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Falgiano PA, Rowland RJ, Heifner JJ, Corces A. Dual-mobility with modular components for primary total hip arthroplasty in bilateral bony ankylosis of the hips: A case report. Int J Surg Case Rep 2024; 122:110161. [PMID: 39159594 DOI: 10.1016/j.ijscr.2024.110161] [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: 06/24/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary total hip arthroplasty (THA) is a procedure performed in the United States for a variety of indications, with operation rates slated to increase over 275 % by 2040 when compared to 2014 (Thilak et al., 2015). Dual-mobility (DM) implants have gained popularity in the United States since gaining approval in the early 2010s (Heckmann et al., 2020). It has been well reported that DM implants decrease the risk of dislocation after primary and revision THA (Vielpeau et al., 2011; Donovan et al., 2022; Heifner et al., 2023; Foissey et al., 2023; Schmidt et al., 2020; Neri et al., 2019). CASE PRESENTATION We present the case of a 33-year-old male with a suspected ankylosing spondylitis (AS) diagnosis and bilateral bony ankylosis of the hips who underwent staged THA with modular dual-mobility (MDM) implants. At one year post-operatively, the patient is walking without the use of an assistive device and reports a VAS pain score of 0 at rest and 2 with activity and HHS of 90. CLINICAL DISCUSSION Implant selection is important in this patient population due to the increased risk of dislocation. Contemporary reports reveal MDM implants have demonstrated a substantial reduction in dislocation risk compared to fixed-bearing implants in patients with a high risk of dislocation. We opted to place the acetabular component inside the safe zone to improve stability and use the dual-mobility prosthesis to achieve our desired range of motion. CONCLUSION The improved stability of DM implants allows for a greater range of acetabular positions in patients who have a highly unpredictable functional outcome at the time of surgery. Our preliminary results contribute to the growing list of indications for MDM total hip arthroplasty.
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Affiliation(s)
| | - Robert J Rowland
- Larkin Hospital Department of Orthopedic Surgery, Miami, FL, USA
| | | | - Arturo Corces
- Larkin Hospital Department of Orthopedic Surgery, Miami, FL, USA
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Sephton BM, Havenhand T, Mace JWA. Outcomes of Dual Mobility Versus Fixed Bearing Components in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2024:S0883-5403(24)00809-X. [PMID: 39128780 DOI: 10.1016/j.arth.2024.08.005] [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: 03/16/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024] Open
Abstract
AIMS Dual mobility (DM) implants have received increasing interest in revision surgery due to their increased stability. The aim of this systematic review was to compare outcomes of DM versus conventional fixed bearing (FB) implants in revision Total Hip Arthroplasty (r-THA). METHODS A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included re-revision due to dislocation, re-revision for other causes, all-cause re-revision, total complication rate, and functional outcome measures. The Methodological Index for Non-Randomized Studies (MINORS) assessment tool was used to evaluate methodological quality and the risk of bias. A pooled meta-analysis was conducted, with an assessment of heterogeneity using the Chi-square and Higgins I2 tests. A further sub-group analysis was performed between DM implants and larger femoral head (> 36 mm) FB implants. RESULTS A total of 13 studies met the final inclusion criteria, with an overall number of 5,004 r-THA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of re-revision due to dislocation (OR [odds ratio] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause re-revision (OR 0.55, P < 0.001) compared to FB implants. No significant difference was seen in the odds of re-revision due to periprosthetic joint infection (PJI) (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the two groups. The total number of complications showed an odds benefit in favor of DM implants (OR 0.43, P < 0.001). In the subgroup analysis, there was no significant difference in the odds of re-revision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants. CONCLUSION Based upon current literature, it appears DM implants are an effective modality for reducing dislocation following r-THA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials (RCTs) with longer term follow up are required.
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Di Gangi C, Prinos A, Buehring W, Meere PA, Meftah M, Hepinstall MS. Fewer Dislocations After Total Hip Arthroplasty With Robotic Assistance or Fluoroscopic Guidance. J Arthroplasty 2024:S0883-5403(24)00688-0. [PMID: 39002766 DOI: 10.1016/j.arth.2024.07.002] [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: 12/16/2023] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Computer navigation and robotic assistance may reduce total hip arthroplasty (THA) dislocations by improving the accuracy and precision of component positioning. We investigated dislocation rates for THAs using conventional techniques, robotic assistance, and computer navigation, while controlling for surgical approach, dual mobility (DM) use, and fluoroscopic guidance. METHODS We reviewed 11,740 primary THAs performed between June 2016 and December 2022, including 5,873 conventional, 1,293 with robotic-arm assistance, and 4,574 with navigation. The approach was posterior in 6,580 (56.0%), anterior in 4,342 (37.0%), and lateral in 818 (7.0%). A DM was used in 10.4%. Fluoroscopy was used in 3,653 cases and only with the anterior approach. Multivariate analyses yielded odds ratios (OR) for dislocation and revision. Additional regression analyses for dislocation were performed for approach and DM. RESULTS Raw dislocation rates were as follows: conventional 1.2%, robotic 0.4%, navigation 0.9%, anterior with fluoroscopy 0.4%, anterior without fluoroscopy 2.3%, posterior 1.3%, and lateral 0.5%. Upon multivariate analysis, use of robotics was found to be associated with significantly reduced dislocation risk compared to conventional (OR: 0.3), as did anterior (OR: 0.6) compared to posterior approach; navigation and lateral approach were not found to be associated with a significant reduction in risk. For the anterior approach, multivariate analysis demonstrated that fluoroscopy significantly reduced dislocation risk (OR: 0.1), while DM, robotics, and navigation were not significant. For the posterior approach, the dislocation risk was lower with robotics than with conventional (OR: 0.2); the use of navigation or DM did not demonstrate a significant reduction in risk. CONCLUSIONS The use of robotics was associated with a reduction in dislocations for this cohort overall. Further, fluoroscopy in the anterior approach and robotic assistance in the posterior approach were both associated with decreased dislocation risk. The role of imageless computer navigation and DM implants requires further study.
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Affiliation(s)
- Catherine Di Gangi
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Alana Prinos
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Weston Buehring
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Patrick A Meere
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Morteza Meftah
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
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Anatone AJ, Hughes AJ, Schiller NC, Vigdorchik JM, Sculco TP, Sculco PK. Decreased "Polar Axis Angle" is Associated With Instability After Total Hip Arthroplasty: A New Method to Assess Functional Component Position on Lateral-Seated Radiographs. J Arthroplasty 2024:S0883-5403(24)00640-5. [PMID: 38909855 DOI: 10.1016/j.arth.2024.06.039] [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: 02/29/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Research on hip instability has focused on establishing "safe" ranges of combined component position in supine posture or functional placement of the acetabular component based on the hip-spine relationship. A new angle, the polar axis angle (PAA), of the total hip arthroplasty (THA) components describes the concentricity of both components and can be evaluated in functional positions that confer a greater risk of instability (ie, sitting). The goal of this study was to compare the PAA in functional positions between patients who experienced a postoperative dislocation and a matched control group who did not have a dislocation. METHODS An institutional database was searched for patients experiencing a dislocation after primary THA. Patients who had postoperative full-length standing and lateral-seatedradiographs were included in the dislocator group. A control group of nondislocator patients was matched 2:1 by age, body mass index, sex, and hip-spine classification. Radiographic measurements of the neck angle, acetabular ante-inclination, and PAA were performed by 2 separate blinded, trained reviewers. RESULTS The lateral-seated neck angle and lateral-seated PAA measurements were significantly lower in the dislocator groups (n = 37) than the control group (n = 74) (23 versus 33 degrees, P < .001; 74 versus 83 degrees, P = .012, respectively). Significant differences were also observed in changes in the polar axes and neck angles between standing and seated positions (P < .001 and P < .001, respectively). When comparing patients who have mobile spines versus stiff spines within the dislocator group, there were no differences in the acetabular, neck, or PAAs. The effect of neck angle on the PAA showed a linear trend across cohorts. CONCLUSIONS Patients who experience postoperative instability have a significantly lower PAA on lateral-seated radiographs when matched for age, sex, body mass index, and hip-spine classification. In addition, the lower seated PAA is driven more strongly by decreased functional femoral anteversion, which emphasizes the role of functional femoral version on stability in THA.
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Affiliation(s)
- Alex J Anatone
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Andrew J Hughes
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Nicholas C Schiller
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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5
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Regis D, Cason M, Magnan B. Dislocation of primary total hip arthroplasty: Analysis of risk factors and preventive options. World J Orthop 2024; 15:501-511. [PMID: 38947255 PMCID: PMC11212535 DOI: 10.5312/wjo.v15.i6.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/10/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
Total hip arthroplasty (THA) is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease. However, dislocation continues to be a troublesome complication after THA, as it is a leading cause of revision and is associated with substantial social, health, and economic costs. It is a relatively rare, usually early occurrence that depends on both the patients' characteristics and the surgical aspects. The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility, which is closely related to the incidence of dislocation. Consequently, clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup. Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA. Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size, dual mobility constructs, constrained liners, and modular neck stems.
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Affiliation(s)
- Dario Regis
- Department of Orthopedic and Trauma Surgery, Integrated University Hospital, Verona 37126, Veneto, Italy
| | - Mattia Cason
- Department of Orthopedic and Trauma Surgery, Integrated University Hospital, Verona 37126, Veneto, Italy
| | - Bruno Magnan
- Department of Orthopedic and Trauma Surgery, Integrated University Hospital, Verona 37126, Veneto, Italy
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Shaker F, Soleimani M, Shafiei SH. Letter to the Editor on "Dislocation Following Anterior and Posterior Total Hip Arthroplasty in the Setting of Spinal Deformity and Stiffness: Evolving Trends Using a High-Risk Protocol at a Single Tertiary Center". J Arthroplasty 2024; 39:e35-e36. [PMID: 38642966 DOI: 10.1016/j.arth.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/06/2023] [Accepted: 01/07/2024] [Indexed: 04/22/2024] Open
Affiliation(s)
- Farhad Shaker
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Shafiei
- Orthopedic Department, Orthopedic Surgery Research Center (OSRC), Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Macdonald H, Gardner A, Sayers A, Evans J, Whitehouse MR. A Meta-Analysis to Evaluate Implant Survival and Benefits of the Use of Dual Mobility Constructs in Total Hip Replacement Following Hip Fracture. Cureus 2024; 16:e58755. [PMID: 38779264 PMCID: PMC11111099 DOI: 10.7759/cureus.58755] [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: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Total hip replacement (THR) is commonly performed to treat hip fractures. Dual-mobility constructs (DMCs) are increasingly used for this indication. The aim of this study was to use evidence synthesis techniques to estimate net all-cause construct survival for THR with DMC performed for hip fracture. Additionally, we aimed to investigate and describe differences in all-cause construct survival (if present) between THRs performed with DMC (DMC-THR) or with a conventional bearing construct following hip fracture. We performed a systematic review and meta-analysis of published studies (including joint registries), including DMC-THR for hip fracture which provided Kaplan-Meier (KM) survival estimates. The primary outcome was all-cause construct survival over time. The study was prospectively registered on PROSPERO (CRD42020173117). A total of 557 papers and 17 registry reports were identified. Six studies (four registry reports, one matched-pair cohort study utilising joint registry data, and one single-institution case series) met the inclusion criteria, including 17,370 DMC THRs and 167,377 conventional THRs. Five-year KM survival estimates (95% confidence intervals) were similar at 95.4% (94.9 to 95.8%) for DMC-THR and 96.2% (96.0 to 96.4%) for conventional THR. The relative risk of revision for DMC-THR at five years was 1.21 (1.05 to 1.41). These results suggest that DMC-THR has a lower all-cause survival than conventional THR following hip fracture. This analysis does not support the routine use of DMC-THR over conventional bearing THR.
