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Lee A, Arthur J, Najdawi J, Durst CR, Rajaee SS, Spitzer AI. No Decrease in Early Survivorship of Dual Mobility Implants in Primary Total Hip Arthroplasty. Arthroplast Today 2024; 28:101452. [PMID: 39071094 PMCID: PMC11282969 DOI: 10.1016/j.artd.2024.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 07/30/2024] Open
Abstract
Background Dual mobility (DM) implants in primary total hip arthroplasty (THA) have gained recent popularity; however, safety concerns persist. The purpose of this study was twofold: 1) assess trends in DM implant adoption; and 2) evaluate the impact of modular DM implants on dislocation and all-cause revision rates at short-term follow-up. Methods This retrospective study identified patients in our institutional arthroplasty database who underwent primary posterior approach THA for degenerative conditions from November 2013 to December 2020. Patients undergoing primary THA for fracture were excluded. Patients were divided into two cohorts: modular DM and non-DM implants. Annual DM utilization and dislocation rates were recorded. Patient records were reviewed to determine implant selection and identify indications for dislocations and reoperations. Results Institutional adoption was rapid, increasing from 3.4% in 2013 to 47.1% in 2020. Of the 4548 primary THA cases from 2013 to 2020, 2859 (62.9%) had minimum one-year follow-up data for inclusion. There were 724 (25.3%) with DM implants and 2135 (74.7%) with non-DM implants. The DM group had a significantly lower dislocation rate (0.14% vs 0.84%, P = .04), with similar all-cause revision rates (2.49% vs 2.72%, P = .74) at one-year follow-up. No cases of DM-specific complications (metallosis or intraprosthetic dislocations) were noted. Conclusions From 2013 to 2020, DM implant utilization in primary THA steadily increased. Use of modular DM implants is associated with a decreased dislocation rate without compromised survivorship at one-year follow-up when compared to non-DM implants. No instances of modular DM-specific complications were identified; however, longer-term surveillance is necessary to verify these findings. Level of Evidence Prognostic Level III.
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Affiliation(s)
- Anderson Lee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jaymeson Arthur
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jawad Najdawi
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Caleb R. Durst
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean S. Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew I. Spitzer
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Ramos-Guarderas P, Arteaga-Guerrero G, Vargas-Morante M, Ramos-Murillo P, Chaves-Lara C, Peñaherrera-Carrillo C, Ramos-Murillo D, Endara-Urresta F, Linzan-Muñoz M. [Translated article] Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00117-6. [PMID: 38971566 DOI: 10.1016/j.recot.2024.07.004] [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: 06/19/2023] [Revised: 03/27/2024] [Accepted: 04/14/2024] [Indexed: 07/08/2024] Open
Abstract
INTRODUCTION Osteoarthritis is a disabling pathology characterised by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. EVIDENCE LEVEL IV. Retrospective observational case series study.
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Affiliation(s)
- P Ramos-Guarderas
- Hospital Metropolitano, Quito, Ecuador; Instituto Arthros, Quito, Ecuador
| | - G Arteaga-Guerrero
- Hospital Metropolitano, Quito, Ecuador; Instituto Arthros, Quito, Ecuador
| | - M Vargas-Morante
- Hospital Metropolitano, Quito, Ecuador; Instituto Arthros, Quito, Ecuador
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Ramos-Guarderas P, Arteaga-Guerrero G, Vargas-Morante M, Ramos-Murillo P, Chaves-Lara C, Peñaherrera-Carrillo C, Ramos-Murillo D, Endara-Urresta F, Linzan-Muñoz M. Total hip arthroplasty with second generation dual mobility system as a treatment for primary coxarthrosis, medium-term results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00078-X. [PMID: 38642734 DOI: 10.1016/j.recot.2024.04.004] [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: 06/19/2023] [Revised: 03/27/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Osteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. MATERIALS AND METHODS A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. RESULTS The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. CONCLUSION The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. EVIDENCE LEVEL IV. Retrospective observational case series study.
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Warwick H, Kwong JW, Namiri NK, Kayupov E, Maher P, Hansen EN. Revision Dual Mobility Constructs With Unmatched Acetabular and Femoral Components Do Not Increase Failure Rate. J Arthroplasty 2024; 39:1044-1047. [PMID: 37914035 DOI: 10.1016/j.arth.2023.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Dual mobility (DM) constructs for revision total hip arthroplasty (THA) have continued to grow in popularity to mitigate instability. This benefit comes at the cost of potential unique modes of failure, and there are theoretical concerns that combining femoral and acetabular components from different manufacturers could lead to increased failure rates. We aimed to investigate rates of reoperation between matched and unmatched DM implants used in revision THA. METHODS We retrospectively reviewed 217 revision THAs performed with DM constructs between July 2012 and September 2021 at a single institution. Dual mobility (DM) constructs were classified as "matched" if the acetabular and femoral components were manufactured by the same company. They were classified as "unmatched" if the acetabular and femoral components were manufactured by different companies. The primary outcome was reoperation for any reason. RESULTS There were 136 matched DM constructs and 81 unmatched constructs. Average follow-up was 4.6 years (range, 2.0 to 9.6 years). There was no difference in reoperation rate between matched and unmatched groups (11.0 versus 13.6%, P = .576). The most common reasons for reoperation in both groups were instability and periprosthetic joint infection. There was 1 revision for intraprosthetic dislocation in the matched group. CONCLUSIONS The use of unmatched DM components in revision THA was common and did not increase the risk of reoperation at an average of 4.6-year follow-up. This information can be helpful in operative planning, but further research on long-term survival will be necessary.
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Affiliation(s)
- Hunter Warwick
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Jeffrey W Kwong
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Nikan K Namiri
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Erdan Kayupov
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Patrick Maher
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Erik N Hansen
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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Khaliq M, Jenkins N, Van Duren B, Palan J, Pandit H, Jain S. Dual-Mobility Acetabular Components in Primary Total Hip Arthroplasty Do Not Increase the Risk of Complication Compared to Conventional Articulations: A Matched Cohort Comparative Analysis. Arthroplast Today 2024; 26:101332. [PMID: 38433873 PMCID: PMC10907504 DOI: 10.1016/j.artd.2024.101332] [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: 08/01/2023] [Revised: 11/19/2023] [Accepted: 01/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background A recent National Joint Registry report suggests a higher local complication risk for dual-mobility (DM) total hip arthroplasty (THA) compared to conventional articulation THA. This report may be subject to data heterogeneity with multiple confounders. Controlling for these factors by matching demographic characteristics may give different results. We aim to compare 2-year local complication rates between matched DM and conventional THAs in primary hip osteoarthritis. Methods Data were collected for consecutive primary THAs undertaken via a posterior approach. The conventional articulation and DM cohorts were matched 3:1 for age, gender, American Society of Anesthesiology grade, body mass index, and operative time using a propensity score and nearest neighbor matching method. Outcome measures were 2-year local complication rates, reoperation rates, systemic complication rates, and mortality rates. Demographic and outcome data were compared, and cumulative survival rates (%) were assessed using Kaplan-Meier methodology with a 2-year local complication as the endpoint. Statistical significance was set at P < .05. Results Four hundred twelve THAs were included: 309 conventional and 103 DM articulations. There were no statistically significant differences between DM and conventional articulation THAs for local complications (7 [6.8%] vs 23 [7.4%], P = .820), reoperations (3 [2.9%] vs 4 [1.3%], P = .374), systemic complications (3 [2.9%] vs 4 [1.3%], P = .374), or 90-day mortality (1 [1%] vs 2 [0.6%], P = 1.000). Kaplan-Meier survival analysis demonstrated similar 2-year survival rates for conventional THAs compared to DM THAs (93.3% [standard error, 0.014] vs 91.9% [standard error, 0.031], P = .906). Conclusions This matched study shows that there is no difference in local complication rates between DM and conventional THA articulations.
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Affiliation(s)
- Mehnoor Khaliq
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Neesha Jenkins
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Bernard Van Duren
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Jeya Palan
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Hemant Pandit
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - Sameer Jain
- Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
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Dubin JA, Westrich GH. Less groin pain with dual-mobility bearings versus fixed bearings in total hip arthroplasty. Hip Int 2024; 34:15-20. [PMID: 36891584 DOI: 10.1177/11207000231158722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION The relationship between implant type, dual mobility (DM) or fixed bearing (FB), and postoperative groin pain remains unexplored. We examined the incidence of groin pain in DM implants and compare this to a cohort of FB THA patients. METHODS From 2006 to 2018, a single surgeon performed 875 DM THA and 856 FB THA procedures with 2.8-year and 3.1-year follow-up, respectively. Each patient received a questionnaire postoperatively and was asked if they had any groin pain (yes/no). Secondary measurements were implant characteristics such as head size, head offset, cup size, and cup-to-head ratio. Additional PROMs that were collected included: Veterans RAND 12 (VR-12), University of California Los Angeles (UCLA) activity score, Pain visual analogue scale (Pain VAS), and range of motion (ROM). RESULTS The incidence of groin pain was 2.3% in the DM THA cohort and 6.3% in the FB THA group (p < 0.001). Also, low head offset (⩽0 mm) had a significant odds ratio (1.61) for groin pain in both cohorts. There was no significant difference in terms of revision rate between the cohorts (2.5% vs. 3.3%, p = 0.39) at the latest follow up. CONCLUSIONS This study demonstrated a lower incidence of groin pain (2.3%) in patients with a DM bearing compared to a FB (6.3%) and a greater risk of groin pain with low head offset (<0 mm). As such, surgeons should try to recreate offset of the hip compared to the contralateral side to avoid groin pain.
