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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
BACKGROUND 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 (rTHA). METHODS A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included rerevision due to dislocation, rerevision for other causes, all-cause rerevision, total complication rate, and functional outcome measures. The Methodological Index for Nonrandomized Studies 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 subgroup 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 rTHA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of rerevision due to dislocation (odds ratio [OR] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause rerevision (OR 0.55, P < 0.001) compared to FB implants. No statistically significant difference was seen in the odds of rerevision due to periprosthetic joint infection (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the 2 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 rerevision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants. CONCLUSIONS Based on current literature, it appears DM implants are an effective modality for reducing dislocation following rTHA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials with longer term follow-up are required.
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Affiliation(s)
- Benjamin M Sephton
- Trauma & Orthopaedic Department, Royal Blackburn Hospital, Blackburn, Lancashire, UK
| | - Tom Havenhand
- Trauma & Orthopaedic Department, Royal Preston Hospital, Preston, Lancashire, UK
| | - James W A Mace
- Trauma & Orthopaedic Department, Royal Bolton Hospital, Bolton, Greater Manchester, UK
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2
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Johnson PK, Lapow J, Grant AR, Lementowski P. A Technique for Difficult Intraoperative Dislocation of Hip Prosthesis in Revision Total Hip Arthroplasty. Cureus 2024; 16:e65600. [PMID: 39205764 PMCID: PMC11349717 DOI: 10.7759/cureus.65600] [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: 07/27/2024] [Indexed: 09/04/2024] Open
Abstract
There are instances where a patient's prosthetic hip is unable to be dislocated intraoperatively during a conversion or revision arthroplasty, despite scar removal and standard dislocation maneuvers. We describe a technique that involves an in situ disassociation of the femoral head component from the trunnion without the need for additional osteotomies. This maneuver may be beneficial in cases of protrusio, muscular stiffness, high soft tissue tension, arthrofibrosis, and ankylosis due to heterotopic ossification, as well as cases that involve a large femoral head or acetabular constraint. We also present a case of a 61-year-old male with a chronic prosthetic hip infection who underwent a two-stage revision surgery where this technique was utilized.
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Affiliation(s)
- Philip K Johnson
- Orthopedic Surgery, New York Medical College, Valhalla, USA
- Orthopedic Surgery, Westchester Medical Center, Valhalla, USA
| | - Justin Lapow
- Orthopedic Surgery, New York Medical College, Valhalla, USA
- Orthopedic Surgery, University of Wisconsin, Madison, USA
| | - Andrew R Grant
- Orthopedic Surgery, New York Medical College, Valhalla, USA
- Orthopedic Surgery, New England Baptist Hospital, Boston, USA
- Orthopedic Surgery, Westchester Medical Center, Valhalla, USA
| | - Peter Lementowski
- Orthopedic Surgery, New York Medical College, Valhalla, USA
- Orthopedic Surgery, Westchester Medical Center, Valhalla, USA
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3
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Carender CN, Bothun CE, Sierra RJ, Trousdale RT, Abdel MP, Bedard NA. Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age: Results of >500 Cases. J Bone Joint Surg Am 2024; 106:1108-1116. [PMID: 38687829 DOI: 10.2106/jbjs.23.01467] [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: 05/02/2024]
Abstract