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Affiliation(s)
| | - Andrew Gardner
- Trauma and Orthopaedics, University of Bristol, Bristol, GBR
| | - Adrian Sayers
- Bristol Medical School, University of Bristol, Bristol, GBR
| | - Jon Evans
- Trauma and Orthopaedics, University of Bristol, Bristol, GBR
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Wilson JM, Trousdale RT, Bedard NA, Lewallen DG, Berry DJ, Abdel MP. Cemented dual-mobility constructs in uncemented revision acetabular components. Bone Joint J 2024; 106-B:352-358. [PMID: 38555941 DOI: 10.1302/0301-620x.106b4.bjj-2023-1061.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell. The goal of this study was to describe the implant survival, complications, and radiological outcomes of this construct. Methods We identified 64 patients (65 hips) who had a single-design cemented DM cup cemented into an uncemented acetabular shell during revision THA between 2018 and 2020 at our institution. Cups were cemented into either uncemented cups designed for liner cementing (n = 48; 74%) or retained (n = 17; 26%) acetabular components. Median outer head diameter was 42 mm. Mean age was 69 years (SD 11), mean BMI was 32 kg/m2 (SD 8), and 52% (n = 34) were female. Survival was assessed using Kaplan-Meier methods. Mean follow-up was two years (SD 0.97). Results There were nine cemented DM cup revisions: three for periprosthetic joint infection, three for acetabular aseptic loosening from bone, two for dislocation, and one for a broken cup-cage construct. The two-year survivals free of aseptic DM revision and dislocation were both 92%. There were five postoperative dislocations, all in patients with prior dislocation or abductor deficiency. On radiological review, the DM cup remained well-fixed at the cemented interface in all but one case. Conclusion While dislocation was not eliminated in this series of complex revision THAs, this technique allowed for maximization of femoral head diameter and optimization of effective acetabular component position during cementing. Of note, there was only one failure at the cemented interface.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas A Bedard
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Streck LE, Chiu YF, Haralambiev L, Boettner F. The Surgical Approach Impacts Component Selection in Total Hip Arthroplasty: A Matched Cohort Study of 7,460 Hips. J Arthroplasty 2024; 39:739-743. [PMID: 37633508 DOI: 10.1016/j.arth.2023.08.066] [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: 05/18/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND A higher risk of dislocation following total hip arthroplasty (THA) has been reported for the posterior approach (PA) compared to the anterior approach (AA). Dual mobility implants, larger head sizes, and elevated or face-changing liners can reduce the risk for dislocation. It remains unclear whether the component selection is influenced by the surgical approach. METHODS This is a retrospective study of 7,048 patients who underwent 7,460 primary THA with either AA or PA for primary hip osteoarthritis or osteonecrosis of the femoral head between 2019 and 2021. A propensity score model based on age, body mass index, height, and American Association of Anesthesiologists Score was applied. There were 2,502 AA-THA matched with 4,958 PA-THA (2,456 1:2, and 46 1:1). Groups were compared with multiple linear regression analyses/multivariate logistic regressions after controlling for American Association of Anesthesiologists Score and body mass index. In a second step, only hips operated by surgeons using both approaches were matched 1:1 (1,204 PA and AA, respectively). The same statistics were performed after controlling for "surgeon". RESULTS The PA was associated with a more frequent use of dual mobility implants, elevated liners, face-changing liners, as well as heads with 36 mm or larger diameters, and the implanted cups were significantly larger (P < .001, respectively). These findings were consistent for both matched cohorts. CONCLUSION The surgical approach impacts the component selection in THA. Patients undergoing PA-THA are more likely to receive implants with larger head size or stabilizing features compared to AA-THA.
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Affiliation(s)
- Laura E Streck
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Hospital for Special Surgery, Biostats Core, Research Administration, New York, New York
| | - Lyubomir Haralambiev
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, New York
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, New York
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Giai Via R, Migliorini F, Bosco F, Onorato F, Secco DC, Giustra F, Lavia AD, Giachino M, Massè A. Superior outcomes of total hip arthroplasty without prior lumbar arthrodesis: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:699-711. [PMID: 37847406 PMCID: PMC10857961 DOI: 10.1007/s00590-023-03761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The number of patients undergoing total hip arthroplasty (THA) surgery after previous lumbar arthrodesis (LA) is rising. Literature suggests that LA may significantly impact pelvic biomechanics and potentially compromise the success of prosthetic hip replacement. This study aims to evaluate complication rates, dislocation rates, and revision rates in patients with prior LA undergoing THA surgery compared to those undergoing THA surgery without prior LA. METHODS A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A PICOS template was developed to ensure a structured approach. The search for relevant studies was performed across five databases, including Pubmed, Scopus, Embase, Medline, and Cochrane. The selected articles were evaluated based on the Levels of Evidence (LoE) criteria. The Coleman Methodology Score (mCMS) was employed to analyze the retrospective studies. This systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that allowed for a meta-analysis performed using R software, a p < 0.05 was considered statistically significant. RESULTS The final analysis included seventeen studies comprising a total of 3,139,164 cases of THA. Among these cases, 3,081,137 underwent THA surgery alone, while 58,027 patients underwent THA with a previous LA. The study investigated various factors, including dislocation rates, revision rates, and complication, as well as the surgical approach and type of implant used, for both the THA-only group and the group of patients who underwent THA with prior LA. The analysis revealed a statistically significant difference (p < 0.05) for all variables studied, favoring the group of patients who underwent THA alone without prior LA. CONCLUSIONS This systematic review and meta-analysis demonstrated a statistically significant superiority in all analyzed outcomes for patients who underwent THA-only without prior LA. Specifically, patients with isolated THA implants experienced significantly lower incidences of THA dislocation, wound complications, periprosthetic joint infection, revision, and mechanical complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Riccardo Giai Via
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Francesco Bosco
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy.
| | - Francesco Onorato
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Davide Carlo Secco
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | | | - Matteo Giachino
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Alessandro Massè
- Centro Traumatologico Ortopedico (CTO), Department of Orthopaedic Surgery, University of Turin, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
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Kim JS, Moon NH, Do MU, Jung SW, Suh KT, Shin WC. The use of dual mobility acetabular cups in total hip replacement reduces dislocation rates in hip dysplasia patients. Sci Rep 2023; 13:22404. [PMID: 38104208 PMCID: PMC10725439 DOI: 10.1038/s41598-023-49703-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
Total hip replacement arthroplasty (THA) in hip dysplasia patients has a higher dislocation rate than in patients with simple hip osteoarthritis due to anatomical deformation. Therefore, to reduce postoperative THA dislocation is the challenge for arthroplasty surgeons. From 2015 to 2020, 1525 patients underwent THA performed by two surgeons at a single institution. A total of 152 patients involving 172 THAs were included. The patients were classified into dual-mobility (DM) and fixed-bearing (FB) acetabular cup groups. The occurrence of postoperative dislocation and functional evaluation of the hip joint, was analyzed before and after surgery using the modified Harris hip score(mHHS). There was no difference in the preoperative demographics and radiographic parameters between the groups. The incidence of postoperative hip dislocation was significantly lower in the DM group (DM 0% vs. FB 9.0%) (P value = 0.003). The mHHS showed no difference before surgery and after surgery (DM 91.80 vs FB 92.03). Treating hip dysplasia patients with THA using a dual-mobility acetabular cup can reduce postoperative dislocations, and could be used for the better management of these patients.
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Affiliation(s)
- Jung Shin Kim
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Min Uk Do
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sung Won Jung
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Sehung Hospital, Busan, Republic of Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
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Heifner JJ, Keller LM, Fox YM, Sakalian PA, Corces A. The Performance of Primary Dual-Mobility Total Hip Arthroplasty in Patients Aged 55 Years and Younger: A Systematic Review. Arthroplast Today 2023; 24:101241. [PMID: 38023650 PMCID: PMC10661692 DOI: 10.1016/j.artd.2023.101241] [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: 08/23/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Dual-mobility (DM) total hip arthroplasty (THA) combines the stabilization advantage provided by large head articulation with the low friction advantage provided by small head articulation. There is momentum for DM to be used in a wider selection of patients, with some advocating for DM to be the routine primary total hip construct. Further investigation is needed to determine whether the use of DM in younger adults is validated by aggregate data. Our objective was to review the literature for the clinical performance of DM THA in patients aged 55 years and younger. Methods A systematic review of the literature was performed according to the guidelines of Preferred Reporting in Systematic Reviews and Meta-Analyses. Inclusion in the review required clinical outcome reporting for DM primary THA in ambulatory patients aged 55 years or younger. The risk of bias was appraised using the Cochrane risk of bias in nonrandomized studies of interventions and the quality of the evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Results Across a sample of 1048 cases, the frequency weighted term of follow-up was 87.7 months. The pooled rate of revision was 9.5%. The Harris Hip Score significantly improved from 49.1 preoperatively to 93 postoperatively. The Postel-Merle d'Aubigné score significantly improved from 10.5 preoperatively to 17.1 postoperatively. Conclusions The literature demonstrates satisfactory short-term outcomes with a mitigated risk of dislocation for DM used as primary THA in patients aged 55 years and younger. The current findings suggest that third-generation designs provide reduced rates of intraprosthetic dislocation and improved survivorship.
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Affiliation(s)
| | - Leah M. Keller
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Yitzak M. Fox
- Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, FL, USA
| | - Philip A. Sakalian
- Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, FL, USA
| | - Arturo Corces
- Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, FL, USA
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Shin HS, Kim DH, Kim HS, Ahn HS, Kim Y. Dislocation after Revision Total Hip Arthroplasty: A Comparison between Dual Mobility and Conventional Total Hip Arthroplasty. Hip Pelvis 2023; 35:233-237. [PMID: 38125272 PMCID: PMC10728044 DOI: 10.5371/hp.2023.35.4.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/22/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose The objective of this study was to analyze the results from a cohort of patients who underwent a revision total hip arthroplasty (THA) using a dual mobility cup (DMC) implant. Materials and Methods A retrospective review of revised THAs was conducted using the database from a single tertiary referral hospital. A total of 91 revision THAs from 91 patients were included in the study. There were 46 male hips and 45 female hips. The mean age was 56.3±14.6 years, and the mean follow-up period was 6.4±5.9 years. In performance of revision THAs, the DMC implants were used in 18 hips (19.8%), and the conventional implants were used in 73 hips (80.2%). Results During the follow-up period, three dislocations were identified, and the overall dislocation rate was 3.3%. Early dislocation (at one month postoperatively) occurred in one patient, while late dislocation (at a mean of 7.5 years) occurred in two patients. There was no occurrence of dislocation in the DMC group (0%), and three dislocations were detected in the conventional group (4.1%). However, no significant difference in the rate of dislocation was observed between the two groups (P=0.891). Conclusion Although the rate of dislocation was higher in the conventional group, there were no statistically significant differences between the two groups due to the small number of patients. Nevertheless, we believe that the dual mobility design is advantageous in terms of reducing dislocation rate and can be recommended as an option for a revision THA.