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Affiliation(s)
- Jeremy A Dubin
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Hidayat T, Ismail R, Tauviqirrahman M, Saputra E, Ammarullah MI, Lamura MDP, Bayuseno AP, Jamari. Running-in behavior of dual-mobility cup during the gait cycle: A finite element analysis. Proc Inst Mech Eng H 2024; 238:99-111. [PMID: 38156402 DOI: 10.1177/09544119231216023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
The running-in process is considered an essential aspect of the comprehensive wear process. The phenomenon of running-in occurs during the initial stages of wear in the prosthetic hip joint. Within the field of tribology, the running-in phenomenon of the hip joint pertains to the mechanism by which the contact surfaces of the artificial hip joint components are adjusted and a suitable lubricating film is formed. During the process of hip joint running-in, there is an interaction between the metal surface of the ball and the joint cup, which results in adjustments being made until a steady state is achieved. The achievement of desirable wear existence and reliable performance of artificial hip joint components are reliant upon the tribological running-in of the hip joint. Despite the establishment of current modeling approaches, there remains a significant lack of understanding concerning running-in wear, particularly the metal-on-polyethylene (MoP) articulations in dual-mobility cups (DMC). An essential aspect to consider is the running-in phase of the dual mobility component. The present study employed finite element analysis to investigate the running-in behavior of dual mobility cups, wherein femoral head components were matched with polyethylene liners of varying thicknesses. The analysis of the running-in phase was conducted during the normal gait cycle. The results of this investigation may be utilized to design a dual-mobility prosthetic hip joint that exhibits minimal running-in wear.
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Affiliation(s)
- Taufiq Hidayat
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Department of Mechanical Engineering, Universitas Muria Kudus, Kudus, Central Java, Indonesia
| | - Rifky Ismail
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Center for Biomechanics Biomaterials Biomechatronics and Biosignal Processing (CBIOM3S) Diponegoro University, Semarang, Central Java, Indonesia
| | - Mohammad Tauviqirrahman
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
| | - Eko Saputra
- Department of Mechanical Engineering, Semarang State Polytechnic, Semarang, Central Java, Indonesia
| | - Muhammad Imam Ammarullah
- Biomechanics and Biomedics Engineering Research Centre, Universitas Pasundan, Bandung, West Java, Indonesia
| | - M Danny Pratama Lamura
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Diponegoro University, Semarang, Central Java, Indonesia
| | | | - Jamari
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Diponegoro University, Semarang, Central Java, Indonesia
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García de la Blanca JC, Cuarental García J, Luengo G, Martí R, Ramos LR. Neglected Dislocation in Adults: A New Therapeutic Strategy for an Uncommon Condition. Geriatrics (Basel) 2023; 8:117. [PMID: 38132488 PMCID: PMC10743121 DOI: 10.3390/geriatrics8060117] [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: 10/27/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: Neglected hip dislocation is an uncommon condition, especially in developed countries because dislocations are considered trauma emergencies and thus are treated early. They are usually treated with methods used in commonly occurring dislocations. The aim of this study is to detail a two-stage strategy for neglected hip dislocations in adults applied in a complicated case. (2) Case presentation: We present a complicated case of neglected hip dislocation in a patient with an associated neurological condition. Two-stage open reduction was performed combined with arthrodiastasis and Ilizarov external fixators. After complications requiring a third intervention, the joint was stabilized, and the patient has presented no more episodes to date. (3) Conclusions: Arthrodiastasis has been used to treat these conditions. Comparing it with the other methods described in the literature, it seems to be a good therapeutic strategy, especially in elderly patients. Because of the limited number of studies, we cannot establish the most efficient therapeutic method, but we believe that the described strategy can be useful for patients with this condition.
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Affiliation(s)
- Juan Carlos García de la Blanca
- Orthopedic Surgery Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (J.C.G.); (G.L.); (R.M.); (L.R.R.)
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Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, Alshammari AS, Misran N, Soliman MS, Mahmud S, Khandakar A. Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties. J Mater Chem B 2023; 11:10507-10537. [PMID: 37873807 DOI: 10.1039/d3tb01469j] [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: 10/25/2023]
Abstract
The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Muhammad E H Chowdhury
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar.
| | - Touhidul Alam
- Pusat Sains Ankasa (ANGKASA), Institut Perubahan Iklim, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia.
| | - Ahmed S Alshammari
- Department of Electrical Engineering, College of Engineering, University Hail, Hail 81481, Saudi Arabia.
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Norbahiah Misran
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohamed S Soliman
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
- Department of Electrical Engineering, Faculty of Energy Engineering, Aswan University, Aswan, 81528, Egypt
| | - Sakib Mahmud
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Amith Khandakar
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
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Ballard T, Corbett A, Murphy JD, Judson W, Harker JN. A Missed Diagnosis of Intraprosthetic Dislocation in a Dual-Mobility Bearing Following Closed Reduction. Cureus 2023; 15:e49361. [PMID: 38143637 PMCID: PMC10749215 DOI: 10.7759/cureus.49361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Dual-mobility bearings have been found to reduce the rate of dislocation following both primary and revision total hip arthroplasty. Their unique design involves two articulating surfaces which increases construct stability but also leaves them susceptible to a unique complication known as intraprosthetic dislocation (IPD). We report the case of a 33-year-old female who sustained an IPD following closed reduction. Following a missed radiographic diagnosis, the patient experienced pain and mechanical symptoms secondary to her implant failure. Surgical removal of the dislodged liner with component revision was required. This case highlights several crucial steps in the management of patients with dislocated total hip arthroplasties including implant identification and careful review of postreduction radiographs. We also discuss several strategies to properly diagnose, manage, and avoid IPD.
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Affiliation(s)
| | | | - John D Murphy
- Orthopedic Surgery, Largo Medical Center, Largo, USA
| | | | - John N Harker
- Orthopedic Surgery, Largo Medical Center, Largo, USA
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11
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Çalışkan E, Gedik CC, Eren İ. Letter to the Editor: Total Hip Arthroplasty in a Patient With Facioscapulohumeral Dystrophy. Arthroplast Today 2023; 22:101173. [PMID: 37521738 PMCID: PMC10374855 DOI: 10.1016/j.artd.2023.101173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Affiliation(s)
| | - Cemil Cihad Gedik
- Corresponding author. Koc University School of Medicine, Rumelifeneri Yolu, Istanbul 34450, Turkey. Tel.: +90 5075348511.
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12
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Otero JE, Heckmann ND, Jaffri H, Mullen KJ, Odum SM, Lieberman JR, Springer BD. Dual Mobility Articulation in Revision Total Hip Arthroplasty: An American Joint Replacement Registry Analysis of Patients Aged 65 Years and Older. J Arthroplasty 2023; 38:S376-S380. [PMID: 37230227 DOI: 10.1016/j.arth.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Increasingly, dual mobility (DM) articulations have been used in revision total hip arthroplasty (THA), which may prevent postoperative hip instability. The purpose of this study was to report on outcomes of DM implants used in revision THA from the American Joint Replacement Registry (AJRR). METHODS Revision THA cases performed between 2012 and 2018 Medicare were eligible and categorized by 3 articulations: DM, ≤32 mm, and ≥36 mm femoral heads. The AJRR-sourced revision THA cases were linked to Centers for Medicare and Medicaid Services (CMS) claims data to supplement (re)revision cases not captured in the AJRR. Patient and hospital characteristics were described and modeled as covariates. Using multivariable Cox proportional hazard models, considering competing risk of mortalities, hazard ratios were estimated for all-cause re-revision and re-revision for instability. Of 20,728 revision THAs, 3,043 (14.7%) received a DM, 6,565 (31.7%) a ≤32 mm head, and 11,120 (53.6%) a ≥36 mm head. RESULTS At 8-year follow-up, the cumulative all-cause re-revision rate for ≤32 mm heads was 21.9% (95%-confidence interval (CI) 20.2%-23.7%) and significantly (P < .0001) higher than DM (16.5%, 95%-CI 15.0%-18.2%) and ≥36 mm heads (15.2%, 95%-CI 14.2%-16.3%). At 8-year follow-up, ≥36 heads had significantly (P < .0001) lower hazard of re-revision for instability (3.3%, 95%-CI 2.9%-3.7%) while the DM (5.4%, 95%-CI 4.5%-6.5%) and ≤32 mm groups (8.6%, 95%-CI 7.7%-9.6%) had higher rates. CONCLUSION The DM bearings are associated with lower rates of revision for instability compared to patients who had ≤32 mm heads and higher revision rates for ≥36 mm heads. These results may be biased due to unidentified covariates associated with implant selection.
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Affiliation(s)
- Jesse E Otero
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina; Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Heena Jaffri
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Rosemont, Illinois
| | - Kyle J Mullen
- American Academy of Orthopaedic Surgeons, Combined Analytics Team, Rosemont, Illinois
| | - Susan M Odum
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Bryan D Springer
- OrthoCarolina Hip and Knee Center, Charlotte, North Carolina; Atrium Health Musculoskeletal Institute, Charlotte, North Carolina
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Hoggett L, Alexander D, Helm A. Post-operative complications following total hip arthroplasty for trauma: A multicentre cohort study comparing dual mobility with conventional acetabular bearings. J Orthop 2023; 40:34-37. [PMID: 37159824 PMCID: PMC10163605 DOI: 10.1016/j.jor.2023.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/16/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
Aims Dislocation of a total hip replacement is a serious complication after total hip arthroplasty (THA). Dislocation rates are higher when surgery is performed following trauma. Our study compares post-operative dislocation rates between conventional acetabular bearing (CAB) and dual mobility acetabular bearing (DMB) THA performed for neck of femur fracture alongside post-operative periprosthetic fracture, revision and mortality. Methods A retrospective multicentre cohort study at 9 hospital trusts in the United Kingdom of all THA performed for neck of femur fracture between March 2018 and February 2019. Results A total of 295 operations were performed. 64% (189) were CAB and 36% (106) were DMB. Average age was 75 years (38-98). 223 Female: 72 Male. The follow-up period was an average of 42 months (36-48). Overall revision rate was 1.6%,8 peri-prosthetic fracture rate was 6 (2%) and overall mortality was 9.8% (29) with no significant difference between cohorts for any outcome. The posterior approach (PA) was favoured 82% (242) vs the lateral approach (LA) 18% (53) with the PA used more often in patients undergoing DMB 96% (102) vs CAB 74% (140) p = 0.001. Patients approached posteriorly at the time of their index procedure were significantly less likely to sustain a simple dislocation following a DMB 0 (0%) vs. CAB 8 (5.7%) p = 0.015. Conclusion Our study demonstrates that the risk of dislocation following THA for trauma is more than four times higher than when conventional bearings are used compared to dual mobility acetabular components. This effect is most pronounced when the PA is utilised for the index procedure. The use of these bearings does not impact mortality, peri-prosthetic fracture or revision rate. We would encourage the use of dual mobility acetabular bearings in patients undergoing THA for fracture via a PA.