BACKGROUND There has been a paucity of long-term outcomes data on aseptic revision total hip arthroplasties (THAs) in the young adult population. The purpose of this study was to evaluate implant survivorship, complications, and clinical outcomes in a large cohort of contemporary aseptic revision THAs in patients ≤50 years of age at the time of the surgical procedure. METHODS We identified 545 aseptic revision THAs performed at a single academic institution from 2000 to 2020 in patients who were 18 to 50 years of age. Patients who underwent conversion THAs and patients with a history of any ipsilateral hip infection were excluded. The mean age was 43 years, the mean body mass index (BMI) was 29 kg/m 2 , and 63% were female. The index indication for revision THA was aseptic loosening in 46% of cases, polyethylene wear or osteolysis in 28% of cases (all revisions of conventional polyethylene), and dislocation in 11% of cases. There were 126 hips (23%) that had undergone at least 1 previous revision (median, 1 revision [range, 1 to 5 revisions]). The mean follow-up was 10 years. RESULTS In the entire cohort, the 20-year survivorship free of any re-revision was 76% (95% confidence interval [95% CI], 69% to 82%). There were 87 re-revisions, with 31 dislocations, 18 cases of aseptic loosening of the femoral component, and 16 periprosthetic joint infections (PJIs) being the most common reasons for re-revision. Dislocation as the indication for the index revision was associated with an increased risk of re-revision (hazard ratio, 2.9; p < 0.001). The 20-year survivorship free of any reoperation was 73% (95% CI, 66% to 78%). There were 75 nonoperative complications (14%), including 32 dislocations. The mean Harris hip score significantly improved (p < 0.001) from 65 preoperatively to 81 at 10 years postoperatively. CONCLUSIONS Contemporary aseptic revision THAs in patients ≤50 years of age demonstrated a re-revision risk of approximately 1 in 4 at 20 years. Dislocation, aseptic loosening of the femoral component, and PJI were the most common reasons for re-revision. Index revision THAs for dislocation had a 3 times higher risk of re-revision. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Scholz J, Perka C, Hipfl C. Dual-mobility bearings reduce instability but may not be the only answer in revision total hip arthroplasty for recurrent dislocation. Bone Joint J 2024; 106-B:89-97. [PMID: 38688508 DOI: 10.1302/0301-620x.106b5.bjj-2023-0828.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims There is little information in the literature about the use of dual-mobility (DM) bearings in preventing re-dislocation in revision total hip arthroplasty (THA). The aim of this study was to compare the use of DM bearings, standard bearings, and constrained liners in revision THA for recurrent dislocation, and to identify risk factors for re-dislocation. Methods We reviewed 86 consecutive revision THAs performed for dislocation between August 2012 and July 2019. A total of 38 revisions (44.2%) involved a DM bearing, while 39 (45.3%) and nine (10.5%) involved a standard bearing and a constrained liner, respectively. Rates of re-dislocation, re-revision for dislocation, and overall re-revision were compared. Radiographs were assessed for the positioning of the acetabular component, the restoration of the centre of rotation, leg length, and offset. Risk factors for re-dislocation were determined by Cox regression analysis. The modified Harris Hip Scores (mHHSs) were recorded. The mean age of the patients at the time of revision was 70 years (43 to 88); 54 were female (62.8%). The mean follow-up was 5.0 years (2.0 to 8.75). Results DM bearings were used significantly more frequently in elderly patients (p = 0.003) and in hips with abductor deficiency (p < 0.001). The re-dislocation rate was 13.2% for DM bearings compared with 17.9% for standard bearings, and 22.2% for constrained liners (p = 0.432). Re-revision-free survival for DM bearings was 84% (95% confidence interval (CI) 0.77 to 0.91) compared with 74% (95% CI 0.67 to 0.81) for standard articulations, and 67% (95% CI 0.51 to 0.82) for constrained liners (p = 0.361). Younger age (hazard ratio (HR) 0.92 (95% CI 0.85 to 0.99); p = 0.031), lower comorbidity (HR 0.44 (95% CI 0.20 to 0.95); p = 0.037), smaller heads (HR 0.80 (95% CI 0.64 to 0.99); p = 0.046), and retention of the acetabular component (HR 8.26 (95% CI 1.37 to 49.96); p = 0.022) were significantly associated with re-dislocation. All DM bearings which re-dislocated were in patients with abductor muscle deficiency (HR 48.34 (95% CI 0.03 to 7,737.98); p = 0.303). The radiological analysis did not reveal a significant relationship between restoration of the geometry of the hip and re-dislocation. The mean mHHSs significantly improved from 43 points (0 to 88) to 67 points (20 to 91; p < 0.001) at the final follow-up, with no differences between the types of bearing. Conclusion We found that the use of DM bearings reduced the rates of re-dislocation and re-revision in revision THA for recurrent dislocation, but did not guarantee stability. Abductor deficiency is an important predictor of persistent instability.
