Niccolò Stefanini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Fabrizio Perna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
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10
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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.
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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
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11
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Schmidt A, Batailler C, Fary C, Servien E, Lustig S. Dual Mobility Cups in Revision Total Hip Arthroplasty: Efficient Strategy to Decrease Dislocation Risk. J Arthroplasty 2020; 35:500-507. [PMID: 31563399 DOI: 10.1016/j.arth.2019.08.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) is a challenging surgery with a higher rate of complications than primary arthroplasty, particularly instability and aseptic loosening. The purpose of this study is to compare dual mobility cup (DMC) and standard mobility cup (SMC) in all rTHAs performed at our institution over a decade with a 1 year minimum follow-up. METHODS Two hundred ninety-five rTHAs (acetabular only and bipolar revisions) between 2006 and 2016 were retrospectively reviewed. These were divided into those with a DMC (184 revisions) or SMC (111 revisions). Dislocation and complications requiring re-revision were reported. RESULTS The rTHA mean age was 69 years ± 13.9 (19-92) and the mean follow-up was 2.3 years. Dislocation risk was statistically lower (P = .01) with a DMC (3.8%; 7/184) than with an SMC (13.5%; 15/111). DMC required re-rTHA in 24/184 (13%) for any reason compared to SMC in 19/111 (17.1%) (P = .34). There was no significant difference in early aseptic loosening (P = .28) between the 2 groups. For young patients (≤55 years), results were similar with a lower dislocation rate in the DMC group (P = .24) and no increased risk of early aseptic loosening (P = .49). CONCLUSION This study demonstrates that for all rTHA indications DMC compared to SMC has a significantly decreased risk of postoperative dislocation without risk of early aseptic loosening at medium term follow-up. The use of DMC in rTHA is an important consideration particularly with the predicted increased incidence of both primary and revision THA globally.
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Affiliation(s)
- Axel Schmidt
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
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Dikmen G, Ozden VE, Karaytug K, Tozun R. Dual-mobility cups in revision acetabular reconstructions: Short-term outcomes in high-risk patients for instability. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:329-333. [PMID: 31281078 PMCID: PMC6819842 DOI: 10.1016/j.aott.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 04/25/2019] [Accepted: 05/24/2019] [Indexed: 02/07/2023]
Abstract
Objective The aim of this study was to evaluate the performance of dual-mobility (DM) cup systems for revision total hip arthroplasty (rTHA) in patients who had high risk for instability. Methods We prospectively followed up 34 hips of 30 patients (27 females, 3 males; mean age: 66.1 (range: 33 to 89) years) who underwent rTHA with DM cups for aseptic loosening in 23 hips, infection treatment as second or single stage in nine hips, and instability in two hips. Clinical functions of the patients were evaluated using the Harris Hip Score (HHS), and radiological migration or loosening of the DM cups were recorded. The survival of the components was calculated with the Kaplan-Meier survival analysis and failure was defined as any dislocation of the polyethylene (PE) insert, intraprosthetic dislocation (IPD), aseptic loosening of any component or total hip system revision due to any reason. Results The mean duration of follow-up was 3.52 (range: 2.05 to 6.26) years. There was one dislocation of PE insert (2.9%), which was treated with closed reduction. There were two (5.8%) re-revisions for cemented DM cup due to migration. There was one PE insert and head change due to subacute infection. The mean HHS increased from 42.8 ± 6.7 (range: 34 to 60) points preoperatively to 87.3 ± 5.8 (range: 75 to 98) points postoperatively. The cumulative survival rate of the DM cup system was 91.2% (95% CI: 81.6–100%) with any revision, 94.1% (95% CI: 86.2–100%) with aseptic loosening and %97.1 (%95 CI: 91.4–100%) with dislocation as the end point at 3.5 years. Conclusion Dual-mobility cups may provide good stability and represent a good option for revision acetabular reconstruction in patients who have high risk for instability. Level of evidence Level IV, therapeutic study.
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