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Affiliation(s)
- Lee Hoggett
- Health Education North West, Trauma and Orthopaedic Surgery, UK
| | | | - Anthony Helm
- Lancashire Teaching Hospitals NHS Foundation Trust, Trauma and Orthopaedic Surgery, UK
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Wakeling CP, Wilson MJ, Whitehouse SL, Howell JR. Mixed manufacturer dual mobility bearing and the Exeter V40 Stem: is it safe? Short-term results in primary and revision hip replacement. Acta Orthop Belg 2023; 89:340-347. [PMID: 37924552 DOI: 10.52628/89.2.6812] [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: 11/06/2023]
Abstract
The aim is to review clinical and radiological outcomes for all cases of primary and revision THA, combining a cemented stem (Exeter V40) with a dual mobility component from a different manufacturer (SERF Novae), to evaluate whether concerns regarding mixing components from different manufacturers are justified. We identified 72 hip replacements performed between May 2010 and December 2015 using the SERF Novae dual mobility cup with an Exeter V40 stem, the majority of which were cemented (90%) and revisions (58%). Patients were evaluated clinically and radiologically at a minimum of two years. There were five (6.9%) dislocations; three (4.2%) requiring revision - one of which was an intra-prosthetic disarticulation and two infections. No cases were lost to follow-up and 49 surviving cases were reviewed at a mean of 4.0 (range 1.8-8.1) years following surgery. Pain and functional outcome scores all improved. There were no radiological failures and no revisions for aseptic loosening of stem or cup. The combination of Exeter cemented stem with a dual mobility bearing from a different manufacturer results in acceptable short-term outcomes in terms of hip stability, revision rates and patient-reported measures.
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Manson TT, Adrados M, Gililland JM, Mahmood BM, Samuel LT, Moskal JT. The Role of Dual-Mobility Components in Total Hip Arthroplasty. J Bone Joint Surg Am 2023; 105:250-261. [PMID: 36473055 DOI: 10.2106/jbjs.22.00185] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
➤ Dual mobility (DM) refers to a now widely available option for total hip articulation. DM implants feature a small inner head, a hard bearing, that connects via a taper fit onto the femoral trunnion. This head freely rotates but is encased inside a larger, outer polyethylene head that articulates with a smooth acetabular component. ➤ DM acetabular components are available in the form of a monoblock shell or as a liner that is impacted into a modular shell, providing a metal articulation for the polyethylene outer head. ➤ DM is designed to increase hip stability by providing the arthroplasty construct with a higher jump distance, head-to-neck ratio, and range of motion prior to impingement. ➤ The use of DM in total hip arthroplasty continues to increase in the United States for both primary and revision arthroplasty. Surgeons should be aware of the potential benefits and pitfalls. ➤ Long-term data are lacking, especially for modular DM implants. Points of concern include a potential for accelerated polyethylene wear, intraprosthetic dislocation, and modular backside fretting corrosion.
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Affiliation(s)
- Theodore T Manson
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland
| | - Murillo Adrados
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Orthopaedic Surgery, Carilion Clinic Institute of Orthopaedics and Neurosciences, Roanoke, Virginia
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Bilal M Mahmood
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Carilion Clinic Institute of Orthopaedics and Neurosciences, Roanoke, Virginia
| | - Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.,Department of Orthopaedic Surgery, Carilion Clinic Institute of Orthopaedics and Neurosciences, Roanoke, Virginia
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Do Dual-mobility Cups Reduce Revision Risk in Femoral Neck Fractures Compared With Conventional THA Designs? An International Meta-analysis of Arthroplasty Registries. Clin Orthop Relat Res 2022; 480:1912-1925. [PMID: 35767813 PMCID: PMC9473769 DOI: 10.1097/corr.0000000000002275] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dual-mobility cups in THA were designed to reduce prosthesis instability and the subsequent risk of revision surgery in high-risk patients, such as those with hip fractures. However, there are limited data from clinical studies reporting a revision benefit of dual-mobility over conventional THA. Collaboration between anthroplasty registries provides an opportunity to describe international practice variation and compare between-country, all-cause revision rates for dual-mobility and conventional THA. QUESTIONS/PURPOSES We summarized observational data from multiple arthroplasty registries for patients receiving either a dual-mobility or conventional THA to ask: (1) Is dual-mobility use associated with a difference in risk of all-cause revision surgery compared with conventional THA? (2) Are there specific patient characteristics associated with dual-mobility use in the hip fracture population? (3) Has the use of dual-mobility constructs changed over time in patients receiving a THA for hip fracture? METHODS Six member registries of the International Society of Arthroplasty Registries (from Australia, Denmark, Sweden, the Netherlands, the United Kingdom, and the United States) provided custom aggregate data reports stratified by acetabular cup type (dual-mobility or conventional THA) in primary THA for hip fracture between January 1, 2002, and December 31, 2019; surgical approach; and patient demographic data (sex, mean age, American Society of Anesthesiologists class, and BMI). The cumulative percent revision and mortality were calculated for each registry. To determine a global hazard ratio of all-cause revision for dual-mobility compared with conventional THA designs, we used a pseudoindividual patient data approach to pool Kaplan-Meier prosthesis revision data from each registry and perform a meta-analysis. The pseudoindividual patient data approach is a validated technique for meta-analysis of aggregate time-to-event survival data, such as revision surgery, from multiple sources. Data were available for 15,024 dual-mobility THAs and 97,200 conventional THAs performed for hip fractures during the study period. RESULTS After pooling of complete Kaplan-Meier survival data from all six registries, the cumulative percent revision for conventional THA was 4.3% (95% confidence interval [CI] 4.2% to 4.5%) and 4.7% (95% CI 4.3% to 5.3%) for dual-mobility THA at 5 years. We did not demonstrate a lower risk of all-cause revision for patients receiving dual-mobility over conventional THA designs for hip fracture in the meta-analysis once between-registry differences were adjusted for (HR 0.96 [95% CI 0.86 to 1.06]). A lower proportion of dual-mobility procedures were revised for dislocation than conventional THAs (0.9% versus 1.4%) but a higher proportion were revised for infection (1.2% versus 0.8%). In most registries, a greater proportion of dual-mobility THA patients were older, had more comorbidities, and underwent a posterior approach compared with conventional THA (p < 0.001). The proportion of dual-mobility THA used to treat hip fractures increased in each registry over time and constituted 21% (2438 of 11,874) of all THA procedures in 2019. CONCLUSION The proportion of dual-mobility THAs in patients with hip fractures increased over time, but there was large variation in use across countries represented here. Dual-mobility cups were not associated with a reduction in the overall risk of revision surgery in patients with hip fractures. A randomized controlled trial powered to detect the incidence of dislocation and subsequent revision surgery is required to clarify the efficacy of dual-mobility cups to treat hip fractures. LEVEL OF EVIDENCE Level III, therapeutic study.
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Yang J, Bryan AJ, Drabchuk R, Tetreault MW, Calkins TE, Della Valle CJ. Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation. Hip Int 2022; 32:648-655. [PMID: 33566709 DOI: 10.1177/1120700020988469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA. METHODS A total of 155 primary THAs with a monoblock, cementless dual-mobility acetabular component were performed in patients at high risk for dislocation. Two patients died prior to their two-year follow-up. The remaining 153 THAs were followed for a mean of 5.1 years (range: 2.1 to 9.3). RESULTS There were no dislocations; however, four patients underwent revision surgery: one for an early periprosthetic acetabular fracture, one for an early periprosthetic femoral fracture, one for a late periprosthetic femoral fracture, and one for leg-length discrepancy. Intraoperative complications included one periprosthetic acetabular fracture treated with protected weight-bearing and one intraoperative proximal femoral fracture treated with cerclage wiring. Harris Hip Scores improved from a mean of 42.4 points preoperatively to a mean of 82.4 points postoperatively (p < 0.001). No cups were radiographically loose. At a mean follow-up of 5.1 years, survivorship of the acetabular component was 99.3% (95% CI, 98.1-100%) and survivorship without any reoperation was 97.4% (95% CI, 95.9-100%). DISCUSSION Although there were no dislocations in this high-risk population, periprosthetic fractures of the femur and acetabulum were common with the implants utilised.
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Affiliation(s)
- JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew J Bryan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Roman Drabchuk
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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18
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Baker CM, Restrepo C, Hozack WJ. Minimum Five-Year Outcomes of Modular Dual Mobility in Primary Total Hip Arthroplasty. J Arthroplasty 2022; 37:S566-S570. [PMID: 35271978 DOI: 10.1016/j.arth.2022.02.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Using a modular dual-mobility (MDM) bearing in primary total hip arthroplasty (THA) has not been widely evaluated. The purpose of this study is to evaluate clinical outcomes and survivorship following MDM bearings in primary THA. METHODS We used our registry database for patients with an MDM bearing on primary THA, performed by 6 surgeons through supine direct lateral or direct anterior approach. MDM bearings were used most often when impingement or subluxation was present intraoperatively despite proper component position. Another indication was a patient with planned activities who might be at a higher risk of instability postoperatively. RESULTS A total of 127 MDM bearings were used in primary THA in 119 patients. Mean follow-up was 6.77 years (range 5-8.9). Five hips were revised, none of which were due to MDM bearing failure. Preoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Veterans RAND/Short Form 12 Physical Health Score and Mental Health Score increased from 25.81 to 52.40 (P < .0001), 30.42 to 44.50 (P < .0001), and 36.21 to 52.70 (P < .0001) at latest completed survey follow-up, respectively. CONCLUSION This MDM bearing shows excellent functional outcomes at a minimum 5 years of follow-up with no bearing-related failures. It can be an excellent choice in primary THA specifically in females where the use of increased head size to prevent instability is not possible due to anatomical restrictions and liner thickness.