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Affiliation(s)
- Johann Scholz
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Hipfl
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
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Sivaloganathan S, Blakeney WG, Rivière C, Vendittoli PA. Evolution of Concepts: Can Personalized Hip Arthroplasty Improve Joint Stability? J Clin Med 2023; 12:jcm12093324. [PMID: 37176765 PMCID: PMC10179336 DOI: 10.3390/jcm12093324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
Hip arthroplasty procedures are successful and reproducible. However, within the first two post-operative years, hip dislocations are the most common cause for revisions. This is despite the majority of the dislocations having the acetabular component within what is described as the 'safe zone'. The limitations of such boundaries do not take into account the variability of individual hip anatomy and functional pelvic orientation that exist. An alternative concept to address hip instability and improve overall outcomes is functional acetabular orientation. In this review article, we discuss the evolution of concepts, particularly the kinematic alignment technique for hip arthroplasty and the use of large-diameter heads to understand why total hip arthroplasty dislocations occur and how to prevent them.
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Affiliation(s)
| | - William G Blakeney
- Department of Orthopedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Charles Rivière
- Clinique de Sport Bordeaux-Mérignac, Bordeaux Arthroplasty Research Institute, Personalized Arthroplasty Society, 33700 Mérignac, France
| | - Pascal-André Vendittoli
- Hôpital Maisonneuve-Rosemont, Clinique Orthopédique Duval, Personalized Arthroplasty Society, Montréal, QC H1T 2M4, Canada
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Liang X, Zhang X, Xu Q, Zhang K, Pang R, Shi W, Li Z, Wang Q, Li H, Zhang H. Global Research Trends on Periprosthetic Fractures After Artificial Joint Replacement Between 2000 and 2021: A Bibliometric Analysis and Visualized Study. Indian J Orthop 2023; 57:703-713. [PMID: 37128556 PMCID: PMC10147874 DOI: 10.1007/s43465-023-00863-0] [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: 01/01/2023] [Accepted: 03/07/2023] [Indexed: 05/03/2023]
Abstract
Background Periprosthetic fractures after prosthetic joint replacement have received increasing attention over the past decades. The purpose of this study was to estimate the trends and state of research in periprosthetic fractures. Methods Articles on periprosthetic fractures were retrieved from the Web of Science database. Information about each article, including country/region, author, institution, issue, journal, and keywords, was recorded for bibliometric analysis. The analysis included only English-language articles from 2000 to 2021, from 58 countries and regions. Results A total of 1668 original articles meeting the research requirements were obtained. The number of manuscripts on periprosthetic fractures has experienced rapid growth, especially since 2009. Productivity was dominated by the USA, followed by the UK and Germany. The most prolific institution was Mayo Clinic. The most cited article was published by Sharkey, P.F. in 2002. The five most frequent keywords were "periprosthetic fractures", "total hip arthroplasty", " revision", "arthroplasty", "total knee arthroplasty". Conclusions Based on the current trends of globalization, there is a rising trend in publications on periprosthetic fractures, with the largest annual contributions made by the United States. The most influential contributors are researchers from the United States and England. In addition, Journal of Arthroplasty is the journal with the most research in this field. Geriatric trauma and dual mobility are the new hot topics in this field. Together these studies have played a key role in periprosthetic fractures decision-making and management.
