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Wilson JM, Mika A, Martin JR. Removing Cemented Dual Mobility Liners From Acetabular Components: A Technical Tip for a Challenging Surgical Problem. Arthroplast Today 2023; 23:101211. [PMID: 37781023 PMCID: PMC10541465 DOI: 10.1016/j.artd.2023.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/11/2023] [Accepted: 08/01/2023] [Indexed: 10/03/2023] Open
Abstract
Dislocation remains the leading cause of failure following revision total hip arthroplasty. Dual mobility (DM) constructs, including monoblock cups designed for cementation, reduce but do not eliminate this risk. Cemented DM constructs offer several unique advantages in revision total hip arthroplasty, and as such, they have gained popularity. Despite their advantages, a portion of these implants will require revision for infection or recurrent dislocation. Removal of a cemented DM cup presents numerous challenges, and there is no effective published technique. Here, we present an effective technique for the safe removal of one design of cemented DM cup.
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Affiliation(s)
- Jacob M. Wilson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aleksander Mika
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J. Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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2
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Shichman I, Habibi AA, Robin JX, Gemayel AC, Lowe DT, Schwarzkopf R. Cementing a Monoblock Dual-Mobility Implant into a Fully Porous Cup in Revision Total Hip Arthroplasty to Address Hip Instability: Surgical Technique. JBJS Essent Surg Tech 2023; 13:e22.00058. [PMID: 38357466 PMCID: PMC10863941 DOI: 10.2106/jbjs.st.22.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background The use of a cemented monoblock dual-mobility implant into a fully porous cup is indicated for patients with acetabular bone loss who have a high risk of postoperative hip instability. Patients undergoing lumbar fusion for sagittal spinal deformities have an increased risk of hip dislocation (7.1%) and should be assessed on sitting and standing radiographs1. Gabor et al. conducted a multicenter, retrospective study assessing the use of a cemented monoblock dual-mobility bearing in a porous acetabular shell in patients with acetabular bone loss and a high risk of hip instability2. Of the 38 patients, 1 (2.6%) experienced a postoperative dislocation that was subsequently treated with closed reduction without further dislocation. This surgical technique represents a favorable surgical option for patients with acetabular bone loss who are at risk for hip instability. In the example case described in the present video article, the patients had a history of dislocations, lumbar fusion, and evidence of Paprosky 3B acetabular defect; as such, the decision was made to revise to a porous shell and cement a monoblock dual-mobility implant. Description With use of the surgeon's preferred approach, the soft tissue is dissected and the hip is aspirated. The hip is dislocated and a subgluteal pocket is made with use of electrocautery to mobilize the trunnion of the femoral stem to aid in acetabular exposure. The femoral component is assessed to ensure appropriate positioning with adequate anteversion. The acetabular component and any acetabular screws are removed. A "ream to fit" technique is performed in the acetabulum until bleeding bone is encountered, with minimal reaming performed in healthy bone from the posterior column. A trial prosthesis is placed within the acetabulum to evaluate if there is satisfactory fixation and if any augment is necessary. Care must be taken during reaming to ensure that enough bone is reamed to accommodate a porous shell that can fit the monoblock dual-mobility implant with a 2-mm cement mantle. Smaller porous shells measuring 56 mm are available for smaller defects but are often not utilized in cases of substantial acetabular bone loss. Fresh-frozen cancellous allograft is utilized to fill any contained defects. The revision porous shell with circumferential screw holes is utilized to allow for screw fixation posterosuperior and anterior toward the pubis. The implants are dried prior to placement of the cement. The cement is applied to the shell and the monoblock dual-mobility implant to ensure adequate coverage. Antibiotic-loaded cement can be utilized according to surgeon preference. Excess cement is removed under direct visualization while the cement is drying, and the position of the dual-mobility implant is adjusted in approximately 20° anteversion and 40° inclination. Stability is assessed after the cement cures, and intraoperative radiography can be performed to confirm cup positioning prior to closure. Any remaining capsule is closed, followed by closure of the remaining soft tissue in a layered fashion. Alternatives A fully porous multi-hole jumbo cup with conventional polyethylene liner and femoral head can be utilized to increase the jump distance of the femoral head. Constrained, lipped, or offset polyethylene liners can be utilized if the shell is well fixed and a dual-mobility implant cannot be inserted. A cemented dual-mobility implant can be utilized in a well-fixed acetabular shell without evidence of loosening or osteolysis. Rationale Dual-mobility implants have become increasingly utilized because of their advantages: (1) ability to decrease dislocation rate without increasing constraint and (2) increasing range of