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Affiliation(s)
- Hyun Sik Shin
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Dong-Hong Kim
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hyung Seok Kim
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hyung Seob Ahn
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Yeesuk Kim
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea
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Wilson EJ, Fricka KB, Ho H, Hamilton WG, Sershon RA. Early Practice All-Cause Complications for Fellowship-Trained Anterior Hip Surgeons Are Not Increased When Compared to "Gold Standard" Experienced Posterior Approach Surgeons. J Arthroplasty 2023; 38:2355-2360. [PMID: 37179026 DOI: 10.1016/j.arth.2023.05.008] [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: 12/12/2022] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Increased complication rates have been reported during the learning curve for direct anterior approach (DAA) total hip arthroplasty (THA). However, emerging literature suggests that complications associated with the learning curve may be substantially reduced with fellowship training. METHODS Our institutional database was queried to identify 2 groups: (1) 600 THAs comprised of the first 300 consecutive cases performed by 2 DAA fellowship-trained surgeons; and (2) 600 posterolateral approach (PA) THAs, including the most recent 300 primary cases performed by 2 experienced PA surgeons. All-cause complications, revision rates, reoperations, operative times, and transfusion rates were evaluated. RESULTS Comparing DAA and PA cases, there were no significant differences in rates of all-cause complications (DAA = 18, 3.0% versus PA = 23, 3.8%; P = .43), periprosthetic fractures (DAA = 5, 0.8% versus PA = 10, 1.7%; P = .19), wound complications (DAA = 7, 1.2% versus PA = 2, 0.3%; P = .09), dislocations (DAA = 2, 0.3% versus PA = 8, 1.3%, P = .06), or revisions (DAA = 2, 0.3% versus PL = 5, 0.8%; P = .45) at 120 days postoperatively. There were 4 patients who required reoperation for wound complications, all within the DAA group (DAA = 4, 0.67% versus PA = 0; P = .045). Operative times were shorter in the DAA group (DAA <1.5 hours = 93% versus PA <1.5 hours = 86%; P < .01). No blood transfusions were given in either group. CONCLUSION In this retrospective study, DAA THAs performed by fellowship-trained surgeons early in practice were not associated with higher complication rates compared to THAs performed by experienced PA surgeons. These results suggest that fellowship training may allow DAA surgeons to complete their learning curve period with complication rates similar to experienced PA surgeons.
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Affiliation(s)
- Eric J Wilson
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
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15
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Lung BE, Donnelly MR, Callan K, McLellan M, Taka T, Stitzlein RN, McMaster WC, So DH, Yang S. Preoperative demographics and laboratory markers may be associated with early dislocation after total hip arthroplasty. J Exp Orthop 2023; 10:100. [PMID: 37801165 PMCID: PMC10558409 DOI: 10.1186/s40634-023-00659-z] [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: 03/05/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE The purpose of this study was to identify modifiable medical comorbidities, laboratory markers and flaws in perioperative management that increase the risk of acute dislocation in total hip arthroplasty (THA) patients. METHODS All THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program (NSQIP) database. Demographic data, preoperative laboratory values, recorded past medical history, operative details as well as outcome and complication information were collected. The study population was divided into two cohorts: non-dislocation and dislocation patients. Statistics were performed to compare the characteristics of both cohorts and to identify risk factors for prosthetic dislocation (α < 0.05). RESULTS 275,107 patients underwent primary THA in 2007 to 2020, of which 1,258 (0.5%) patients experienced a prosthetic hip dislocation. Demographics between non-dislocation and dislocation cohorts varied significantly in that dislocation patients were more likely to be female, older, with lower body mass index and a more extensive past medical history (all p < 0.05). Moreover, hypoalbuminemia and moderate/severe anemia were associated with increased risk of dislocation in a multivariate model (all p < 0.05). Finally, use of general anesthesia, longer operative time, and longer length of hospital stay correlated with greater risk of prosthetic dislocation (all p < 0.05). CONCLUSIONS Elderly female patients and patients with certain abnormal preoperative laboratory values are at risk for sustaining acute dislocations after index THA. Careful interdisciplinary planning and medical optimization should be considered in high-risk patients as dislocations significantly increase the risk of sepsis, cerebral vascular accident, and blood transfusions on readmission.
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Affiliation(s)
- Brandon E Lung
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA.
| | - Megan R Donnelly
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Kylie Callan
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Maddison McLellan
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Taha Taka
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Russell N Stitzlein
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - William C McMaster
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - David H So
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
| | - Steven Yang
- Irvine School of Medicine, Department of Orthopaedic Surgery, University of California, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, USA
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Mika AP, Martin JR, Engstrom SM, Polkowski GG, Wilson JM. Assessing ChatGPT Responses to Common Patient Questions Regarding Total Hip Arthroplasty. J Bone Joint Surg Am 2023; 105:1519-1526. [PMID: 37459402 DOI: 10.2106/jbjs.23.00209] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND The contemporary patient has access to numerous resources on common orthopaedic procedures before ever presenting for a clinical evaluation. Recently, artificial intelligence (AI)-driven chatbots have become mainstream, allowing patients to engage with interfaces that supply convincing, human-like responses to prompts. ChatGPT (OpenAI), a recently developed AI-based chat technology, is one such application that has garnered rapid growth in popularity. Given the likelihood that patients may soon call on this technology for preoperative education, we sought to determine whether ChatGPT could appropriately answer frequently asked questions regarding total hip arthroplasty (THA). METHODS Ten frequently asked questions regarding total hip arthroplasty were posed to the chatbot during a conversation thread, with no follow-up questions or repetition. Each response was analyzed for accuracy with use of an evidence-based approach. Responses were rated as "excellent response not requiring clarification," "satisfactory requiring minimal clarification," "satisfactory requiring moderate clarification," or "unsatisfactory requiring substantial clarification." RESULTS Of the responses given by the chatbot, only 1 received an "unsatisfactory" rating; 2 did not require any correction, and the majority required either minimal (4 of 10) or moderate (3 of 10) clarification. Although several responses required nuanced clarification, the chatbot's responses were generally unbiased and evidence-based, even for controversial topics. CONCLUSIONS The chatbot effectively provided evidence-based responses to questions commonly asked by patients prior to THA. The chatbot presented information in a way that most patients would be able to understand. This resource may serve as a valuable clinical tool for patient education and understanding prior to orthopaedic consultation in the future.
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Affiliation(s)
- Aleksander P Mika
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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17
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Wilson JM, Mika A, Martin JR. Removing Cemented Dual Mobility Liners From Acetabular Components: A Technical Tip for a Challenging Surgical Problem. Arthroplast Today 2023; 23:101211. [PMID: 37781023 PMCID: PMC10541465 DOI: 10.1016/j.artd.2023.101211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/11/2023] [Accepted: 08/01/2023] [Indexed: 10/03/2023] Open
Abstract
Dislocation remains the leading cause of failure following revision total hip arthroplasty. Dual mobility (DM) constructs, including monoblock cups designed for cementation, reduce but do not eliminate this risk. Cemented DM constructs offer several unique advantages in revision total hip arthroplasty, and as such, they have gained popularity. Despite their advantages, a portion of these implants will require revision for infection or recurrent dislocation. Removal of a cemented DM cup presents numerous challenges, and there is no effective published technique. Here, we present an effective technique for the safe removal of one design of cemented DM cup.
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Affiliation(s)
- Jacob M. Wilson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aleksander Mika
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J. Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Unter Ecker N, Sangaletti R, Ohlmeier M, Akkaya M, Ekhtiari S, Klaber I, Gehrke T, Citak M. What is the rate of successful closed reduction of dislocated dual mobility cups following complex revision hip arthroplasty? Arch Orthop Trauma Surg 2023; 143:6439-6445. [PMID: 37000267 DOI: 10.1007/s00402-023-04826-w] [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: 12/18/2022] [Accepted: 02/26/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE The aim of this study was to assess the difference in success rates of closed reduction in septic and aseptic revision total hip arthroplasty (THA) performed with a dual mobility (DM) implant. Our objective was to answer the following questions: (1) Is there a difference in success rates of closed reduction between septic and aseptic revision THA with a DM implant? (2) Is closed or open reduction more successful in preventing re-dislocation? METHODS Between January 2009 and October 2021, 924 revisions were performed with a DM implant. All patients presenting to our institution with a dislocation following septic or aseptic revision THA using a cemented DM cup were included in this study. We analyzed 106 cases of dislocation in 74 patients. For all patients, we collected reason for revision, and classified index surgery as septic or aseptic. RESULTS Overall, 106 dislocations occurred (106/924, 11.5%). Thirty-nine cases (52.7%) had a dislocation after a septic exchange THA, while in 35 patients (47.3%), a dislocation occurred after an aseptic rTHA. In 29 patients (39.2%), successful closed reduction under general anesthesia was feasible, while the majority of cases required open reduction. In 31 of these patients (67.4%), open reduction was combined with a revision arthroplasty. CONCLUSIONS In case of DM cup dislocation, there is a low success rate of closed reduction. To prevent re-dislocation, total revision leads to a significantly reduced risk compared to open or closed reduction alone. Careful X-ray analysis for a halo sign showing intra-prosthetic DM cup dislocation is mandatory to avoid futile reduction attempts. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Niklas Unter Ecker
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Rudy Sangaletti
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Malte Ohlmeier
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Akkaya
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Seper Ekhtiari
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Ianiv Klaber
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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Dubin JA, Bains SS, Chen Z, Hameed D, Moore MC, Mont MA, Nace J, Delanois RE. Single center evaluation of outcomes of modular dual mobility liners during revision total hip arthroplasty: A five-year follow-up. J Orthop 2023; 43:75-78. [PMID: 37559883 PMCID: PMC10407033 DOI: 10.1016/j.jor.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Revision total hip arthroplasty (rTHA) is at increased risk for postoperative instability when compared to primary cases, which has been mitigated to some extent with the introduction of dual mobility (DM) reconstructions. These constructs were designed to lower dislocation rates and to improve impingement-free range of motion. As a follow-up to our prior institutional study, we expanded on a cohort of DM reconstructions compared to non-DM constructs. We examined a modular dual mobility system in rTHA to measure loosening of the acetabular component, as well as revision and dislocation rates in comparison to an historical cohort of single articulation prostheses.Materials/Methods: This retrospective cohort study from a single center included 254 patients who underwent rTHA with a dual mobility liner by three fellowship-trained surgeons between January 1, 2014 and December 1, 2019. This was a follow-up to an historical cohort of revisions performed with a single articulation prosthesis (n = 120) from the same surgeons performed between January 1, 2011 and December 23, 2013. The inclusion criteria included consecutively performed rTHAs that had a minimum follow-up of 2 years. We excluded patients who had femoral revisions and head/liner revisions only. The average follow-up in the dual mobility cohort and the single articulation cohort was 5 years (range, 2-10 years) and 2.5 years (range, 1.5-4.3 years), respectively. The primary outcomes were dislocation, aseptic loosening, and re-revision rates. Secondary outcomes were radiographic analyses of cup migration and osteolysis. RESULTS There were 4 out of 256 (1.6%) dislocations from the dual mobility cohort compared to 7 out of 120 (5.8%), P < 0.001 from the single articulation cohort. The rates of aseptic loosening were 3.2% (8 out of 254) and 4.2% (5 out of 120), P = 0.124, respectively, between the cohorts. The re-revision rate was 5.9% for the DM liners and 8.3% in the control cohort, P = 0.38. Radiographic analyses revealed no cup migration and osteolysis in any of the patients that had no dislocations. CONCLUSION The dual mobility articulations in rTHA demonstrated improved results in terms of lower dislocations rates when compared to a single articulation prostheses. Our center uses these articulations for revisions and surgeons should consider the use of these bearings when performing rTHA.