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Affiliation(s)
- Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - William J Hozack
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Bertault-Le Gourrierec J, Cavaignac E, Berard E, Moretti F, Marot V, Chiron P, Reina N. Comparative study of total hip arthroplasties with dual mobility cups versus hemiarthroplasties in management of femoral neck fractures: Survival and dislocation rate at 5 years of follow-up? Orthop Traumatol Surg Res 2022; 108:103098. [PMID: 34624538 DOI: 10.1016/j.otsr.2021.103098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/02/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Instability after hip arthroplasty, whether it is a total (THA) or intermediate (HA), poses a major risk, however arthroplasty is the standard treatment for displaced intracapsular fractures of the femoral neck of the elderly. Three types of arthroplasties can be proposed: total prostheses with or without a dual mobility cup (DM THA) reducing the risk of dislocation, and hemiarthroplasties. In the absence of clear recommendations regarding the type of implant to be used and the scarcity of studies comparing HA and DM THA, we conducted a monocentric comparative retrospective study using the propensity score method to compare DM THA versus HA on recently displaced femoral neck fractures: (1) survival and risk of dislocation, (2) functional results, (3) mortality. HYPOTHESIS The rate of dislocation of THA fitted with a DM cup is lower than that of HA. PATIENTS AND METHODS We retrospectively identified 112 patients in the HA group and 153 patients in the DM THA group who underwent an emergency arthroplasty for a displaced cervical fracture between 2010 and 2013. The minimum follow-up was 5 years (range, 5-9 years). The mean age at surgery was 81 years (range, 55-101 years). Elective surgery patients (n=2), hardware fractures (n=10), pathological fractures of the femoral neck (n=6), associated fractures (n=3), and revision surgeries (n=5) were excluded. The primary outcome measure was instability. Clinical follow-up was performed by the WOMAC score and the risk of mortality was determined after adjusting for confounding factors using the propensity score method. RESULTS After adjustment by the propensity score, the dislocation rate at 2-years was 2.2% (n=3/153) in the dual mobility THA group and 6.3% (n=7/112) in the HA group (OR=0.34 [95% CI: 0.06-1.96] (p=0.23)). After adjustment by the propensity score, the mean WOMAC score was 8.20 (±6.56) in the THA group, compared to 10.78±3.92 on average in the HA group (p=0.031). After adjustment by the propensity score, we did not find any significant difference in the reoperation rate without changing implants and revisions, and postoperative complications. After adjustment by the propensity score, mortality was significantly higher in the HA group 45.5% (n=69/152) versus 91.5% (n=102/112) in the HA group (OR=0.50 [95% CI: 0.25-0.98] (p=0.042)). DISCUSSION Few studies have compared these two types of implant in the context of trauma. Although the results of our study are not significant regarding the risk of dislocation, the use of a dual mobility cup seems to be a very satisfactory solution in this trauma context. LEVEL OF EVIDENCE III; comparative retrospective cohort.
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Affiliation(s)
- Juliette Bertault-Le Gourrierec
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Etienne Cavaignac
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Emilie Berard
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France; CERPOP, Inserm, UPS, Purpan faculty of medicine, university of Toulouse, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Federico Moretti
- Department of epidemiology, university hospital of Toulouse, Purpan faculty of medicine, 37, allées Jules-Guesdes, 31000 Toulouse, France
| | - Vincent Marot
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Philippe Chiron
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France
| | - Nicolas Reina
- Department of orthopedic and trauma surgery, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France; I2R - Riquet Research Institute, Pierre Paul Riquet hospital, university hospital of Toulouse, place du Docteur Baylac, 31059 Toulouse, France.
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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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21
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Rodríguez Pérez D, Agulló Ferre JL, Del Carmen Rodríguez M, Tramunt Monsonet C. Late Breakage of a Dual-Mobility Polyethylene Insert in a Revision Total Hip Arthroplasty: An Unusual Failure Mode. Arthroplast Today 2021; 12:7-11. [PMID: 34746346 PMCID: PMC8551416 DOI: 10.1016/j.artd.2021.07.013] [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: 05/14/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
The use of dual-mobility cups has gained popularity in recent years. Thus, surgeons can expect an increase in known and new causes of failure. We report a previously undescribed form of a late intraprosthetic dislocation consisting of a complete breakage of a polyethylene mobile bearing that suffered a dislocation 3 months after its implantation. Two years later, he began feeling anterior groin pain and suffered gait changes. Computed tomography scan revealed an eccentric alignment of the mobile polyethylene bearing suggestive of poly wear. During the revision surgery, the polyethylene was found to be split in 2. Possible causes of this complication are proposed. Our case shows a previously unreported implant-specific complication, so surgeons can identify it.
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Sadozai Z, Limb R, Awais Bokhari S, Ng A, Bhamra M. Dual mobility versus unipolar total hip arthroplasty for neck of femur fractures: a single centre study. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Current national guidelines (NICE) recommends that all medically fit, independently-mobile patients without cognitive impairment receive a total hip arTHAoplasty(THA) for displaced intracapsular neck of femur (NOF) fractures. Dislocation is a concern(2-10%). Dual mobility cups have been suggested to address this complication. Our study sets out to compare dislocation rates between dual mobility cups versus unipolar cups.
We performed a retrospective single centre multiple surgeon study of all THAs performed for NOFs between January 2012 and May 2018. A total of 322 total hip replacements (127 dual mobility and 195 unipolar ; Age range of patients, 29 to 91, mean 70 years) were identified for analysis using a database. Data was obtained from electronic patient records and radiographs.
12 patients sustained a dislocation of their THA out of our 322 patients. Of these, 10 dislocations occurred in the unipolar group (5.13%). From the dual mobility cups, 2 had dislocations(1.57%), both with a 28mm head. Both of these dislocations were in alcohol dependent patients with increased susceptibility to falls. Statistical analysis of our data was performed using chi-squared test (p value = 0.0723)
In ‘Getting It Right First Time’ (GIRFT), the authors recommend that all patients that sustain a NOF fracture meeting the criteria of a THA to be offered a dual mobility acetabular cup to reduce the risk of dislocation. The cost of the dual mobility acetabular cup is offset from the cost of overall revision surgery. Limitations of our study are its retrospective nature and selection bias.
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Emara AK, Peterson J, Piuzzi NS, Klika A, Rajaravivarma R, Higuera-Rueda C, Roy S. Effect of liner offset and inclination on cement retention strength of metal-in-metal acetabular constructs: A biomechanical study. J Orthop Res 2021; 39:813-820. [PMID: 32678920 DOI: 10.1002/jor.24807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 02/04/2023]
Abstract
Cementing metallic liners into well-fixed acetabular shells facilitates utilizing dual-mobility cups in revision total hip arthroplasty without shell replacement. The current biomechanical study investigated the effect of increasing cemented liner (a) inclination; and (b) offset on the cement retention strength measured as the lever-out moment at cement failure. Eighteen metallic liner prototypes were cemented into cluster-hole acetabular shells at variable inclinations (0°, 10°, and 20°) and offsets (0 and 10 mm) relative to the enclosing acetabular shell (6 groups; n = 3 constructs per group). The constructs were connected to a material testing frame, and lever-out failure moments were tested through an established protocol. Failure occurred at the liner-cement interface (18/18). There was no correlation between liner inclination and the lever-out failure moment (r = -0.327, P = .185). Liner offset demonstrated a strong negative correlation to mean lever-out failure moments (r = -0.788, P < .001). There was no significant difference between mean lever-out failure moments at variable liner inclinations, regardless of offset (P = .358). Greater liner offset was associated with diminished mean lever-out failure moments (P < .001). Compared with neutral (0° inclination, 0 mm offset), the maximum inclination and offset group had the lowest mean lever-out failure moment (P = .011). Cemented metal-in-metal constructs are significantly affected by the liner positioning. While a correlation between liner inclination and cement retention strength could not be asserted, cement retention strength is significantly diminished by increased liner offset.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jennifer Peterson
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Shammodip Roy
- Stryker Orthopaedics, Stryker Corporation, Mahwah, New Jersey
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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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Lamo-Espinosa JM, Gómez-Álvarez J, Gatica J, Suárez Á, Moreno V, Díaz de Rada P, Valentí-Azcárate A, Alfonso-Olmos M, San-Julián M, Valentí-Nin JR. Cemented Dual Mobility Cup for Primary Total Hip Arthroplasty in Elder Patients with High-Risk Instability. Geriatrics (Basel) 2021; 6:23. [PMID: 33800068 PMCID: PMC8005968 DOI: 10.3390/geriatrics6010023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/20/2022] Open
Abstract
Several studies have shown that double mobility (DM) cups reduce postoperative dislocations. Does the cemented dual mobility cup reduce dislocations in a specific cohort of elder patients with a high dislocation risk? Our hypothesis is that this implant is optimal for elder patients because it reduces early dislocation. We have retrospectively reviewed elder patients who underwent total hip arthroplasty (THA) with cemented double mobility cup between March 2009 and January 2018. The inclusion criteria were patients (>75 years) who were operated on for primary THA (osteoarthritis or necrosis) with a cemented dual mobility cup and a high-risk instability (at least two patient-dependent risk factors for instability). The exclusion criteria were revision surgeries or hip fracture. In all the cases, the same surgical approach was performed with a Watson Jones modified approach in supine position. We have collected demographic data, instability risk factors. Patients were classified using the Devane's score, Merle d'Aubigné score and the patient's likelihood of falling with the Morse Fall Scale. Surgical and follow-up complications were collected from their medical history. Sixty-eight arthroplasties (68 patients) were included in the study. The median age was 81.7 years (SD 6.4), and the American Society of Anesthesiologists (ASA) score showed a distribution: II 27.94%, III 63.24% and IV 8.82%. Devane's score was less than five in all of the cases. At least two patient-dependent risk factors for instability (87% had three or more) were present in each case. The median follow-up time was 49.04 months (SD 22.6). Complications observed were two cases of infection and one case of aseptic loosening at 15 months which required revision surgery. We did not observe any prosthetic dislocation. The cemented dual mobility cup is an excellent surgical option on primary total hip arthroplasties for elder patients with high-risk instability.