motion with reduced impingement risk2-8. These implants are particularly useful in the setting of revision cases with large acetabular bone defects. In a study of 76 patients with dual-mobility implants cemented into porous acetabular shells, Muthusamy et al. found that only 3.3% of patients experienced postoperative dislocations9. Moreover, acetabular cup survival was excellent, with 100% survival at 1 year and 96.2% at 2 years. Expected Outcomes The use of a dual-mobility implant is a viable treatment option in cases of revision total hip arthroplasty, particularly those in which postoperative stability is a concern; monoblock dual-mobility implants cemented into porous shells are particularly useful in this setting2-8. These trends are similarly seen in patients treated with monoblock dual-mobility implants cemented into porous shells. Muthusamy et al. evaluated the use of this construct to treat instability or risk of hip dislocation in 76 hips, reporting a dislocation rate of 3.3% at 2 years. Additionally, the authors reported rates of all-cause acetabular survival from re-revision of 96.7% at 6 months, 93.3% at 1 year, and 89.7% at 2 years9. Physicians should be aware of the possibility for intra-prosthetic dislocations, as although this complication is rare, it has been reported in the literature7,10. Important Tips In order to allow for circumferential coverage for fixation and ingrowth potential in cases with acetabular defects, the shell is typically impacted slightly vertical (45° to 50° of inclination) and in neutral version (0° to 5° of anteversion). Positioning can be adjusted to improve osseous contact and ingrowth as determined by the size and shape of the defect.The use of a drill guide for the locking screws allows limited degrees of variable screw angulation. In the revision setting, longer screws may be placed posterosuperior toward the sciatic notch or anteroinferior into the pubis. Surgeons should be aware of the anatomy and should predrill holes to reduce the risk of injury to surrounding neurovascular structures such as the obturator artery anteriorly.Any screw holes that are not filled should be covered with plastic hole covers in order to prevent cement from migrating behind the cup. Implants should be dried prior to the placement of the cement, and the cement should be applied to the shell and the dual-mobility implant to ensure adequate coverage.Utilize a monoblock dual-mobility implant that is designed for cementation in order to avoid implant dissociation from the acetabular shell.Remove all fibrous tissue that may hinder bony integration.Assess for pelvis discontinuity; pelvis discontinuity and acetabular bone loss are risk factors in the setting of any revision and should be properly assessed preoperatively and intraoperatively and managed accordingly.Avoid over-reaming and damage of the posterior column.Utilize a reamer or trial to assess defect size and need for augments.Place a compression screw where the cup is in contact with the bone in order to avoid tilting.Cover unused screw holes. Acronyms and Abbreviations THA = total hip arthroplastyS/P = status postTKA = total knee arthroplastyCT = computed tomographyKM = Kaplan MeierDMC = dual-mobility cupPE = polyethylene.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
- Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Akram A. Habibi
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Joseph X. Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Dylan T. Lowe
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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van den Broek M, Govaers K. Total Hip Arthroplasty with Cemented Dual Mobility Cup into a Fully Porous Multihole Cup with Variable Angle Locking Screws for Acetabular Fractures in the Frail Elderly. Hip Pelvis 2023; 35:54-61. [PMID: 36937212 PMCID: PMC10020729 DOI: 10.5371/hp.2023.35.1.54] [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: 09/18/2022] [Revised: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 03/21/2023] Open
Abstract
Purpose The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.
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Affiliation(s)
| | - Kris Govaers
- Department of Orthopaedic Surgery, az Sint-Blasius, Dendermonde, Belgium
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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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Nabet A, Sax OC, Nace J, Delanois RE, Peroutka RM. Liner Dissociation and Acetabular Erosion Treated by Implant Retention and Dual-Mobility Liner Cementation: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00025. [PMID: 35977042 DOI: 10.2106/jbjs.cc.22.00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 56-year-old woman underwent a left total hip arthroplasty (THA) after developing avascular necrosis after chemotherapeutic treatment of breast cancer. She presented approximately 2 years after index THA with left groin pain and complaints of instability. Imaging revealed pseudodislocation of the ceramic femoral head with erosion through the acetabular component. Intraoperative evaluation revealed a dissociated polyethylene liner, damaged acetabular locking mechanism, metallosis, and well-fixed and aligned components. Treatment consisted of component retention, bone grafting, and dual-mobility liner cementation into the acetabular component. CONCLUSIONS The two-year follow-up demonstrated a pain-free, well-functioning hip, bone graft incorporation, and no evidence of loosening.