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Affiliation(s)
- Jeremy A. Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Mallory C. Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Michael A. Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Kim HS, Yoo JH, Lee YK, Park JS, Won YY. Treatment of Femoral Neck Fractures in the Elderly: A Survey of the Korean Hip Society Surgeons. Hip Pelvis 2023; 35:157-163. [PMID: 37727295 PMCID: PMC10505840 DOI: 10.5371/hp.2023.35.3.157] [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: 12/26/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 09/21/2023] Open
Abstract
Purpose This study examined the methods for treatment of femoral neck fracture (FNF) preferred by members of the Korean Hip Society (KHS) and identified factors that influence decisions regarding the surgical intervention of choice. Materials and Methods A total of 97 members of the KHS responded to the 16-question survey which included questions about the mean number of surgeries performed each month for treatment of femoral neck fractures, the cut-off age for deciding between internal fixation and arthroplasty, the implant used most often, usage of cement, and factors influencing each decision. Results The mean cut-off age used when deciding between internal fixation and arthroplasty was 64 years old. Hemiarthroplasty (HA) (70%) was the most preferred option for treatment of displaced FNFs in cases where arthroplasty was indicated (total hip arthroplasty [THA] 19% and dual mobility THA 11%). The main reasons for selection of arthroplasty over reduction with internal fixation were age and pre-fracture ambulatory status. Pre-trauma ambulatory status and/or sports activity were the main factors in selection of HA over THA. Cement was used by 33% of responders. Poor bone quality and a broad femoral canal were factors that influenced the usage of cement. Conclusion Management of FNFs in the elderly is a major health problem worldwide; thus, remaining alert to current trends in treatment is essential for surgeons. The mean cut-off age used in deciding between internal fixation and arthroplasty was 64 years old. HA is the preferred method for treatment of displaced FNFs for members of the KHS.
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Affiliation(s)
- Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Je-Hyun Yoo
- Department of Orthropaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Seok Park
- Department of Orthopedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - Ye-Yeon Won
- Department of Orthopaedic Surgery, Ajou University Medical Center, Ajou University College of Medicine, Suwon, Korea
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21
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Christensen TH, Egol A, Pope C, Shatkin M, Schwarzkopf R, Davidovitch RI, Aggarwal VK. How Does Surgical Approach Affect Characteristics of Dislocation After Primary Total Hip Arthroplasty? J Arthroplasty 2023; 38:S300-S305. [PMID: 37236286 DOI: 10.1016/j.arth.2023.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Concerns have been voiced regarding how surgical approach impacts risk of dislocation after total hip arthroplasty (THA). This study investigated how surgical approach impacts rate, direction, and timing of dislocations following THA. METHODS We conducted a retrospective review of 13,335 primary THAs from 2011 to 2020 and identified 118 patients with prosthetic hip dislocation. Patients were stratified into cohorts by surgical approach used during primary THA. Patient demographics, index THA acetabular cup positioning, number, direction, timing of dislocations, and subsequent revisions were collected. RESULTS Dislocation rate differed significantly between posterior approach (PA), direct anterior approach (DAA), and laterally-based approach (LA) (1.1 versus 0.7% versus 0.5%, P = .026). Rate of hips dislocating anteriorly was lowest in the PA group (19.2%) compared to LA (50.0%) and DAA groups (38.2%, P = .044). There was no difference in rate of hips dislocating posteriorly (P = .159) or multidirectional (P = .508) instability; notably 58.8% of dislocations in the DAA cohort occurred posteriorly. There were no differences in dislocation timing or revision rate. Acetabular anteversion was highest in the PA cohort compared to DAA and LA (21.5 versus 19.2 versus 11.7 degrees, P = .049). CONCLUSION After THA, patients in the PA group had a slightly higher dislocation rate compared to the DAA and LA groups. The PA group had a lower rate of anterior dislocation and nearly 60% of DAA dislocations occurred posteriorly. However, with no differences in other parameters including revision rates or timing, our data suggests surgical approach may impact dislocation characteristics to a lesser degree than previous studies have suggested.
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Affiliation(s)
| | - Alexander Egol
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Caleigh Pope
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Michael Shatkin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Roy I Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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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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Ameztoy Gallego J, Cruz Pardos A, Gomez Luque J, Cuadrado Rubio LE, Fernández Fernández R. Dislocation and survival rate of dual mobility cups in revision total hip arthroplasty in patients with high risk of instability. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05816-8. [PMID: 37085676 DOI: 10.1007/s00264-023-05816-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Instability remains as an unsolved complication after revision total hip arthroplasty (rTHA). Dual mobility (DM) cups have decreased dislocation rate in rTHA; however, there are few clinical studies that evaluate the risk of dislocation after rTHA in patients with high risk of instability. METHODS Between 2007 and 2019, 95 consecutive rTHA using a DM cup, in 93 patients with instability risk factors were retrospectively reviewed. Instability risk factors were defined as follows: deficient abductor mechanism (22.1%), previous dislocation (68.4%), Paprosky 3 acetabular bone defect (21.1%), neuromuscular disease (4.2%), lumbar spine arthrodesis (6.3%), and more than one previous surgery (33.6%). Mean follow-up was 4.3 ± 2.4 years. Clinical and radiographic parameters were reported. DM cup survival was determined using a Kaplan-Meier analysis with re-revision for any cause as the end-point. Surgical complications and re-dislocation rate was recorded. RESULTS Seven DM cups were re-revised; three due to aseptic loosening, three due to peri-prosthetic joint infection (PJI), and one due to instability. At seven years follow-up, the survival rate of the DM cup using re-revision for any reason as the end-point was 82.4% (95% confidence interval, 66.4-98.4%). There were 12 (12.6%) complications: two (2.1%) dislocations, six (6.3%) PJI, four (4.2%) peri-prosthetic fractures. CONCLUSION Our findings suggest DM cups are effective reducing dislocation rate in rTHA in patients with a high risk of instability, without increasing early aseptic loosening and with a low rate of dislocation. Nevertheless, longer follow-up is needed to confirm implant stability and dislocation rates in the long term.
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Affiliation(s)
- Juan Ameztoy Gallego
- Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
| | - Ana Cruz Pardos
- Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Javier Gomez Luque
- Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
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Morell AT, Mildren ME, Smith S, Yoo J, Kagan R. Fibromyalgia Increases Post-Operative Healthcare Utilization Following Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00365-0. [PMID: 37084922 DOI: 10.1016/j.arth.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Pre-operative factors can complicate the post-operative course and increase healthcare utilization following total hip arthroplasty (THA). Fibromyalgia is not generally recognized as a modifiable risk factor prior to THA. The aim of this investigation was to assess the effect of fibromyalgia on post-operative healthcare utilization following THA. METHODS Patients who underwent primary THA from 2018 to 2019 were identified from a large national database using Current Procedural Terminology (CPT) and International Classification of Diseases, tenth revision (ICD-10) codes. Patient demographics, age, sex, and pre-operative opioid use were collected. Analysis compared patients who did and did not have fibromyalgia for post-operative healthcare utilization metrics; lengths of stay (LOS), 90-day post-operative opioid usages, dislocations, and emergency room visits. Independent t-testings were used to compare LOS, and rates of ongoing opioid use. Logistic regression analyses with adjusted Odds Ratios (aORs) evaluated the risk of dislocation and emergency room visit after adjusting for demographic characteristics and comorbidities. RESULTS Compared to those who did not have fibromyalgia, patients who had fibromyalgia experienced longer LOS (P<0.0001), increased odds of opioid use 90-days post-operatively (P<0.0001), as well as increased odds of hip dislocation (P<0.0001) and presentation to the emergency room (P<0.0001). Patients who had fibromyalgia were also more likely to be "frequent flyers" with >5 emergency room visits after THA (P<0.0001). CONCLUSIONS Fibromyalgia can complicate post-operative care following THA with increased LOS, higher rates of opioid use, and increased odds of dislocation and emergency room visits. As focus shifts to pre-operative optimization and risk stratification, more attention should be placed on fibromyalgia prior to THA.
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Affiliation(s)
- Aidan T Morell
- Department of Orthopaedics and Rehabilitation Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239
| | - Mark E Mildren
- Slocum Center for Orthopedics & Sports Medicine, 55 Coburg Road, Eugene, Oregon, 97401
| | - Spencer Smith
- Department of Orthopaedics and Rehabilitation Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon, 97239.
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Weintraub MT, DeBenedetti A, Nam D, Darrith B, Baker CM, Waren D, Schwarzkopf R, Courtney PM, Della Valle CJ. Dual-Mobility Versus Large Femoral Heads in Revision Total Hip Arthroplasty: Interim Analysis of A Randomized Controlled Trial. J Arthroplasty 2023:S0883-5403(23)00339-X. [PMID: 37019309 DOI: 10.1016/j.arth.2023.03.089] [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: 12/05/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION This multicenter randomized controlled trial evaluated if dual-mobility bearings (DM) lower the risk of dislocation compared to large femoral heads (≥36mm) for patients undergoing revision total hip arthroplasty (THA) via a posterior approach. METHODS A total of 146 Patients were randomized to a DM (n=76; 46 mm median effective head size, range 36 to 59 mm) or a large femoral head (n=70; twenty-five 36 mm heads [35.7%], forty-one 40 mm heads [58.6%], and four 44mm heads [5.7%]). There were 71 single-component revisions (48.6%), 39 both-component revisions (26.7%), 24 reimplantations of THA after 2-stage revision (16.4%), seven isolated head and liner exchanges (4.8%), four conversions of hemiarthroplasty (2.7%), and one revision of a hip resurfacing (0.7%). Power analysis determined that 161 patients were required in each group to lower the dislocation rate from 8.4 to 2.2% (power=0.8, alpha=0.05). RESULTS At a mean of 18.2 months (range, 1.4 to 48.2), there were three dislocations in the large femoral head group compared to two in the DM cohort (4.3 vs. 2.6%; P=0.67). One patient in the large head group and none in the DM group were successfully treated with closed reduction without subsequent revision. CONCLUSION Interim analysis of this randomized controlled trial found no difference in the risk of dislocation between DM and large femoral heads in revision THA, although the rate of dislocation was lower than anticipated and continued follow up is needed.
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Affiliation(s)
- Matthew T Weintraub
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street, Chicago, IL 60612, USA
| | - Anne DeBenedetti
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street, Chicago, IL 60612, USA
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street, Chicago, IL 60612, USA
| | - Brian Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street, Chicago, IL 60612, USA
| | - Colin M Baker
- Department of Orthopaedic Surgery, Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Daniel Waren
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17(th) Street, New York, NY 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17(th) Street, New York, NY 10003, USA
| | - P Maxwell Courtney
- Department of Orthopaedic Surgery, Rothman Institute, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street, Chicago, IL 60612, USA.