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Affiliation(s)
- José María Lamo-Espinosa
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Jorge Gómez-Álvarez
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Javier Gatica
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Álvaro Suárez
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Victoria Moreno
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Pablo Díaz de Rada
- Department of Orthopaedic Surgery and Traumatology, Hospital Reina Sofía, Tudela, 31005 Navarra, Spain;
| | - Andrés Valentí-Azcárate
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Matías Alfonso-Olmos
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Mikel San-Julián
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
| | - Juan Ramón Valentí-Nin
- Department of Orthopaedic Surgery and Traumatology, Clínica Universidad de Navarra, Pamplona, 31008 Navarra, Spain; (J.G.-Á.); (J.G.); (Á.S.); (V.M.); (A.V.-A.); (M.A.-O.); (M.S.-J.); (J.R.V.-N.)
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Matzko C, Naylor B, Cummings R, Korshunov Y, Cooper HJ, Hepinstall MS. Impingement Resulting in Femoral Notching and Elevated Metal-Ion Levels After Dual-Mobility Total Hip Arthroplasty. Arthroplast Today 2020; 6:1045-1051. [PMID: 33385049 PMCID: PMC7772443 DOI: 10.1016/j.artd.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
A 60-year-old woman underwent revision total hip arthroplasty with a modular dual-mobility articulation for recurrent dislocation. At 1-year follow-up, the patient reported no dislocations but had occasional clicking and discomfort with extreme motion. A Dunn radiograph identified notching of the femoral stem, attributed to impingement. Metal ions were elevated without adverse local-tissue reaction. After 4.5 years of observation, the notch size remained stable. She denied pain. Neither stem fracture nor prosthetic dislocation occurred. Impingement against cobalt-chromium acetabular bearing surfaces can result in notching of titanium femoral components after total hip arthroplasty. Increased anteversion intended to protect against posterior dislocation may be a risk factor. Posterior notching is best visualized on Dunn views, so incidence may be underestimated. No associated femoral implant fractures were identified on literature review.
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Affiliation(s)
- Chelsea Matzko
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Brandon Naylor
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Ryan Cummings
- SUNY Downstate College of Medicine, Brooklyn, NY, USA
| | - Yevgeniy Korshunov
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA.,Department of Orthopedic Surgery, NYU Goldman School of Medicine, New York, NY, USA.,Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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27
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Sunilkumar PD, Oh KJ, Cho HW, Kim SM. Monolithic Dual Mobility Cup Total Hip Arthroplasty Has High Complication Rates With Surgical Fixation in Elderly With Femur Neck Fracture. J Arthroplasty 2020; 35:3621-3626. [PMID: 32773273 DOI: 10.1016/j.arth.2020.06.091] [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: 03/31/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study is prospectively conducted to evaluate surgical complications of monolithic dual mobility cup total hip arthroplasty (THA) in elderly patients with fractured neck of the femur. METHODS Ninety-seven patients (97 hips) with displaced femoral neck fracture who gave informed consent for participation were prospectively enrolled. Their mean age was 76.6 years (range, 60-95 years), and the mean bone mineral density T-score of neck of the femur was -2.8 (range, -1.2 to -5.5). All patients underwent THA with monolithic dual mobility cup, and computed tomography scans were obtained to evaluate radiographic parameters including anteversion, inclination, and loosening of acetabular cups, and periprosthetic acetabular fractures. RESULTS With regard to cup orientation, mean inclination angle was 40.2° (range, 23.5°-63°) and mean anteversion was 32.6° (range, 7°-66.2°). The proportion of surgical outliers was 10.3% (10/97) in inclination and 35.1% (34/97) in anteversion. Early cup loosening within 2 weeks was detected in 2 hips. Periprosthetic acetabular fractures were identified in 6 hips (6/97, 6.2%). Of the 6 fractures, 5 nondisplaced fractures were healed with conservative management, but 1 fracture with displacement eventually led to cup loosening and the patient underwent revision surgery. Reoperation rate of the monolithic dual mobility cup was 4.1% (4/97). CONCLUSION The use of the monolithic dual mobility was associated with improper cup fixation and periprosthetic acetabular fractures in the elderly with poor bone stock, although the dual mobility cup lowered the risk of early dislocation after THA.
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Affiliation(s)
- P D Sunilkumar
- Sharada Orthopaedics and Trauma Centre, Hubli, Republic of India
| | - Kwang-Jun Oh
- Department of Orthopedic Surgery, Sungmin Hospital, Incheon, Republic of Korea
| | - Hyun-Woo Cho
- Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Republic of Korea
| | - Sang-Min Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Guro Hospital, Seoul, Republic of Korea
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D'Apolito R, Bandettini G, Jacquot FMP, Zagra L. Modular dual-mobility cups using ceramic liners: an original solution for selected indications? Hip Int 2020; 30:59-65. [PMID: 33267689 DOI: 10.1177/1120700020964976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dual mobility (DM) has been shown to improve stability both in primary and revision total hip arthroplasty (THA) and is increasingly used in patients at high risk of dislocation and in the treatment of THA instability. The introduction of modular liners has helped to overcome some of the limitations of monoblock DM cups. In this context, the use of a ceramic liner would avoid the conventional cobalt-chromium liner in the titanium shell, which can be problematic in some situations. The aim of this paper is to report the outcomes of a consecutive series of patients undergoing revision THA using a modular DM cup with a ceramic liner instead of the conventional metal one, and to clarify the rationale for this currently "off-label" use. PATIENTS AND METHODS This is a retrospective series of patients who received this new DM bearing in a single institution. Patients were followed up clinically and radiologically at 1 month, 3 months, 6 months and yearly thereafter. RESULTS 5 patients received the ceramic liner in the study period (2014-2019). The indications were instability or high risk of dislocation in ceramic liner fracture and ARMD with soft tissue damage after MoM THA. The mean age at surgery was 74 (63-82) years, the mean follow-up was 36 (12-72) months. No dislocation occurred, and no adverse events related to the implant were recorded. CONCLUSIONS The use of a ceramic liner in a modular DM cup offers several advantages in selected patients, and the results of our cohort are encouraging. However, caution is needed in introducing this new bearing because knowledge is currently limited. Further studies on a larger number of patients and with longer follow-ups are needed to confirm these findings and before widespread use of the device.
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Affiliation(s)
- Rocco D'Apolito
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | - Guido Bandettini
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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29
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Stavrakis AI, Khoshbin A, Joseph A, Lee LY, Bostrom MP, Westrich GH, McLawhorn AS. Dual Mobility Total Hip Arthroplasty Is Not Associated with a Greater Incidence of Groin Pain in Comparison with Conventional Total Hip Arthroplasty and Hip Resurfacing:A Retrospective Comparative Study. HSS J 2020; 16:394-399. [PMID: 33380972 PMCID: PMC7749877 DOI: 10.1007/s11420-020-09764-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Groin pain is a common long-term complication of total hip arthroplasty (THA). Femoral head size has been proposed as one of the primary causes. The implants used in dual mobility (DM) THA have large outer-bearing articulations, which could increase the risk of post-operative groin pain. Hip resurfacing (HR), too, has been shown to be associated with a risk of groin pain. QUESTIONS/PURPOSES The goals of this study were to compare the incidence of groin pain at 1 year after hip arthroplasty in patients with different femoral head diameters and in patients undergoing conventional THA, DM THA, and HR. METHODS After combing an institutional registry for all patients who had undergone THA or HR for primary hip osteoarthritis, we included 3193 patients in the analysis; 2008 underwent conventional THA, 416 underwent DM THA, and 769 underwent HR. We used logistic regression modeling to analyze the relation of groin pain at 1 year after surgery to patient demographics and clinical characteristics, including age, sex, body mass index (BMI), University of California at Los Angeles activity score at 1 year after surgery, bearing couple, and the ratio of acetabular diameter to femoral head diameter. We also measured cup inclination and anteversion in a subset of patients with and without groin pain at 1 year to assess whether pain could be related to implant position. RESULTS Overall, 8.7% of patients reported groin pain at 1 year. Patients with groin pain were younger and had lower BMIs. There were increased odds of groin pain with a greater cup-to-head ratio, although DM implants, interestingly, were not significantly associated with groin pain; this may be attributable to so much of their movement taking place inside the implant. Subgroup analysis measuring cup inclination and anteversion showed no difference in cup position between patients with and without pain. CONCLUSION In this population of hip arthroplasty patients, the incidence of groin pain 1 year after surgery did not differ among patients undergoing DM and conventional THA; DM THA in particular was not associated with a higher risk of groin pain, despite its comparatively larger femoral head sizes. HR, on the other hand, was associated with a higher risk of pain. Appropriate implant sizing and bearing couple choice may optimize the functional benefit of THA.