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Affiliation(s)
- Xinyu Liang
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Xinglong Zhang
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China
- Graduate School of Tianjin Medical University, Tianjin, China
- Department of Orthopedics, Sanmenxia Yellow River Hospital, Sanmenxia, China
| | - Qian Xu
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Kai Zhang
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Ran Pang
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Wei Shi
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Zhijun Li
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China
| | - Qiang Wang
- Department of Intensive Care Unit, The First Hospital Affiliated to Kunming Medical University, Kunming, Yunnan China
| | - Hui Li
- Department of Orthopedics, Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Huafeng Zhang
- Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, China
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Maniar A, Kazarian GS, Torres-Ramirez RJ, Ranawat A. Short term outcomes (average follow up of 2.4 years) of a constrained acetabular liner in primary and revision total hip arthroplasty. J Arthroplasty 2023:S0883-5403(23)00342-X. [PMID: 37028773 DOI: 10.1016/j.arth.2023.03.092] [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: 11/19/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND As instability continues to be a burden post total hip arthroplasty (THA), there has been a controversial discussion on the ideal implant choice. We report here the outcomes of a modern constrained acetabular liner (CAL) system in primary and revision THA at an average follow up of 2.4 years. METHODS We performed a retrospective study of all patients undergoing primary and revision hip arthroplasty and being implanted with the modern CAL system from 2013 to 2021. We identified 31 hips, of which 13 underwent primary THA and the remaining 18 underwent revision THA for instability. RESULTS Of those implanted with CAL primarily, 3 had concomitant abductor tear repair and gluteus maximus transfer, 5 had Parkinson's disease, 2 had inclusion body myositis, 1 had amyotrophic lateral sclerosis, and the remaining 2 were above 94 years of age. All patients implanted with the CAL were as a result of active instability post-primary THA and underwent only liner and head exchange without revision of the acetabular or femoral components. At an average follow up of 2.4 years (range, 9 months to 5 years and 4 months), we had 1 case (3.2 %) of dislocation post-CAL implantation. None of the patients undergoing surgery with CAL for active instability had a re-dislocation. CONCLUSION In conclusion, a constrained acetabular liner provides excellent stability in both primary THA in high risk individuals and revision THA in cases of active instability. There were no dislocations when using a constrained acetabular liner to treat active instability post THA.
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Affiliation(s)
- Adit Maniar
- Fellow in Adult Reconstruction and Total Joint Replacement, Ranawat Orthopaedic Research Foundation, 535 E 70th St, New York, NY 10021, USA.
| | - Gregory S Kazarian
- Resident (PGY-3), Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ricardo J Torres-Ramirez
- Research Coordinator for Adult Reconstruction and Joint replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Amar Ranawat
- Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College, Attending Surgeon, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Synnott PA, Sivaloganathan S, Kiss MO, Binette B, Morcos MW, Vendittoli PA. Monobloc press-fit cups with large-diameter bearings are safe in revision total hip arthroplasty. Orthop Rev (Pavia) 2022; 14:38926. [PMID: 36349354 PMCID: PMC9635988 DOI: 10.52965/001c.38926] [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: 11/12/2022] Open
Abstract
BACKGROUND Instability is a major cause of failure of revision total hip arthroplasty (THA) which can be avoided with the use of monobloc press-fit cups with large diameter heads (LDH). OBJECTIVE This consecutive case series analyses whether LDH monobloc components are a safe and clinically beneficial option for revision THA. METHODS This consecutive case series includes 47 revision THA with LDH monobloc acetabular cup. Acetabular bone defects were Paprosky type I (42), type IIA (2) and type IIC (3). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS) and the Patient's Joint Perception (PJP) scores were analysed and a radiographic evaluation for signs of implant dysfunction was performed. RESULTS After a mean follow-up of 4.5 years, there were 5 (10.6%) acetabular cup re-revisions: 2 loss of primary fixation and 3 instabilities. Implant survivorship at 4-years was 89.4% (95% CI: 89.3 to 89.5). Recurrent hip dislocation was reported in 1 patient (2.1%) and remains under conservative treatment. The mean WOMAC and FJS were 19.5 (16.8; 0.0 to 58.3) and 57.3 (28.9; 6.3 to 100.0), respectively. Regarding the PJP, 3 (8.8%) patients perceived their hip as natural, 8 (23.5%) as an artificial joint with no restriction, 14 (41.2%) with minor restriction and 9 (26.5%) with major restriction. CONCLUSION In cases of revision THA with limited bone loss, press-fit primary fixation with LDH monobloc acetabular components are valuable options that offer excellent mid-term out-comes with low re-revision and joint instability rates.