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Butler JT, Stegelmann SD, Butler JL, Bullock M, M Miller R. Comparing dislocation rates by approach following elective primary dual mobility total hip arthroplasty: a systematic review. J Orthop Surg Res 2023; 18:226. [PMID: 36945061 PMCID: PMC10032016 DOI: 10.1186/s13018-023-03724-6] [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: 11/30/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dual mobility components can be implanted during total hip arthroplasty (THA) for primary osteoarthritis via a direct anterior approach (DAA), anterolateral approach (ALA), direct lateral approach (DLA), or posterior/posterolateral approach (PLA). This review compares dual mobility hip dislocation rates using these approaches for elective primary THA. METHODS PubMed, Embase, and Cochrane databases were systematically searched for articles published after January 1, 2006 that reported dislocation rates for adult patients after primary THA with dual mobility implants. Articles were excluded if they reported revision procedures, nonelective THA for femoral neck fractures, acetabular defects requiring supplemental implants, prior surgery, or ≤ 5 patients. The primary outcome was hip dislocation rate. Secondary outcomes included infection, Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) score. RESULTS After screening 542 articles, 63 met inclusion criteria. Due to study heterogeneity, we did not perform a meta-analysis. Eight studies reported DAA, 5 reported ALA, 6 reported the DLA, and 56 reported PLA. Study size ranged from 41 to 2,601 patients. Mean follow-up time ranged from 6 months to 25 years. Rates of infection and dislocation were low; 80% of ALA, 87.5% of DAA, 100% of DLA, and 82.1% of PLA studies reported zero postoperative dislocations. Studies reporting postoperative HHS and PMA scores showed considerable improvement for all approaches. CONCLUSIONS Patients undergoing primary THA with dual mobility implants rarely experience postoperative dislocation, regardless of surgical approach. Additional studies directly comparing DAA, ALA, DLA, and PLA are needed to confirm these findings.
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Affiliation(s)
- Justin T Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA.
| | - Samuel D Stegelmann
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Johnathon L Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Matthew Bullock
- Department of Orthopedic Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Richard M Miller
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
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van den Broek M, Govaers K. Total Hip Arthroplasty with Cemented Dual Mobility Cup into a Fully Porous Multihole Cup with Variable Angle Locking Screws for Acetabular Fractures in the Frail Elderly. Hip Pelvis 2023; 35:54-61. [PMID: 36937212 PMCID: PMC10020729 DOI: 10.5371/hp.2023.35.1.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 03/21/2023] Open
Abstract
Purpose The purpose was to examine the clinical and radiological outcomes after surgical treatment of acetabular fractures with total hip arthroplasty with a dual mobility cup cemented into a porous multihole cup in the population of frail elderly patients. Materials and Methods A retrospective review of 16 patients who underwent surgery (mean age, 76.7 years) with a mean follow-up period of 36.9 months was conducted. Following surgery, patients underwent postoperative follow-up at six weeks, three, six, and 12 months and clinical and radiological examinations were performed. Results Classification of fractures was based on the Letournel classification. Following surgery, all patients were allowed weight-bearing as tolerated immediately postoperative. Fourteen patients showed maintenance of preoperative mobility status at one year. The mean Harris hip score was 64.8 (range, 34.7-82.8) and 80.0 (range, 60.8-93.8) at three months and one year, respectively. The mortality rate was 12.5% at one year (2/16). Complications included heterotopic ossification (2/16), deep venous thrombosis (1/16), heamatoma (1/16), and femoral revision due to a Vancouver B2 fracture (1/16). No case of deep infection, dislocation, or implant loosening was reported. Conclusion Total hip arthroplasty using a dual mobility cup cemented into a porous multihole cup with locking screws resulted in a stable construct with a capacity for immediate weight-bearing as tolerated with rapid relief of pain. The findings of this study suggest that this procedure can be regarded as a safe method that has shown promising clinical and radiological outcomes for treatment of patients with medical frailty.
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Affiliation(s)
| | - Kris Govaers
- Department of Orthopaedic Surgery, az Sint-Blasius, Dendermonde, Belgium
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28
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Ebied A, Ebied AA, Badr IT, Affara M, Marie S. Cementless augmented versus cemented Dual Mobility cups: medium-term outcome of case series with a control group. BMC Musculoskelet Disord 2023; 24:97. [PMID: 36740673 PMCID: PMC9900940 DOI: 10.1186/s12891-023-06204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/30/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Post-operative dislocation and reconstruction of acetabular defects are two challenging topics in revision Total Hip Arthroplasty (rTHA). Cemented Dual Mobility (DM) cups on top of Kerboull Cross and bone graft have been successfully employed to overcome these challenges. The cementless augmented DM cups were recently introduced. In this study medium term results of the augmented cementless DM Coptos cups are reported and compared to the established technique of cemented DM cups and Kerboull plate. MATERIAL AND METHODS This is a retrospective analysis of data collected on patients who received rTHA using DM cups in the period between June 2015 and September 2020. Two groups of patients were identified. The first group received cementless augmented DM-cups (NOVAE® Coptos TH-SERF) (Coptos TH cup group). The second comparable group who had Kerboull ring (KE ring group) and cemented DM cups (NOVAE® STICK). Demographic data, surgical technique, functional and radiological outcome as well as complications during the follow-up visits are reported. RESULTS Forty-two patients with a mean age at the time of revision 48.8 ± 13.6 years. 29 patients received Coptos TH DM-cup, while 13 patients had Bone Graft (BG), KE ring and cemented DM cups for acetabular reconstruction. Acetabular defects were Paprosky types IIB and IIC in 31 patients and IIIA and B in 11 patients. The follow-up was 52.8 ± 21 months (mean ± STD); and the mean Harris Hip Score (HHS) at last visit was 91 ± 5. Good stability of all cups was reported. Full integration of the impaction graft was observed in 94% of the Coptos and 92% of the KE groups. One of the Coptos cups was readjusted and one case of single dislocation was recorded in the KE group. None of the DM cups in both groups was revised or awaiting revision. CONCLUSION Coptos TH cups achieve similar results to the cemented DM on KE ring at the medium term but long term outcome remains to be seen.
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Affiliation(s)
- Ayman Ebied
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Ahmed Ali Ebied
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Ismail Tawfeek Badr
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Mostafa Affara
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
| | - Sameh Marie
- grid.411775.10000 0004 0621 4712Department of Orthopedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, 32511 Menoufia, Egypt
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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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Bellova P, Goronzy J, Riedel R, Grothe T, Hartmann A, Günther KP. Dual-Mobility Cups in Primary Total Hip Arthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:74-84. [PMID: 34500491 DOI: 10.1055/a-1527-7758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Dual-mobility cups (DMCs) were introduced in France more than 40 years ago and are increasingly used not only in hip revision but also primary hip arthroplasty. Due to a simulated large-head articulation and increased jumping distance, DMCs can contribute to a high range of motion in the hip joint and reduce the risk of instability. Numerous studies have reported low dislocation rates and high survival rates in the mid-term follow-up. Nevertheless, long-term data, especially on primary hip replacement, remain limited, and the effect of recent designs and material innovations is still unclear. Therefore, primary DMCs are mainly proposed in patients at high risk for dislocation (i.e. pelvitrochanteric insufficiency, compromised spinopelvic mobility, neuromuscular disorders, obesity and femoral neck fractures). Based on a review of recently published studies referring to these indications, the current study discusses the advantages and disadvantages of DMCs.
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Affiliation(s)
- Petri Bellova
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jens Goronzy
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Roman Riedel
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Tim Grothe
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Albrecht Hartmann
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus-Peter Günther
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
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de Cano JJM, Trias E. THE CEMENTED DOUBLE MOBILITY CUP IN HIP REVISION: DIFFERENT POSSIBILITIES OF USE. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e256913. [PMID: 37082167 PMCID: PMC10112351 DOI: 10.1590/1413-785220233101e256913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/10/2022] [Indexed: 04/22/2023]
Abstract
Introduction The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. Material and methods The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). Results The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. Conclusion The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series .
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32
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Does fusion length matter? Total hip arthroplasty dislocation after extension of lumbosacral fusion: a case report. Spine Deform 2023; 11:253-257. [PMID: 35921039 DOI: 10.1007/s43390-022-00563-z] [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: 06/09/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
CASE Hip-spine syndrome is a complex challenge for orthopedic surgeons. We present a 60-year-old female with a history of spinal fusion and total hip arthroplasty. The patient underwent extension of the previous fusion with sacropelvic fixation, and 5 months later she presented with left posterior prosthetic hip dislocation which required sedation and closed reduction. CONCLUSION Even with no change in lumbar lordosis or pelvic tilt and adequate acetabular cup position, extension of the fusion construct may predispose patients to dislocation. This may be the result of an increased lever arm acting at the hip joint, thereby leading to instability.
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Antoniadis A, Wegrzyn J. Direct Cementation of Dual Mobility Cups Into the Bony Acetabulum in Primary Total Hip Arthroplasty: Clinical and Radiographic Outcomes at a Minimum 5-Year Follow-Up. J Arthroplasty 2022; 38:1120-1125. [PMID: 36566998 DOI: 10.1016/j.arth.2022.12.031] [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: 08/22/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cemented dual mobility cups (DMCs) are commonly used in combination with acetabular reinforcement devices. Indeed, according to literature, direct cementation of metal-backed acetabular components into the bony acetabulum remains controversial as this technique is potentially associated with increased rates of aseptic loosening. Therefore, this study aimed to evaluate the clinical and radiographic outcomes of DMC cemented into the bony acetabulum in primary total hip arthroplasty (THA). METHODS A total of 49 THA (48 patients, mean age 78 years [range, 51 to 91]) performed with direct cementation of a DMC into the bony acetabulum were prospectively included in our total joint registry and retrospectively reviewed. The clinical outcome was assessed using the Harris hip score (HHS). The radiographic outcome included measurement of component positioning and occurrence and progression of demarcation around the cemented DMC. Complications were reported with a particular attention to cemented fixation failure and aseptic loosening. RESULTS At a 7-year mean follow-up (range, 5 to 8), the pre-to postoperative HHS improved from 47 (range, 30 to 58) to 92 points (range, 80 to 98) (P < .01). Nonprogressive and focalized demarcations were observed in 7 THA (14%). Importantly, no progressive demarcation or DMC aseptic loosening was observed. CONCLUSION Direct cementation of DMC into the bony acetabulum ensured a stable fixation with no progressive demarcation or aseptic loosening at midterm follow-up. Therefore, this technique can be selectively considered in primary THA, especially in elderly or frail patients to avoid potential mechanical failure of press-fit fixation due to altered bone quality or additional morbidity related to the use of acetabular reinforcement devices.