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Affiliation(s)
- Alexandra I. Stavrakis
- grid.19006.3e0000 0000 9632 6718Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Amir Khoshbin
- grid.17063.330000 0001 2157 2938Division of Orthopaedic Surgery, University of Toronto, Toronto, ON Canada
| | - Amethia Joseph
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Lily Y. Lee
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Mathias P. Bostrom
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Geoffrey H. Westrich
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
| | - Alexander S. McLawhorn
- grid.239915.50000 0001 2285 8823Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY USA
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Wolf O, Mukka S, Notini M, Möller M, Hailer NP. Study protocol: The DUALITY trial-a register-based, randomized controlled trial to investigate dual mobility cups in hip fracture patients. Acta Orthop 2020; 91:506-513. [PMID: 32567472 PMCID: PMC8023882 DOI: 10.1080/17453674.2020.1780059] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Physically and mentally fit patients with a displaced femoral neck fracture (FNF) are mostly treated with total hip arthroplasty (THA). Dislocation is a severe and frequent complication in this group, and dual mobility cups (DMC) were developed to reduce the risk of dislocation after THA. The DUALITY trial investigates whether the use of DMC in FNF patients treated with a THA reduces the risk of dislocation.Patients and methods - The trial is a national, multicenter, register-based, randomized controlled trial (rRCT). Patients ≥ 65 years with a non-pathological, displaced FNF (Type Garden 3-4/AO 31-B2 or B3) who are suitable for a THA according to local guidelines are assessed for eligibility using the web-based registration platform of the Swedish Fracture Register (SFR). 1,600 patients will be randomized 1:1 to either insertion of a DMC (intervention group) or a standard cup (control group). The study is pragmatic in that the choice of implant brands, surgical approach, and peri- and postoperative protocols follow the local routines of each participating unit. All outcome variables will be retrieved after linkage of the study cohort obtained from the SFR with the Swedish Hip Arthroplasty Register and the National Patient Register.Outcomes - The primary outcome is the occurrence of any dislocation of the index joint treated with closed or open reduction within 1 year after surgery, expressed as a relative risk when comparing groups, and a risk reduction of at least 45% is considered clinically relevant. Secondary outcomes are the relative risk of any reoperation of the index joint, periprosthetic joint infection, and mortality within 90 days and 1 year. Patient-reported outcomes and health economics are evaluated.Start of trial and estimated duration - The DUALITY trial started recruiting patients in January 2020 and will continue for approximately 5 years.Trial registration - The trial is registered at clinicaltrials.gov (NCT03909815; December 12, 2019).
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Affiliation(s)
- Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University; ,Correspondence:
| | - Sebastian Mukka
- Department of Surgical and Perioperative Science (Orthopaedics), Umeå University;
| | - Maja Notini
- Department of Surgical Sciences, Orthopaedics, Uppsala University;
| | - Michael Möller
- Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Orthopaedics, Uppsala University;
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Godoy-Monzon D, Garcia-Mansilla A, Buljubasich M, Cid-Casteulani A, Valentini R. Dual mobility system. The French solution in elderly patients with intracapsular hip fracture and high risk of dislocation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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32
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Young JR, O’Connor CM, Anoushiravani AA, DiCaprio MR. The Use of Dual Mobility Implants in Patients Who Are at High Risk for Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2020; 8:e20.00028. [DOI: 10.2106/jbjs.rvw.20.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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You D, Sepehri A, Kooner S, Krzyzaniak H, Johal H, Duffy P, Schneider P, Powell J. Outcomes of total hip arthroplasty using dual mobility components in patients with a femoral neck fracture. Bone Joint J 2020; 102-B:811-821. [PMID: 32600134 DOI: 10.1302/0301-620x.102b7.bjj-2019-1486.r1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with dual mobility components (THA-DMC) following a femoral neck fracture and to compare outcomes between THA-DMC, conventional THA, and hemiarthroplasty (HA). METHODS We performed a systematic review of all English language articles on THA-DMC published between 2010 and 2019 in the MEDLINE, EMBASE, and Cochrane databases. After the application of rigorous inclusion and exclusion criteria, 23 studies dealing with patients who underwent treatment for a femoral neck fracture using THA-DMC were analyzed for the rate of dislocation. Secondary outcomes included reoperation, periprosthetic fracture, infection, mortality, and functional outcome. The review included 7,189 patients with a mean age of 77.8 years (66.4 to 87.6) and a mean follow-up of 30.9 months (9.0 to 68.0). RESULTS THA-DMC was associated with a significantly lower dislocation rate compared with both THA (OR 0.26; 95% CI 0.08 to 0.79) and HA (odds ratio (OR) 0.27; 95% confidence interval (CI) 0.15 to 0.50). The rate of large articulations and of intraprosthetic dislocation was 1.5% (n = 105) and 0.04% (n = 3) respectively. CONCLUSION THA-DMC when used in patients with a femoral neck fracture is associated with a lower dislocation rate compared with conventional arthroplasty options. There was no increase in the rates of other complication when THA-DMC was used. Future cost analysis and prospective, comparative studies are required to assess the potential benefit of using THA-DMC in these patients. Cite this article: Bone Joint J 2020;102-B(7):811-821.
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Affiliation(s)
- Daniel You
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Sahil Kooner
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Halli Krzyzaniak
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Paul Duffy
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Prism Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - James Powell
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Godoy-Monzon D, Garcia-Mansilla A, Buljubasich M, Cid-Casteulani A, Valentini R. Dual mobility system. The French solution in elderly patients with intracapsular hip fracture and high risk of dislocation. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:335-341. [PMID: 32493649 DOI: 10.1016/j.recot.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/11/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Actually there is a controversy about the treatment of hip fractures on older patients with high risk of dislocation. Our study is focused on report clinico-functional and radiographic results in this population treated with total hip replacement using a dual mobility system after a minimum follow up of 2 years. MATERIALS AND METHODS In the period from January 2015 to January 2016 patients assisted at the Emergency Unit at the participant hospital were recluted for participation. A total of 137 patients were assisted and 41 fulfilled the inclusion criteria and accepted to participate. All patients received a total hip replacement with a dual mobility system (cemented or uncemented). The patients were evaluated with the Mini-Mental State Examination, walking distance test, preop and postop at 3 and 6 weeks, 3 months, 6 months, one year and subsequent years. Radiographic evaluation was scheduled with clinico-functional review. RESULTS Forty-one patients included, follow up average 2.4 years (range 2 to 3.2 years). Mean age 85.2 (range 80 to 96 years). Four patients died during follow up due to causes not related to the total hip replacement and the implant was functioning. One case have an infection and was revised in one stage procedure. One case have an infection at 8 months follow-up and was revised in one stage procedure. There were no dislocations. CONCLUSION The use of dual mobility system in this high dislocation risk population has shown good clinical and functional results, and support the sistematic indication in our services.
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Affiliation(s)
- D Godoy-Monzon
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - A Garcia-Mansilla
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Buljubasich
- Servicio de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Cid-Casteulani
- Servicio de Ortopedia y Traumatología, Centro Médico Fitz Roy, Buenos Aires, Argentina
| | - R Valentini
- Servicio de Ortopedia y Traumatología, Centro de Educación Médica e Investigación Clínicas (CEMIC), Buenos Aires, Argentina
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Garceau SP, Igbokwe EN, Warschawski Y, Neufeld ME, Safir OA, Wade JP, Guy P, Wolfstadt JI. Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity: A Critical Analysis Review. JBJS Rev 2020; 8:e0146. [PMID: 32487976 DOI: 10.2106/jbjs.rvw.19.00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Post-polio syndrome is characterized by a late functional deterioration (usually after >=15 years from the initial infection) in patients with a history of paralytic poliomyelitis infection, and it is defined by the March of Dimes criteria. Patients with post-polio syndrome are at increased risk for falls and associated hip and femoral fractures as a result of lower bone mineral density, decreased lean muscle mass, and musculoskeletal deformities.
Current evidence suggests that treatment modalities for femoral fractures should emphasize fixation that allows early progressive weight-bearing and ambulation to optimize functional outcomes. Good results after hip arthroplasty have been described with both cemented and uncemented implants in patients who have been treated for osteoarthritis, but there has been little evidence guiding hip fracture management. Anatomic challenges that are encountered are osteoporotic bone, a valgus neck-shaft angle, increased femoral anteversion, and a small femoral canal diameter.
Intramedullary nailing of hip and femoral fractures can be challenging due to the small femoral canal diameter that frequently is encountered. Alternative methods of fixation have shown promising results. These include the use of sliding hip screws for hip fracture management and fixed-angle locking plates for hip and femoral fracture management.
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Affiliation(s)
- Simon P Garceau
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Yaniv Warschawski
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael E Neufeld
- Division of Orthopaedics, Department of Adult Joint Reconstruction, Western University, London, Ontario, Canada
| | - Oleg A Safir
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John P Wade
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse I Wolfstadt
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
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Hoggett L, Cross C, Helm A. Acetabular revision using a dual mobility cup as treatment for dislocation in Charnley total hip arthroplasty. Bone Joint J 2020; 102-B:423-425. [PMID: 32228082 DOI: 10.1302/0301-620x.102b4.bjj-2019-1492.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS Dislocation remains a significant complication after total hip arthroplasty (THA), being the third leading indication for revision. We present a series of acetabular revision using a dual mobility cup (DMC) and compare this with our previous series using the posterior lip augmentation device (PLAD). METHODS A retrospective review of patients treated with either a DMC or PLAD for dislocation in patients with a Charnley THA was performed. They were identified using electronic patient records (EPR). EPR data and radiographs were evaluated to determine operating time, length of stay, and the incidence of complications and recurrent dislocation postoperatively. RESULTS A total of 28 patients underwent revision using a DMC for dislocation following Charnley THA between 2013 and 2017. The rate of recurrent dislocation and overall complications were compared with those of a previous series of 54 patients who underwent revision for dislocation using a PLAD, between 2007 and 2013. There was no statistically significant difference in the mean distribution of sex or age between the groups. The mean operating time was 71 mins (45 to 113) for DMCs and 43 mins (21 to 84) for PLADs (p = 0.001). There were no redislocations or revisions in the DMC group at a mean follow-up of 55 months (21 to 76), compared with our previous series of PLAD which had a redislocation rate of 16% (n = 9) and an overall revision rate of 25% (n = 14, p = 0.001) at a mean follow-up of 86 months (45 to 128). CONCLUSION These results indicate that DMC outperforms PLAD as a treatment for dislocation in patients with a Charnley THA. This should therefore be the preferred form of treatment for these patients despite a slightly longer operating time. Work is currently ongoing to review outcomes of DMC over a longer follow-up period. PLAD should be used with caution in this patient group with preference given to acetabular revision to DMC. Cite this article: Bone Joint J 2020;102-B(4):423-425.