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Affiliation(s)
- Austin Nabet
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Tucker K, Günther KP, Kjaersgaard-Andersen P, Lützner J, Kretzer JP, Nelissen RGHH, Lange T, Zagra L. EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty. EFORT Open Rev 2021; 6:982-1005. [PMID: 34909220 PMCID: PMC8631244 DOI: 10.1302/2058-5241.6.210080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended. Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced). Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty. Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately. Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake. Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results. Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures.
Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080
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Affiliation(s)
- Keith Tucker
- Orthopaedic Data Evaluation Panel (ODEP), Norwich, UK
| | - Klaus-Peter Günther
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | | | - Jörg Lützner
- University Centre of Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands
| | - Toni Lange
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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7
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Bellova P, Koch F, Stiehler M, Hartmann A, Fritzsche H, Günther KP, Goronzy J. Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty? BMC Musculoskelet Disord 2021; 22:982. [PMID: 34819056 PMCID: PMC8613958 DOI: 10.1186/s12891-021-04835-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The "cup-in-cup" technique allows for revision of failed total hip arthroplasty (THA) when the cementless cup is well fixed. Furthermore, it can be used for liner wear or mechanical failure where liner replacement may be impossible or impractical. Recently, the "cup-in-cup" technique in combination with dual mobility cups (DMC) has drawn increased attention. Our aim was to report on the clinical and radiographic outcomes following this surgery. METHODS From 2015 to 2020, 33 patients treated with the DMC- "cup in cup" technique were retrospectively reviewed. Fourteen patients had died while 19 were available for the final follow-up (FU), of which 15 underwent both a radiograph and a FU visit, 2 underwent a radiograph only and 2 underwent a telephone interview only. Patient-related outcome measures included the HHS and the WOMAC. Radiographs were assessed for implant loosening and positioning. Primary endpoint was revision of any cause and secondary endpoint was loosening of the DMC at the latest FU. The survival analysis was conducted using the Kaplan-Meier method. RESULTS The mean age at surgery was 78.6 ± 7.1 (63-93) years and the mean surgery duration was 124.4 ± 52.0 (60-245) minutes. Recurrent dislocation (42.4%), periprosthetic fracture (39.4%) and polyethylene wear (6.1%) were the most frequent reasons for surgery. The mean FU duration (n = 19) was 28.5 ± 17.3 (3-64) months. The mean HHS score at FU was 59.4 ± 22.2 (29-91) and the mean WOMAC score was 59.7 ± 25.6 (15.6-93.8). Two cups were revised due to instability and one revision was performed due to periprosthetic joint infection, accounting for an overall cup survival rate of 86.8% after a mean FU of 22.9 ± 18.0 (1.5-64.6) months. The survival rate free of loosening was 90.9% after a mean FU of 22.3 ± 18.5 (1.5-64.7) months. CONCLUSIONS We found that the cementation of a DMC in a well-fixed cup is a promising short- to mid-term treatment addressing THA instability especially in elderly and frail patients, who benefit from a reduced operation time. Proper cementation technique, adequate cup positioning as well as selection of a sufficiently large DMC are crucial for treatment success. Longer FUs will be needed in the future in order to further prove the benefit of this technique.
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Affiliation(s)
- Petri Bellova
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Fiona Koch
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Maik Stiehler
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Albrecht Hartmann
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Hagen Fritzsche
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Klaus-Peter Günther
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jens Goronzy
- Klinik für Orthopädie, Unfall- und Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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8
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Greenberg A, Nocon A, De Martino I, Mayman DJ, Sculco TP, Sculco PK. Serum Metal Ions in Contemporary Monoblock and Modular Dual Mobility Articulations. Arthroplast Today 2021; 12:51-56. [PMID: 34761094 PMCID: PMC8567330 DOI: 10.1016/j.artd.2021.08.021] [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: 08/15/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Questions exist about the release of cobalt and chromium ions from dual mobility (DM) cups. Modular implants, with potential backside wear between the cobalt-chromium liner and titanium cup, are of particular concern. This study compares the metal ion profile of patients with contemporary monoblock and modular DM articulations from two commonly used designs. Methods Cobalt and chromium serum levels were measured one year after surgery in a prospective cohort of patients undergoing total hip arthroplasty with a DM construct. Ion levels were detected above 1 μg/L. Clinical and surgical data were correlated with the ion levels for analysis. Results Overall, 29% of the patients had levels above 1 μg/L of either ion. More patients with modular cups had detectable ions than patients with monoblock cups (39% vs 20%, P = .05). Cobalt was more commonly detected in the monoblock group, and chromium was more commonly detected in the modular group (P = .05). There were no differences in the actual ion levels between the groups (1.35 μg/L vs 1.64 μg/L, P = .44, for cobalt and 1.35 μg/L vs 1.31 μg/L, P = .77, for chromium). No patient underwent revision during the follow-up period. Conclusions We found similar cobalt and chromium levels in patients with monoblock and modular DM cups. More patients in the modular group had detectable ions. Cobalt was more frequently detected in the monoblock group. These results suggest that both implants are performing well in the short term, but further follow-up is needed to determine whether the differences found are of clinical significance.