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Affiliation(s)
- Alexander Antoniadis
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Wegrzyn
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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34
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Chen M, Takahashi E, Kaneuji A, Tachi Y, Fukui M, Orita Y, Ichiseki T, Zhou Y, Kawahara N. Does the Dual Mobility Cup Reduce Dislocation After Primary Total Hip Arthroplasty in Elderly Patients at High Risk of Dislocation? Orthop Surg 2022; 15:496-501. [PMID: 36479825 PMCID: PMC9891910 DOI: 10.1111/os.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/27/2022] [Accepted: 11/06/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The dual mobility cup (DMC) is designed to extend the longevity of the prosthesis by improving stability, enhancing the range of motion, and decreasing impingement without increasing wear. We hypothesized that DMC would reduce the risk of dislocation in elderly patients. This study aimed to investigate the clinical and radiographic outcomes of DMC-total hip arthroplasty (THA) in elderly patients at high risk of dislocation. METHODS From June 2016 to March 2020, 94 patients with a mean age of 77.7 years (97 hips) who underwent a posterolateral approach for DMC-THA in our department were followed up for at least one year. Preoperative and postoperative pelvic tilt angles (PTA) and DMC orientation were prospectively collected for all patients. Intraoperative and postoperative complications were recorded. A parametric test was used for normal distribution, and a non-parametric test was used for non-normal distribution. RESULTS Abduction and anteversion angles of the cup were 42.4 and 18.0° in the supine position immediately postoperative. The average PTA for patients in the supine and standing positions were 26.5 and 34.5°, respectively. When moving from the supine to the standing position, patients experienced a mean posterior pelvic tilt of 9°. No intraoperative acetabular-related complications were recorded. Postoperative complications included early infection in one patient (1.0%) and dislocation in one patient (1.0%). CONCLUSION Our study demonstrates that DMC-THA provides satisfactory short-term outcomes in elderly patients at a high risk of dislocation, regardless of the change in PTA resulting from postural transition.
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Affiliation(s)
- Mingliang Chen
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan,Department of OrthopaedicsAffiliated Renhe Hospital of China Three Gorges UniversityYichangChina
| | - Eiji Takahashi
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Ayumi Kaneuji
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Yoshiyuki Tachi
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Makoto Fukui
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Yugo Orita
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - Toru Ichiseki
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
| | - You Zhou
- Department of OrthopaedicsAffiliated Renhe Hospital of China Three Gorges UniversityYichangChina
| | - Norio Kawahara
- Department of Orthopaedic SurgeryKanazawa Medical UniversityUchinadaJapan
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A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants. J Arthroplasty 2022; 38:957-969.e1. [PMID: 36481281 DOI: 10.1016/j.arth.2022.11.007] [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: 06/30/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence of dislocation after revision total hip arthroplasty (rTHA) is reported to be up to 25% and remains a common source of failure. Constrained acetabular components and dual mobility implants are two implant classes being utilized to alleviate this burden in patients who have recurrent instability or major intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with constrained acetabular components and dual mobility implants in rTHA. METHODS Longitudinal studies reporting dislocation after the use of constrained acetabular components or dual mobility implants in rTHA were sought from Medline and Embase to October 2022. Secondary outcomes included re-revision surgery for dislocation and all causes. A total of 75 relevant citations were identified comprising 36 datasets of 3,784 constrained acetabular components and 47 datasets of 10,216 dual mobility implants. RESULTS For constrained acetabular components, the pooled incidence of dislocation was 9% (95% confidence interval: 7.2, 11.7) (range 0.0%-35.3%) over a weighted mean follow-up of 6 years, in contrast to 3% (95% confidence interval: 2.2, 4.4) (range 0.0%-21.4%) over 5 years for dual mobility implants. Re-revision rates for dislocation after using constrained acetabular components were around 9%, in contrast to 2% for dual mobility implants. Re-revision rates for all causes after using constrained acetabular components were around 19%, in contrast to 8% for dual mobility implants. CONCLUSION Dual mobility implants in the context of rTHA demonstrate lower incidences of dislocation (3% versus 9%), re-revision for dislocation (2% versus 9%), and rer-evision for any cause (8% versus 19%) in contrast to constrained acetabular components. This must be considered by surgeons when implanting such devices, often selected to treat instability.
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Daji AV, Workman KK, Yoo CJ, Smith CN, Kumar D, Weber MA, Snyder MJ, Urish KL. Risk Stratification and Pain Outcomes Following Revision Total Hip Arthroplasty for Adverse Local Tissue Reactions. J Arthroplasty 2022; 37:2406-2411. [PMID: 35738363 DOI: 10.1016/j.arth.2022.06.012] [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: 03/22/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (THA) for adverse local tissue reactions (ALTRs) secondary to head-neck taper corrosion is associated with a high complication rate. Diagnosis of ALTR is based on risk stratification using the patient's history and examination, implant risk, serum metal ion levels, and imaging. The purpose of this study was to determine if stratification using similar risk factors is predictive of outcomes following revision THA for metal-on-polyethylene (MoP) ALTR. METHODS We performed a retrospective review on 141 patients revised for ALTR due to head-neck taper corrosion. Pain outcomes following surgery were analyzed using a generalized linear mixed model. Complications were defined as instability/dislocation, infection, fracture, nerve palsy, leg-length discrepancy, or reoperation. RESULTS The overall complication rate was 17.7%. The odds of having pain decreased by 44% after revision surgery (Odds Ratio = 0.56, 95% Confidence Interval: 0.324 to 0.952). There was no significant difference in instability/dislocation based on either increased or decreased head-neck offset (P = .67) or magnetic resonance imaging findings of abductor loss, effusion size, and degree of ALTR (P = .73). Increased serum cobalt (P = .31) and chromium (P = .08) levels did not predict complications; however, a decreased cobalt-chromium ratio was associated with postoperative complications (2.8 versus 3.5; P = .002). CONCLUSION These findings are the first to suggest that patients who have ALTR after MoP THA undergoing revision surgery demonstrated major pain relief. Increasing femoral head offset did not change rates of instability/dislocation. In clinical scenarios where preoperative cobalt-chromium femoral head offsets were greater than available ceramic head offsets, a mandatory decrease in femoral head offset did not increase rates of instability/dislocation.
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Affiliation(s)
- Akshay V Daji
- Department of Orthopaedic Surgery, HCA Florida JFK/University of Miami Miller School of Medicine, Palm Beach, Florida
| | - Kalain K Workman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center-Pinnacle, Harrisburg, Pennsylvania
| | - Charlie J Yoo
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center-Pinnacle, Harrisburg, Pennsylvania
| | - Clair N Smith
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Deepak Kumar
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Margaret A Weber
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Matthew J Snyder
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kenneth L Urish
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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Wang G, Wang H, Yang J, Shen B, Zhou Z, Zeng Y. Reduction of posterior dislocated hip prosthesis using a modified lateral position maneuver: a retrospective, clinical comparative, and follow-up study. BMC Musculoskelet Disord 2022; 23:926. [PMID: 36266648 DOI: 10.1186/s12891-022-05876-8] [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: 06/29/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posterior dislocation (PD) is a common complication after total hip arthroplasty (THA), and the Allis maneuver is the most widely used method for reduction. However, this classic maneuver has some disadvantages. The aim of the present study was to investigate whether a modified lateral position (MLP) reduction maneuver provides an easier and safer method for PD reduction than the Allis maneuver. METHODS Between August 2019 and September 2021, a series of 88 consecutive PD patients who underwent THA were retrospectively evaluated. The patients were divided into the MLP reduction group and Allis reduction group according to the electronic health medical record. The success rate of closed reduction, Harris hip score (HHS), and radiographic outcomes were determined. Satisfaction scores, doctor safety events and complications were also determined and compared between the groups. The mean follow-up period was 1.66 ± 0.88 years. RESULTS The success rate of reduction in the MLP group was significantly 12.5% higher than that in the Allis group (P = 0.024). Periprosthetic fracture and implant loosening were retrospectively identified in 2 hips and 1 hip, which all occurred in the Allis group. The mean doctor and patient SAPS scores in the MLP group were 84.00 points and 76.97 points, respectively, which were significantly higher than those in the Allis group (72.12, P = 0.008 and 63.28 points, P = 0.001). Four adverse events were reported in the Allis group, compared with 0 in the MLP group. CONCLUSIONS For PD after THA, the MLP reduction maneuver can effectively increase the reduction success rate, satisfaction, and doctor safety without increasing the risk of complications compared with the traditional Allis supine reduction maneuver. TRIAL REGISTRATION This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100054562) in December 19th 2021.
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Affiliation(s)
- Gang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Haoyang Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Jing Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Xiao Q, Ling T, Zhou K, Yuan M, Xu B, Zhou Z. Constrained acetabular liners are a viable option in second-stage re-implantation for chronic infected total hip arthroplasty with abductor or greater trochanter deficiency and large acetabular bone defects. BMC Musculoskelet Disord 2022; 23:915. [PMID: 36242038 PMCID: PMC9563789 DOI: 10.1186/s12891-022-05861-1] [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: 03/08/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Abductor mechanism deficiency is a clear indication for using constrained acetabular liners (CALs), and large acetabular bone defects are considered a relative contraindication to CALs. We report the results of using CALs in special cases in which abductor or greater trochanter deficiency was accompanied by large acetabular bone defects at second-stage re-implantation for chronic infected total hip arthroplasty (THA). Methods Between January 2010 and January 2018, 19 patients who used CALs at second-stage re-implantation and had abductor or greater trochanter deficiency and large acetabular bone defects were included in this study. We followed up with the clinical and radiological results of these patients. Complications and infection-related information were also recorded. Results Eight patients, 4 patients, and 7 patients had Paprosky type IIB, type IIC, and type IIIA acetabular bone defects at second-stage re-implantation, respectively. The indication for using CALs was abductor deficiency in 14 patients and greater trochanter deficiency in the other 5 patients. The mean follow-up was 74.4 months (range 50–96). The mean Harris Hip Score (HHS) was 76.3 points (range 62–86) at the last follow-up. Three patients presented acetabular radiolucent lines with no progress: zone 3, zone 3 and zone 2 and 3, respectively. One patient suffered transient sciatic nerve palsy. There was no dislocation, failure of the CALs, reoperation, or recurrence of infection. Conclusion Our results suggested that for screened patients, CALs are a viable option in second-stage re-implantation for chronic infected THA with abductor or greater trochanter deficiency and large bone defects.
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Affiliation(s)
- Qiang Xiao
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China.,Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Tingxian Ling
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Kai Zhou
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Mingcheng Yuan
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Bing Xu
- Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, 37# Wuhou Guoxue Road, 610041, Chengdu, People's Republic of China.
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Tikhilov RM, Dzhavadov AA, Demin AS, Bilyk SS, Denisov AO, Shubnyakov II. Early outcomes of using custom-made augments in revision total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:2229-2235. [PMID: 35729351 DOI: 10.1007/s00264-022-05489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The continuing high demand for revision total hip arthroplasty (RTHA) requires not only additional economic costs, but also the search for new, effective methods to manage the reconstruction of acetabular bone loss. This study focuses on the assessment of the clinical and radiographic outcomes after RTHA using custom-made augments (CMA) in the short-term follow-up period. MATERIALS AND METHODS We retrospectively analyzed the results of using CMAs in 19 patients (20 hips). The average follow-up period was 41.3 months. All surgery was performed on defect types III and IV as per the Gross and Saleh classification. RESULTS There was a statistically significant difference when comparing the Oxford Hip Score before RTHA of 15.0 (Std. deviation-5.9) and after RTHA of 36.3 (Std. deviation-6.3) (p = 0.01). All implants were radiologically stable. CMA has demonstrated a good ability to restore position of hip centre of rotation (HCOR). In the postoperative period, two patients (2 hips) had dislocations. Only one of two patients underwent re-revision due to dislocation. CONCLUSION Treatment of uncontained loss of bone stock in RTHA using CMA shows promising clinical and radiographic results at short-term follow-up period; however, dislocation rate is 10% in this study.