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Affiliation(s)
- Lee Hoggett
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Charlotte Cross
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Anthony Helm
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
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Lack of early dislocation for dual mobility vs. fixed bearing total hip arthroplasty: A multi-center analysis of comparable cohorts. J Orthop 2020; 21:1-5. [PMID: 32071524 DOI: 10.1016/j.jor.2020.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background Dislocation is a major cause of morbidity and revision surgery following total hip arthroplasty (THA). To address such issues, dual mobility (DM) bearings were introduced as a more stable alternative to fixed-bearing (FB) prostheses. As such, we compared DM and FB systems in a cohort study in terms of dislocations, readmissions, and revisions. Methods A 27 multi-center retrospective review was performed of 664 DM and 218 FB cases from the same manufacturer with mean follow-up of 2.09 years and 1.83 years, respectively. Patient reported outcome measures (PROMs) including Harris Hip Score (HHS), SF12, EQ5D, and Lower Extremity Activity Score (LEAS) were evaluated as well as dislocation rates, readmissions, and revisions rates. We also performed a survivorship analysis through Kaplan-Meier estimator. Students t-test was used for normally distributed continuous data and Fisher exact test (P < 0.05) was used for discrete data. Results There were 0 dislocations in the DM (0%) group and 2 dislocations in the FB (0.92%) group (p = 0.06). Latest follow up HHS revealed a significant difference between groups (91.44 DM and 87.81 FB; p = 0.006). In addition, there was significant difference between DM and FB on SF12 Physical Component Score (PCS) (46.83 and 44.55, respectively, p = 0.015). Also, readmission rates at 30, 60 and 90 days remained lower for DM than for FB at each time point (1.05% vs. 2.75%, 1.81% vs. 2.75%, and 1.81% vs. 2.75, respectively). Overall, DM had a lower revision rate at 1.51% compared to 2.29% for FB (p = 0.24). The revision breakdown for DM revealed 0 (0%) for both Anatomic Dual Mobility (ADM) and Modular Dual Mobility (MDM) due to the acetabular component.) There was a difference, 14 (87.5%) for ADM and 2 (12.5%) due to the femoral component. The survivorship analysis revealed no significance difference between DM and FB at 4 years (97.90% and 97.26%, respectively). Conclusion In comparison to patients who undergo FB THA, DM bearings have improved PROMs and a lower rate of dislocation, readmission, and revision.
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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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Elbuluk AM, Coxe FR, Schimizzi GV, Ranawat AS, Bostrom MP, Sierra RJ, Sculco PK. Abductor Deficiency-Induced Recurrent Instability After Total Hip Arthroplasty. JBJS Rev 2020; 8:e0164. [DOI: 10.2106/jbjs.rvw.18.00164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dubin JA, Westrich GH. Anatomic dual mobility compared to modular dual mobility in primary total hip arthroplasty: a matched cohort study. Arthroplast Today 2019; 5:509-514. [PMID: 31886399 PMCID: PMC6920720 DOI: 10.1016/j.artd.2019.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 01/19/2023] Open
Abstract
Background Dual mobility (DM) has been used in primary total hip arthroplasty recently for their low dislocation rates, low revision rates, and improved patient functional outcomes. We compared 2 DM systems, anatomic dual mobility (ADM; Stryker, Mahwah, NJ) and modular dual mobility (MDM; Stryker, Mahwah, NJ), to determine differences in dislocation rates, revision rates, and patient outcome scores. Methods The study was a single-center matched retrospective review of prospectively collected data of patients who underwent primary total hip arthroplasty surgery with an ADM or MDM system by a single surgeon from 2012 to 2017. Demographics, operative details, postoperative patient-reported outcomes, and clinical outcomes were recorded. A Kaplan-Meier survivorship curve to compare survival time between groups was collected as well. Results Five hundred seventy-four patients were included in the study with 287 patients matched in each group with mean 2.86 years of follow-up. The dislocation rate in each cohort was 0%, the acetabular-specific revision rate was 0%, and in each cohort, overall revision rate in each cohort was 1.7%. In general, patient-reported outcomes were similar for each group (Harris Hip Score Pain (P = .919), Harris Hip Score Function (P = .736), Western Ontario and McMaster Universities Osteoarthritis Index (P = .139), Pain Visual Analog Scale (P = .146), Veterans RAND 12-Item Health Survey (P = .99), University of California, Los Angeles (P = .417), and Harris Hip Score Total (P = .136). There was a slight clinically insignificant increase in hip flexion between the cohorts favoring the ADM group (98.6 ± 9.8 vs 94.0 ± 9.7, P < .001). Conclusions Both DM systems had similar patient-reported outcomes that were quite favorable. At 2.86 years of follow-up, neither the ADM nor MDM systems demonstrated dislocation, and both had low acetabular-specific and overall revision rates in this matched cohort study.
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Affiliation(s)
- J A Dubin
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - G H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Fessy MH, Jacquot L, Rollier JC, Chouteau J, Ait-Si-Selmi T, Bothorel H, Chatelet JC. Midterm Clinical and Radiographic Outcomes of a Contemporary Monoblock Dual-Mobility Cup in Uncemented Total Hip Arthroplasty. J Arthroplasty 2019; 34:2983-2991. [PMID: 31444020 DOI: 10.1016/j.arth.2019.07.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The efficacy of contemporary monoblock dual-mobility (DM) cups to prevent dislocations in total hip arthroplasty (THA) is well reported, but there is little published data on their mid- to long-term outcomes. The authors aimed at reporting the 10-year survival of a contemporary DM cup as well as its clinical and radiographic outcomes. METHODS From a retrospective consecutive multicentric series of 516 patients (541 hips) that received uncemented THA between June 2007 and June 2010, 6 patients (6 hips) had cup and stem revisions, 5 patients (5 hips) had isolated stem revision, and 2 patients (2 hips) had isolated insert revision. A total of 103 patients (111 hips) died with their original implants, and 41 patients (42 hips) were lost to follow-up. This left 358 patients (375 hips) for clinical assessment at a median follow-up of 8.7 years (range, 6.8-10.5 years), including 279 patients (290 hips) with postoperative radiographs. Implant survival was calculated using the Kaplan-Meier method, and multivariable analyses were performed to determine whether clinical outcomes are associated with patient or surgical factors. RESULTS The 10-year survival considering revision for aseptic loosening as end point was 100% for the cup and 99.2% for the stem. No dislocations were observed, and radiographic assessment revealed 1 acetabular granuloma (0.3%), but no radiolucencies nor fractures. The Harris hip score improved from 49.6 ± 15.5 to 85.2 ± 14.5, and the postoperative Oxford hip score was 19.2 ± 7.6. Multivariable analyses revealed that improvement in Harris hip score increased with cup diameter (beta, 1.28; P = .039). CONCLUSION Our data confirmed satisfactory midterm outcomes of uncemented THA using a contemporary DM cup, with no dislocations nor cup revisions due to aseptic loosening. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Michel-Henri Fessy
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France; Artro Group Institute, Lyon, France
| | - Laurent Jacquot
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Jean-Charles Rollier
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Julien Chouteau
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Tarik Ait-Si-Selmi
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Jean-Christophe Chatelet
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Centre de Chirurgie Orthopédique du Beaujolais, Arnas, France
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Fahad S, Nawaz Khan MZ, Aqueel T, Hashmi P. Comparison of bipolar hemiarthroplasty and total hip arthroplasty with dual mobility cup in the treatment of old active patients with displaced neck of femur fracture: A retrospective cohort study. Ann Med Surg (Lond) 2019; 45:62-65. [PMID: 31372217 PMCID: PMC6660598 DOI: 10.1016/j.amsu.2019.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 01/28/2023] Open
Abstract
Background The standard treatment of displaced femoral neck fracture is arthroplasty. THA is reportedly superior to BHA in terms of hip pain, function and reoperation rate. On the other hand THA has a higher rate of dislocation. Total hip replacement with dual mobility cup increases the range of motion and reduces the chances of dislocation. The aim of this study is to compare the functional outcome, rate of dislocation, complications and mortality between BHA and THA with dual mobility cuff for the treatment of displaced neck of femur fracture. Patients and method This is a non-commercialized retrospective cohort study conducted at our tertiary care level 1 trauma centre. Patients of age group 60 years and above who underwent hip arthroplasty (BHA or THA with dual mobility implant) between 2015 and 2017 for displaced neck of femur fracture with a complete follow up for one year were included. Both groups were assessed for postoperative surgical complications including dislocation, fracture, surgical site infection, and medical complications, one-year mortality and functional outcome were analysed via Harris Hip Score (HHS) at the latest follow up. Results Overall 104 patients were included in the study out of which 77 patients underwent BHA while 27 underwent THA with dual mobility cup. Baseline characteristics were found to be similar in both groups. Mean pre-op HHS for bipolar group was found to be 71.01 while for THA with dual mobility cup group it was 73.52 with the difference being statistically insignificant (P = 0.12). Mean post-op HHS for bipolar group was noted to be 68.82 whereas for THA with dual mobility cup group it was 76.81. The difference was found to be statistically significant with a P-value of <0.01. With regards to post-operative complications and one-year post-operative mortality, no significant difference was noted between both groups. Conclusion In relatively young and active elderly patients with displaced neck of femur fracture, a THA with dual mobility cuff provides better hip functional outcome, does not increase mortality or morbidity as compared to BHA and can be considered as primary treatment modality. The standard treatment of displaced femoral neck fracture is arthroplasty. Total Hip Arthroplasty is reportedly superior to Bipolar Hemiarthroplasty in terms of hip pain, function and reoperation rate. Total Hip Arthroplasty has a higher rate of dislocation rate than Bipolar Hemiarthroplasty. Total Hip Arthroplasty with Dual mobility cup increases the functional outcome and reduces the chances of dislocation.
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Jones CW, De Martino I, D'Apolito R, Nocon AA, Sculco PK, Sculco TP. The use of dual-mobility bearings in patients at high risk of dislocation. Bone Joint J 2019; 101-B:41-45. [PMID: 30648492 DOI: 10.1302/0301-620x.101b1.bjj-2018-0506.r1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years. MATERIALS AND METHODS We performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum. RESULTS There were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation; there were no other dislocations. CONCLUSION At mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.