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Affiliation(s)
- Alexander Greenberg
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Hadassah Mount Scopus Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Allina Nocon
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Ivan De Martino
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA.,Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Roma, Italy
| | - David J Mayman
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Thomas P Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
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9
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Wang PH, Tsai SW, Chen CF, Wu PK, Chen CM, Chang MC, Chen WM. Cementation of the highly cross-linked polyethylene liner into a well-fixed acetabular shell to treat patients with recurrent dislocation after total hip arthroplasty. Artif Organs 2020; 45:E136-E145. [PMID: 33277711 DOI: 10.1111/aor.13852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 10/22/2020] [Indexed: 01/02/2023]
Abstract
Cementation of a highly cross-linked polyethylene liner into a well-fixed acetabular shell provided a good durability for liner wear. However, its efficacy in treating recurrent instability due to malposition cup is less reported. The aim of this study is to evaluate the outcome of this surgical technique to treat hip instability. From 2009 to 2019, we have identified 38 patients who had been surgically treated for recurrent instability, including cementation liner (N = 20) and revision cup (N = 18) procedures. Patients were followed for a mean of 45.66 months. We have recorded and analyzed all causes of implant failure including recurrent instability. Clinical outcomes were assessed including complication and Harris Hip Score (HHS) preoperatively and at the latest follow-up. Revision-free survivorship for any cause was 95.0% at 1 year, and 84.4% at 5 years in cementation liner group and 88.9% at 1 year and 5 years in revision cup group. Mean Harris hip score improved from 48.3 points preoperatively to 79.5 points at the last follow-up in cementation liner group and mean HHS improved from 43.3 points preoperatively to 77.2 points in revision cup group. There were two implant failures in each group, including one is due to persistent hip instability and the other is due to periprosthetic joint infection in the cementation liner group and two implant failure are due to persistent hip instability in the revision cup group. Functional scores and implant survival were similar in both groups. We demonstrated that orientation correction via the cementation of the polyethylene liner into well-fixed acetabular shell is a promising option to treat and prevent instability. Level of Evidence: Therapeutic Level IV.
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Affiliation(s)
- Pai-Han Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chao-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Thirty-Day Readmissions After Aseptic Revision Total Hip Arthroplasty: Rates, Predictors, and Reasons Vary by Surgical Indication. J Arthroplasty 2020; 35:3673-3678. [PMID: 32684401 DOI: 10.1016/j.arth.2020.06.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/01/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) is performed for different surgical indications. With increasing attention being focused to minimize readmission risk, the National Surgical Quality Improvement Program (NSQIP) was used to assess 30-day readmissions after rTHA for 3 aseptic indications. METHODS Patients undergoing rTHA were identified in the 2013-2017 NSQIP and classified as being performed for osteolysis/aseptic loosening, recurrent dislocation, or periprosthetic fracture. Rates and predictors of 30-day readmission were determined by indication. Reasons for readmission were also assessed as being either related or unrelated to the surgical site. RESULTS Of 6104 patients meeting inclusion criteria, osteolysis/aseptic loosening represented 46% of the revisions (readmission rate: 6.2%), recurrent dislocation represented 33.2% (readmission rate: 10.9%), and periprosthetic fractures represented 20.9% (readmission rate: 9.3%). These readmission rates represented statistically significant variation across the 3 indications (P < .0001). On multivariate analysis, demographic, procedural, and postoperative predictors of readmission varied by indication. The osteolysis/aseptic loosening and periprosthetic fracture cohorts had surgical site-related readmissions in 43.9% and 42.4% of readmitted cases, respectively. On the contrary, readmissions after rTHA performed for recurrent dislocation were mostly surgical site-related (63.3%) and driven primarily by a postoperative dislocation. Further multivariate analysis showed that the rTHA indication of recurrent dislocation itself was the strongest predictor (odds ratio, 3.34; P < .0001) of a postoperative dislocation leading to a 30-day readmission. CONCLUSION Thirty-day readmissions varied from 6.2% to 10.9% based on surgical indication for aseptic rTHA. Reasons for readmission also differed across the 3 cohorts. These findings may aid postoperative care pathways and protocol optimization.
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