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Affiliation(s)
- R M Tikhilov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - A A Dzhavadov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation.
| | - A S Demin
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - S S Bilyk
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - A O Denisov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
| | - I I Shubnyakov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, Academician Baykova Street House 8, 195427, St. Petersburg, Russian Federation
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Rogmark C, Nåtman J, Jobory A, Hailer NP, Cnudde P. The association of surgical approach and bearing size and type with dislocation in total hip arthroplasty for acute hip fracture. Bone Joint J 2022; 104-B:844-851. [PMID: 35775180 DOI: 10.1302/0301-620x.104b7.bjj-2021-1772.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS Patients with femoral neck fractures (FNFs) treated with total hip arthroplasty (THA) have an almost ten-fold increased risk of dislocation compared to patients undergoing elective THA. The surgical approach influences the risk of dislocation. To date, the influence of differing head sizes and dual-mobility components (DMCs) on the risk of dislocation has not been well studied. METHODS In an observational cohort study on 8,031 FNF patients with THA between January 2005 and December 2014, Swedish Arthroplasty Register data were linked with the National Patient Register, recording the total dislocation rates at one year and revision rates at three years after surgery. The cumulative incidence of events was estimated using the Kaplan-Meier method. Cox multivariable regression models were fitted to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of dislocation, revision, or mortality, stratified by surgical approach. RESULTS The cumulative dislocation rate at one year was 8.3% (95% CI 7.3 to 9.3) for patients operated on using the posterior approach and 2.7% (95% CI 2.2 to 3.2) when using the direct lateral approach. In the posterior approach group, use of DMC was associated with reduced adjusted risk of dislocation compared to 32 mm heads (HR 0.21 (95% CI 0.07 to 0.68); p = 0.009). This risk was increased with head sizes < 32 mm (HR 1.47 (95% CI 1.10 to 1.98); p = 0.010). Neither DMC nor different head sizes influenced the risk of revision following the posterior approach. Neither articulation was associated with a statistically significantly reduced adjusted risk of dislocation in patients where the direct lateral approach was performed, although this risk was estimated to be HR 0.14 (95% CI 0.02 to 1.02; p = 0.053) after the use of DMC. DMC inserted through a direct lateral approach was associated with a reduced risk of revision for any reason versus THA with 32 mm heads (HR 0.36 (95% CI 0.13 to 0.99); p = 0.047). CONCLUSION When using a posterior approach for THA in FNF patients, DMC reduces the risk of dislocation, while a non-significant risk reduction is seen for DMC after use of the direct lateral approach. The direct lateral approach is protective against dislocation and is also associated with a lower rate of revision at three years, compared to the posterior approach. Cite this article: Bone Joint J 2022;104-B(7):844-851.
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Affiliation(s)
- Cecilia Rogmark
- Swedish Arthroplasty Register, Vastra Götaland Centre for Registers, Gothenburg, Sweden.,Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jonatan Nåtman
- Swedish Arthroplasty Register, Vastra Götaland Centre for Registers, Gothenburg, Sweden
| | - Ammar Jobory
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Nils P Hailer
- Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Cnudde
- Swedish Arthroplasty Register, Vastra Götaland Centre for Registers, Gothenburg, Sweden.,Department of Orthopaedics, Hywel Dda University Healthboard, Llanelli, UK
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Galvain T, Mantel J, Kakade O, Board TN. Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England. Bone Joint J 2022; 104-B:811-819. [PMID: 35775184 PMCID: PMC9251137 DOI: 10.1302/0301-620x.104b7.bjj-2021-1732.r1] [Citation(s) in RCA: 6] [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: 11/29/2022]
Abstract
Aims The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England. Methods This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation. Results Among 13,044 patients (mean age 69.2 years (SD 11.4), 60.9% female), 191 (1.5%) had THA dislocation. Two-year median direct medical costs were £15,333 (interquartile range (IQR) 14,437 to 16,156) higher for patients with THA dislocation. Patients underwent revision surgery after a mean of 1.5 dislocations (1 to 5). Two-year costs increased to £54,088 (IQR 34,126 to 59,117) for patients with multiple closed reductions and a revision procedure. On average, patients with dislocation had greater healthcare resource use and less improvement in EuroQol five-dimension index (mean 0.24 (SD 0.35) vs 0.44 (SD 0.35); p < 0.001) and visual analogue scale (0.95 vs 8.85; p = 0.038) scores, and Oxford Hip Scores (12.93 vs 21.19; p < 0.001). Conclusion The cost, resource use, and QoL burden of THA dislocation in England are substantial. Further research is required to understand optimal timing of revision after dislocation, with regard to cost-effectiveness and impact on QoL. Cite this article: Bone Joint J 2022;104-B(7):811–819.
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Affiliation(s)
- Thibaut Galvain
- Global Health Economics, Johnson and Johnson Medical Devices, New Brunswick, New Jersey, USA
| | - Jack Mantel
- Health Economics and Market Access, DePuy Synthes, Leeds, UK
| | | | - Tim N Board
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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Beckert M, Meneghini RM, Meding JB. Instability After Primary Total Hip Arthroplasty: Dual Mobility Versus Jumbo Femoral Heads. J Arthroplasty 2022; 37:S571-S576. [PMID: 35271976 DOI: 10.1016/j.arth.2022.02.113] [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] [Received: 11/19/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of dual mobility (DM) articulations has grown substantially over the last decade to help minimize dislocation risk. The purpose of this study is to compare the results of DM articulations to jumbo femoral heads of equivalent sizes as they relate to postoperative dislocation. METHODS This is a retrospective cohort study of primary total hip arthroplasties (THAs) performed at a single institution between 2005 and 2018. DM articulations and large-diameter metal-on-metal femoral heads were included. Patients were followed with Harris Hip Scores and standard radiographs. Complications were prospectively recorded. Statistical analyses included chi-squared and Brown-Forsythe tests. RESULTS In total, 1,288 Magnum femoral head THAs and 365 Active Articulation DM THAs were included for analysis. The same monoblock cup was implanted via a posterior approach in all cases. Age, gender, body mass index, and diagnosis were similar between groups. Average follow-up in the DM group was 49 months, and 126 months in the jumbo head group. The average head sizes in the DM and jumbo head groups were 50 mm. There were no dislocations in the DM hips and only 2 (0.2%) in the jumbo femoral head group. Both groups had significant improvements in Harris Hip Score from their preoperative baseline. CONCLUSION Our study found similarly low dislocation rates in DM and jumbo femoral heads in primary THA. No evidence currently exists showing a benefit of the DM articulation beyond that of the large effective head size, and we recommend making every attempt at maximizing head size prior to using DM articulations.
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Affiliation(s)
- Mitchell Beckert
- The Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; The IU Hip and Knee Center, Fishers, IN
| | - R Michael Meneghini
- The Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; The IU Hip and Knee Center, Fishers, IN
| | - John B Meding
- The Center for Hip and Knee Surgery, St. Francis Hospital Mooresville, Mooresville, IN
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Wakeling CP, Sandiford NA, Ghani R, Bridle SJ, Mitchell PA, Hutt JR. Dual-mobility bearings in complex revision hip arthroplasty. Hip Int 2022; 32:460-465. [PMID: 33736488 DOI: 10.1177/1120700021999795] [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
BACKGROUND Revision total hip arthroplasty (rTHA) is associated with an increased dislocation risk. Dual-mobility (DM) bearings have been used to address this issue. Such constructs offer increased range of motion and enhanced stability whilst avoiding some issues associated with fully-constrained devices. DM bearings have been used in our unit since 2013. METHODS All rTHA cases since 2013 were reviewed using the following criteria: (1) use of a DM bearing; (2) extensive soft tissue or bone loss resulting from ARMD, infection or multiple revisions, or requiring custom or megaprosthetic reconstruction; (3) minimum 2-month follow-up. RESULTS 52 cases were identified with a median of 2 previous operations (range 1-6) and mean follow-up of 14 (2-41) months. The Novae-Stick component was used in 50 cases, the Avantage in 2 and the Trident MDM in 1 case. 19 required acetabular reconstruction using trabecular metal and four required custom acetabular components. 19 required femoral reconstruction with a proximal or total femoral replacement.Postoperatively, 8 patients (15.4%) sustained a dislocation at a mean of 1.6 (range 1-3) months. 3 (5.8%) requiring re-revision. 1 required excision arthroplasty and 2 a constrained liner, 1 of which went on to have further instability. There were no intraprosthetic dislocations. CONCLUSIONS Dual-mobility components are a viable option in the complex rTHA setting. Early dislocations can occur but the rate of instability is acceptable in this high-risk group.
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Affiliation(s)
| | | | - Rafia Ghani
- St. George's Hospital NHS Foundation Trust, London, UK
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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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Wegrzyn J, Longaray J, Baez R, Herrera L. Which femoral neck for a dual mobility cup? A biomechanical evaluation. INTERNATIONAL ORTHOPAEDICS 2022; 46:1783-1793. [PMID: 35570206 PMCID: PMC9349148 DOI: 10.1007/s00264-022-05415-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
This study aimed to evaluate polyethylene (PE) damage and wear lesions to the chamfer of mobile components under mobile and fixed femoral neck impingement at the third articulation, and to determine which femoral neck characteristics should be considered with a dual mobility cup to limit those lesions.
Methods
Two femoral neck geometries (cylindrical and quadrangular) with two surface finishing roughness (rough and polished), and two head-to-neck ratios (28- and 22.2-mm diameter femoral heads) were evaluated in a hip simulator testing. For each characteristic, six femoral necks were tested with six dual mobility cups under fixed and mobile femoral neck impingement conditions. Chamfer PE damage and volumetric wear were evaluated and compared for each femoral neck characteristic and impingement condition.
Results
Under mobile impingement condition, femoral neck characteristics did not significantly affect PE damage and wear lesions to the chamfer (p = 0.283 to 0.810). However, under fixed impingement condition, significantly higher PE damage and wear lesions to the chamfer were produced by the quadrangular geometry compared to the cylindrical geometry (p = 0.004 to 0.025). In addition, with the quadrangular geometry, rough surface finishing was demonstrated to increase volumetric wear of the chamfer (p = 0.009). No significant influence of head-to-neck ratio was observed on PE damage and wear lesions to the chamfer (p = 0.244 to 0.714).
Discussion
This biomechanical study emphasized that femoral neck characteristics are critical with dual mobility cup and tend to favor a cylindrical geometry particularly whether fixed impingement at the third articulation occurs.
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Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre Decker, 4, CH - 1011, Lausanne, Switzerland.