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Affiliation(s)
- C W Jones
- University of Sydney, Sydney, Australia
| | - I De Martino
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - R D'Apolito
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - A A Nocon
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - P K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
| | - T P Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York, USA
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A comparative study about the incidence of dislocation and peri-prosthetic fracture between dual mobility versus standard cups after primary total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2019; 43:2691-2695. [DOI: 10.1007/s00264-018-4279-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/18/2018] [Indexed: 01/18/2023]
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Affiliation(s)
- S Horriat
- The Princess Grace Hospital, London, UK
| | - F S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Chalmers BP, Ledford CK, Taunton MJ, Sierra RJ, Lewallen DG, Trousdale RT. Cementation of a Dual Mobility Construct in Recurrently Dislocating and High Risk Patients Undergoing Revision Total Arthroplasty. J Arthroplasty 2018; 33:1501-1506. [PMID: 29273288 DOI: 10.1016/j.arth.2017.11.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/09/2017] [Accepted: 11/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recurrent instability remains a challenge after revision total hip arthroplasty (THA). We report the outcomes of cementing a cementless dual mobility (DM) component into a stable acetabular shell for the treatment and/or prevention of instability in revision THA. METHODS Eighteen patients (18 THAs) undergoing revision THA with a specific monoblock DM construct cemented into a new acetabular component or an existing well-fixed component from 2011 to 2014 were retrospectively reviewed. Tumor prostheses and total femoral replacements were excluded. In 9 patients (50%), components were implanted specifically for recurrent dislocations. Mean age was 64 years; mean follow-up was 3 years. Patients underwent an average of 4 prior hip operations (range 2-6). RESULTS No cemented DM cups dissociated at the cement-cup interface. Three patients (17%) experienced a postoperative dislocation. One required a revision to constrained liner and 2 underwent open reduction with retention of the DM construct. Harris Hip Scores improved from 53 to 82 postoperatively (P < .001). CONCLUSION Cementation of a monoblock cup DM construct, an off-label use as the construct is not specifically made for cementation, into a well-fixed acetabular component provides an alternative to enhance prosthetic stability in (1) recurrently dislocating THAs with well fixed, well-positioned acetabular components and (2) complex acetabular reconstructions in which constraint should be avoided. While not a perfect solution in this series, DM constructs provide a number of advantages including no added constraint at the interface and a large effective femoral head to diminish prosthetic impingement.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Rivière C, Lazic S, Villet L, Wiart Y, Allwood SM, Cobb J. Kinematic alignment technique for total hip and knee arthroplasty: The personalized implant positioning surgery. EFORT Open Rev 2018; 3:98-105. [PMID: 29657851 PMCID: PMC5890135 DOI: 10.1302/2058-5241.3.170022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality. Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined. By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity. The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation. The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy. The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.
Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK; South West London Elective Orthopaedic Center, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Center, UK
| | | | - Yann Wiart
- Unfallchirurgie, Theresienkrankenhauss Mannheim, Germany
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Ayub K, Corrigan RA, Misra J, Galitzine S. Audio-visual distraction as an adjunct to standby anaesthesia in persons with paraplegia: a case series of five operations. Spinal Cord Ser Cases 2018; 4:5. [PMID: 29423310 DOI: 10.1038/s41394-017-0035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/10/2017] [Accepted: 11/11/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction Persons with paraplegia present complex challenges to anaesthetists. Complications experienced by these patients can require major orthoplastic surgery such as excision of infected bone and soft tissue due to pressure sores and soft tissue reconstruction. Anaesthetic strategies deemed both safe and acceptable to this population are essential. Case presentation We report a case series of five procedures in four patients with complete chronic spinal cord injury (CSCI) who underwent operations in lateral position under standby anaesthesia and audio-visual distraction (AVD) with minimal sedation. Patients' experience was formally assessed as part of the ongoing AVD service evaluation in our institution. All stated that they were not concerned in the operating theatre and felt "comfortable" or "very comfortable" throughout. All patients rated the experience as "better" than their previous experience with general anaesthesia and felt "very satisfied" with their anaesthetic. Importantly, all patients would recommend sedation with AVD to other patients. Discussion To our knowledge, this is the first report of AVD application as an adjunct to standby anaesthesia during major surgery in persons with paraplegia. Patient feedback was extremely positive, therefore it is likely that by making standby anaesthesia more acceptable to patients the use of AVD could reduce anaesthetic risk in this complex patient group.
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Affiliation(s)
- Khurram Ayub
- Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation Trust, Headley Way, Oxford, OX3 9DU UK
| | - Ruth A Corrigan
- Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation Trust, Headley Way, Oxford, OX3 9DU UK
| | - Jyoti Misra
- Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation Trust, Headley Way, Oxford, OX3 9DU UK
| | - Svetlana Galitzine
- Nuffield Department of Anaesthetics, Oxford University Hospitals Foundation Trust, Headley Way, Oxford, OX3 9DU UK
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Chalmers BP, Pallante GD, Taunton MJ, Sierra RJ, Trousdale RT. Can Dislocation of a Constrained Liner Be Salvaged With Dual-mobility Constructs in Revision THA? Clin Orthop Relat Res 2018; 476. [PMID: 29529660 PMCID: PMC6259719 DOI: 10.1007/s11999.0000000000000026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revision THA to treat recurrent instability can itself be complicated by recurrent instability, and when this occurs, this problem is difficult to treat. Some patients' THAs will continue to dislocate despite use of a constrained liner. One option in this difficult-to-treat group is conversion to a dual-mobility (DM) construct, but there are few data on this approach. QUESTIONS/PURPOSES (1) What were the Harris hip scores in a small group of patients whose constrained liners were converted to DM constructs to treat recurrent dislocation? (2) What were the redislocation, rerevision, and DM construct retention rates in these patients? METHODS We conducted a retrospective analysis of a longitudinally maintained institutional database maintained by individuals other than the treating surgeons to identify patients undergoing conversion of constrained liners to DM constructs in revision THA from 2011 to 2014. We identified 16 patients who underwent revision of dislocated constrained liners to DM constructs. Two patients died before 2-year followup, leaving 14 patients available for followup at a minimum of 24 months and a median of 37 months (range, 24-71 months). Indications for conversion to DM constructs included patients with dislocation of multiple prior constrained liners, patients with at least partial abductor functioning and soft tissue tensioning, and patients at very high risk for recurrent instability as an alternative to resection arthroplasty. Ten patients (10 of 14) underwent DM conversion at the time of cup revision, whereas four patients (four of 14) had a DM construct cemented into a preexisting cup. Median age was 65 years (range, 53-93 years). Median number of prior hip surgeries was five (range, three to 10) and seven patients (seven of 14) had dislocated more than one constrained liner. RESULTS Harris hip score improved from a median of 57 (range, 55-67) to 84 (range, 68-96) postoperatively (p < 0.001). Three patients (three of 14) experienced a redislocation. Two (two of 14) of these patients were closed reduced and treated successfully nonoperatively; one (one of 14) patient experienced an intraprosthetic dislocation and underwent modular exchange. One patient (one of 14) underwent early resection arthroplasty for acetabular loosening after complex acetabular reconstruction. Overall, all other patients (13 of 14) retained a DM construct at final followup. CONCLUSIONS Conversion to a DM construct shows promise as a salvage option in high-risk, multiply operated on patients with dislocated constrained liners undergoing revision THA for recurrent instability. The ability to close reduce a dislocated DM construct is a distinct advantage over constrained liners. However, longer followup is required given that three of 14 redislocated, and one of those underwent revision for persistent instability at short-term followup. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Abstract
Aims Instability remains a challenging problem in both primary and revision total hip arthroplasty (THA). Dual mobility components confer increased stability, but there are concerns about the unique complications associated with these designs, as well as the long-term survivorship. Materials and Methods We performed a systematic review of all English language articles dealing with dual mobility THAs published between 2007 and 2016 in the MEDLINE and Embase electronic databases. A total of 54 articles met inclusion criteria for the final analysis of primary and revision dual mobility THAs and dual mobility THAs used in the treatment of fractures of the femoral neck. We analysed the survivorship and rates of aseptic loosening and of intraprosthetic and extra-articular dislocation. Results For the 10 783 primary dual mobility THAs, the incidence of aseptic loosening was 1.3% (142 hips); the rate of intraprosthetic dislocation was 1.1% (122 hips) and the incidence of extra-articular dislocation was 0.46% (41 hips). The overall survivorship of the acetabular component and the dual mobility components was 98.0%, with all-cause revision as the endpoint at a mean follow-up of 8.5 years (2 to 16.5). For the 3008 revision dual mobility THAs, the rate of aseptic acetabular loosening was 1.4% (29 hips); the rate of intraprosthetic dislocation was 0.3% (eight hips) and the rate of extra-articular dislocation was 2.2% (67 hips). The survivorship of the acatabular and dual mobility components was 96.6% at a mean of 5.4 years (2 to 8). For the 554 dual mobility THAs which were undertaken in patients with a fracture of the femoral neck, the rate of intraprosthetic dislocation was 0.18% (one hip), the rate of extra-articular dislocation was 2.3% (13 hips) and there was one aseptic loosening. The survivorship was 97.8% at a mean of 1.3 years (0.75 to 2). Conclusion Dual mobility articulations are a viable alternative to traditional bearing surfaces, with low rates of instability and good overall survivorship in primary and revision THAs, and in those undertaken in patients with a fracture of the femoral neck. The incidence of intraprosthetic dislocation is low and limited mainly to earlier designs. High-quality, prospective, comparative studies are needed to evaluate further the use of dual mobility components in THA. Cite this article: Bone Joint J 2018;100-B:11–19.
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Affiliation(s)
- B. Darrith
- Rush University Medical Center, 1611
W. Harrison St, Suite 300, Chicago, Illinois 60612, USA
| | - P. M. Courtney
- Rothman Institute, Thomas Jefferson University
Hospital, 925 Chestnut St., Phildelphia, 19107, USA
| | - C. J. Della Valle
- Rush University Medical Center, 1611
W. Harrison St, Suite 300, Chicago, Illinois 60612, USA
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