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Epinette JA, Coulomb R, Pradel S, Kouyoumdjian P. Do Modular Dual Mobility Cups Offer a Reliable Benefit? Minimum 5-Year Follow-Up of 102 Cups. J Arthroplasty 2022; 37:910-916. [PMID: 35065216 DOI: 10.1016/j.arth.2022.01.025] [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] [Received: 12/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Among various options suggested to prevent hip instability after total hip replacement, the MDM-tritanium (modular dual mobility) cup features a cobalt-chrome liner (CoCr) positioned in a titanium acetabular shell and matched with a mobile insert in highly cross-linked annealed X3 polyethylene. The purpose of this study aimed to confirm whether there was no significant release of ions (Co and Cr) or higher occurrence of dislocation or even cases of aseptic loosening of the cementless shell with the use of MDM-tritanium cups at minimum of 5-year follow-up. METHODS The clinical study was carried out on a homogeneous consecutive and nonselective series with 102 MDM cups (98 patients) implanted in 2 centers. This MDM-tritanium cup had been systematically used for surgical revisions (70% of cases) or for patients with major hip dysplasia or in elderly patients with poor bone quality. A biological assessment of ion releases has been performed in a specific cohort of 39 cases that had an internal ceramic head. RESULTS None of the following complications was observed: no case of immunoallergic event, no aseptic loosening, and the dislocation rate was 4.9% involving only the difficult primary and revision cases. The clinical results were encouraging, with 89.7 points for Harris Hip Score, 41.16 points/48 for the OHS-12. The Agora Roentgenographic Assessment (ARA) radiologic score was graded "excellent" in 94.4%. The MDM-tritanium survivorship with revision for any cause in 102 cups at 7.95 years was 92.7%. CONCLUSION Based on the results of our first 102 cases, there were no immunoallergic complications-contrary to what was initially feared with the CoCr bearing-titanium pair-and no postoperative instability, including for complex primary and revisions total hip replacements. LEVEL OF EVIDENCE Individual Cohort Study: 2B.
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Affiliation(s)
| | - Remy Coulomb
- Department of Orthopaedic Surgery, University Hospital of Nîmes, Nîmes, France
| | - Sarah Pradel
- Department of Orthopaedic Surgery, University Hospital of Nîmes, Nîmes, France
| | - Pascal Kouyoumdjian
- Department of Orthopaedic Surgery, University Hospital of Nîmes, Nîmes, France; Laboratory of Mechanics and Civil Engineering (LMGC), CNRS-UM1, Montpellier, France
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Donovan RL, Johnson H, Fernando S, Foxall-Smith M, Whitehouse MR, Blom AW, Kunutsor SK. The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: A Systematic Review and Meta-Analysis of Longitudinal Observational Studies. J Arthroplasty 2022; 37:993-1001.e8. [PMID: 35051608 DOI: 10.1016/j.arth.2022.01.017] [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: 10/17/2021] [Revised: 12/20/2021] [Accepted: 01/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dislocation after a primary total hip replacement (pTHR) remains a common cause of treatment failure. Constrained acetabular components (CACs) and dual mobility implants (DMIs) may mitigate this in patients at high risk of dislocation or with significant intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with CACs and DMIs in pTHR. METHODS Longitudinal studies reporting dislocation after the use of CACs or DMIs in pTHR were sought from Medline and Embase to September 2020. Secondary outcomes included revision surgery for dislocation and for all causes. RESULTS A total of 46 studies (3 CAC and 43 DMI) comprising 582 CACs and 18,748 DMIs were included. The pooled incidence of dislocation was 1.08% (95% confidence interval [CI]: 0.00-3.72; range 0.27%-2.60%) over a weighted mean follow-up of 4.1 years for CACs, compared with 0.25% (95% CI: 0.08-0.46; range 0.00%-4.72%) over 6.2 years for DMIs. For DMIs, there was a temporal decline in dislocations from the 1980s onward, and dislocation rates remained low (<1%) until 15 years postoperatively. There were insufficient data for similar analysis of CACs. All studies were at high risk of bias. The incidence of revision for dislocation after CACs was 0.3% vs 0.1% for DMIs, and the incidence of revision for all causes after CACs was 4.8% vs 2.7% for DMIs. CONCLUSION DMIs demonstrated a lower incidence of dislocation compared with CACs; however, there was a relative absence of CACs used in the context of pTHR in the literature. Temporal trends in dislocation have improved over time for DMIs.
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Affiliation(s)
- Richard L Donovan
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Harvey Johnson
- Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sherwin Fernando
- Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Michael Foxall-Smith
- Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, Unite Kingdom
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, Unite Kingdom
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, Unite Kingdom
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Hip stability parameters with dual mobility, modular dual mobility and fixed bearing in total hip arthroplasty: an analytical evaluation. BMC Musculoskelet Disord 2022; 23:373. [PMID: 35443656 PMCID: PMC9022332 DOI: 10.1186/s12891-022-05280-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Use of dual mobility (DM) in total hip arthroplasty has gained popularity due to the ability to reduce dislocation through increased jumping distance and impingement-free arc of movement. Recently, modular dual mobility (modDM) systems were introduced to give the possibility to use DM with standard metal-backed shells, however few has been studied to date regarding how jumping distance and the center of rotation change with modDM. The objective of this study was to evaluate, through analytical simulation, how jumping distance, center of rotation and arc of movement change between DM and standard cups with modDM or fixed bearings (FB). Methods 3D-models of DM and standard press-fit cups with modDM or FB liners were used to simulate DM, modDM and FB implant configurations, matched for same cup size, according to same cup position and different femoral head diameters. Jumping distance was calculated and center of rotation lateralization and oscillation angles were measured for each size of these three implant configurations. Results Jumping distance with modDM was reduced by -3.9 mm to -8.6 mm in comparison with DM, from 48 to 64 mm size, but resulted comparable to polyethylene 36 mm FB and increased by + 1.1 mm and + 1.4 mm than ceramic 36 and 40 mm FBs for sizes > 54 mm. ModDM lateralized the center of rotation up to + 2.5 mm and + 4.0 mm in comparison with DM and FBs, respectively. Oscillation angle with modDM resulted higher than + 16°, + 23°, + 17° and + 14° in comparison to DM, 28 mm, 32 mm and 36 mm FB cups, respectively, for 56 mm cup size. Conclusions According to its specific design, modDM might change hip stability parameters in comparison to DM, worsening jumping distance and center of rotation position, but increasing arc of movement. As not restoring stability parameters in the same fashion, modDM implants should be properly used when DM cups are not feasible.
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Hoskins W, McDonald L, Claireaux H, Bingham R, Griffin X. Dual-mobility constructs versus large femoral head bearings in primary and revision total hip arthroplasty: a systematic review and meta-analysis of comparative studies. Hip Int 2022:11207000221082927. [PMID: 35438011 DOI: 10.1177/11207000221082927] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Both dual-mobility (DM) constructs and large femoral head bearings (⩾36 mm) reduce dislocation following total hip arthroplasty (THA). There is limited research comparing DM with large bearings. METHODS A systematic review of published literature was performed including studies that compared DM with large femoral head bearings in primary or revision THA according to PRISMA guidelines. The primary outcome was revision surgery for dislocation. The secondary outcome was all-cause revision surgery. Other complications were recorded. 2 authors independently selected studies, performed data extraction, and risk of bias assessment. Treatment effects were assessed using odds ratios and data were pooled using a fixed-effect model, where appropriate. RESULTS 9 studies, all retrospective, met the final inclusion criteria. 2722 patients received DM and 9,789 large femoral head bearings. The difference in the odds of revision surgery for dislocation (OR 0.67; 95% CI, 0.45-1.01; p = 0.06) and aseptic loosening are unclear (OR 0.61; 95% CI, 0.36-1.05; p = 0.07); including important benefits and no difference. There was a benefit favouring DM for the risk of all-cause revision (OR 0.70; 95% CI, 0.56-0.86; p = 0.001), revision for fracture (OR 0.49; 95% CI, 0.29-0.81; p = 0.005) and dislocation not requiring revision (OR 0.29; 95% CI, 0.14-0.57; p < 0.001). The estimate in the difference in the odds of revision surgery for infection was imprecise (OR 0.78; 95% CI, 05.1-1.20; p = 0.26). CONCLUSIONS This study provides evidence that there may be clinically relevant benefits of DM constructs over large femoral head bearings. Prospective randomised studies are warranted given these findings.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Traumaplasty Melbourne, East Melbourne, Victoria, Australia
| | | | - Harry Claireaux
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.,Department of Trauma and Orthopaedic Surgery, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Roger Bingham
- Traumaplasty Melbourne, East Melbourne, Victoria, Australia
| | - Xavier Griffin
- Department of Trauma and Orthopaedic Surgery, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.,Barts Health NHS Trust, London, UK
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Aguado-Maestro I, de Blas-Sanz I, Sanz-Peñas AE, Campesino-Nieto SV, Diez-Rodríguez J, Valle-López S, Espinel-Riol A, Fernández-Díez D, García-Alonso M. Dual Mobility Cups as the Routine Choice in Total Hip Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:528. [PMID: 35454367 PMCID: PMC9029134 DOI: 10.3390/medicina58040528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Total hip arthroplasty (THA) is considered the most successful surgical procedure in orthopedics. However, dislocation remains the main indication for surgical revision. New designs of dual mobility cups (DMC) have lowered the classical complications and have extended the indications of DMC in elective surgeries. Our aim is to assess the trend of DMC indications in THA as well as the incidence of their dislocation. Materials and Methods: We retrospectively reviewed all patients undergoing THA with DMC during the years 2015 and 2021. The original indication for DMC included patients sustaining neck of femur fractures (NOF#) and associated risk factors for dislocations. Five years later, DMC was considered our standard of care in total hip arthroplasty. The approach (anterolateral or posterolateral) was chosen by the surgeon according to his/her preferences, as was the implant. Data collected included patients' demographics, diagnosis, admission time, surgical approach, cup models, and inclination and complications. Patients sustaining a hip dislocation were prospectively reviewed and assessed for treatment received, new dislocations, and need for surgical revision. Two groups were created for the analysis according to the presence or absence of dislocation during follow-up. Results: In the analysis, 531 arthroplasties were included (mean age 72.2 years) with a mean follow-up of 2.86 years. The trend of indications for DMC increased from 16% of THA in 2015 to 78% of THA in 2021. We found a total of 8 dislocations (1.5%), none of them associated with elective surgery. Closed reduction was unsatisfactory in four cases (50%). There was one case of intraprosthetic dislocation. Dislocations were associated to smaller heads (22 mm) (1.5% vs. 25%, p = 0.008) and cups (51.2 mm vs. 48.7 mm, p = 0.038) and posterior approach (62.5% vs. 37.5%, p = 0.011). Conclusion: Dual mobility cups are a great option to reduce the risk of dislocation after a THA both in the neck of femur fractures and elective cases. The use of an anterolateral approach in THA after a neck or femur fracture might considerably decrease the risk of dislocation.
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Affiliation(s)
- Ignacio Aguado-Maestro
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
| | - Inés de Blas-Sanz
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
| | - Ana Elena Sanz-Peñas
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
| | - Silvia Virginia Campesino-Nieto
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
| | - Jesús Diez-Rodríguez
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
| | - Sergio Valle-López
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
| | - Alberto Espinel-Riol
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
| | - Diego Fernández-Díez
- Department of Traumatology and Orthopaedic Surgery, Infanta Sofía University Hospital, 28703 Madrid, Spain;
| | - Manuel García-Alonso
- Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain; (I.d.B.-S.); (A.E.S.-P.); (S.V.C.-N.); (J.D.-R.); (S.V.-L.); (A.E.-R.); (M.G.-A.)
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