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Affiliation(s)
| | - Sivan Sivaloganathan
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University
| | - Marc-Olivier Kiss
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University; Clinique Orthopédique Duval, Laval, Canada
| | - Benoit Binette
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University
| | - Mina W. Morcos
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University
| | - Pascal-André Vendittoli
- University of Montreal, Hôpital Maisonneuve-Rosemont; Surgery Department, Montreal University; Clinique Orthopédique Duval, Laval, Canada; Personalized Arthroplasty Society, Georgia, USA
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9
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Hoskins W, Corfield S, Lorimer M, Peng Y, Bingham R, Graves SE, Vince KG. Is the Revision Rate for Femoral Neck Fracture Lower for Total Hip Arthroplasty Than for Hemiarthroplasty?: A Comparison of Registry Data for Contemporary Surgical Options. J Bone Joint Surg Am 2022; 104:1530-1541. [PMID: 35920553 DOI: 10.2106/jbjs.21.01256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND When arthroplasty is indicated for a femoral neck fracture (FNF), it is unclear whether total hip arthroplasty (THA) or hemiarthroplasty (HA) is best. This study compares data from the Australian Orthopaedic Association National Joint Replacement Registry using contemporary surgical options. METHODS Patients from 60 to 85 years old who were treated with arthroplasty for FNF, between September 1999 and December 2019, were included if the femoral stems were cemented. Only THAs with femoral heads of ≥36 mm or dual-mobility articulations were included. Patients who had monoblock HA were excluded. Rates of revision for all aseptic failures and dislocation were compared. Competing risks of revision and death were considered using the cumulative incidence function. Subdistribution hazard ratios (HRs) for revision or death from a Fine-Gray regression model were used to compare THA and HA. Interactions of procedure with age group and sex were considered. Secondary analysis adjusting for body mass index (BMI) and American Society of Anesthesiologists (ASA) classification was also considered. RESULTS There were 4,551 THA and 29,714 HA procedures included. The rate of revision for THA was lower for women from 60 to 69 years old (HR = 0.58 [95% confidence interval (CI), 0.39 to 0.85]) and from 70 to 74 years old (HR = 0.65 [95% CI, 0.43 to 0.98]) compared with HA. However, women from 80 to 85 years old (HR = 1.56 [95% CI, 1.03 to 2.35]) and men from 75 to 79 years old (HR = 1.61 [95% CI, 1.05 to 2.46]) and 80 to 85 years old (HR = 2.73 [95% CI, 1.89 to 3.95]) had an increased rate of revision when THA was undertaken compared with HA. There was no difference in the rate of revision for dislocation between THA and HA for either sex or age categories. CONCLUSIONS When contemporary surgical options for FNF are used, there is a benefit with respect to revision outcomes for THA in women who are <75 years old and a benefit for HA in women who are ≥80 years old and men who are ≥75 years old. There is no difference in dislocation rates. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Traumaplasty Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, Northland District Health Board, Whangarei, Northland, New Zealand
| | - Sophia Corfield
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Yi Peng
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Roger Bingham
- Traumaplasty Melbourne, Melbourne, Victoria, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Kelly G Vince
- Department of Orthopaedics, Northland District Health Board, Whangarei, Northland, New Zealand
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10
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Hoskins W, Rainbird S, Holder C, Stoney J, Graves SE, Bingham R. A Comparison of Revision Rates and Dislocation After Primary Total Hip Arthroplasty with 28, 32, and 36-mm Femoral Heads and Different Cup Sizes: An Analysis of 188,591 Primary Total Hip Arthroplasties. J Bone Joint Surg Am 2022; 104:1462-1474. [PMID: 35703140 DOI: 10.2106/jbjs.21.01101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article was updated on August 17, 2022, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 1462, in the first sentence of the Abstract section entitled "Results," the phrase that had read "and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003), but more dislocations than 32-mm heads (HR for >2 weeks = 2.25 [95% CI, 1.13 to 4.49]; p = 0.021)" now reads "and 36-mm heads had fewer dislocations than 28-mm (HR = 0.33 [95% CI, 0.16 to 0.68]; p = 0.003) and 32-mm heads (HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88]; p = 0.021)." On page 1468, in the last sentence of the section entitled "Acetabular Components with a Diameter of <51 mm," the phrase that had read "and HR for ≥2 weeks = 2.25 [95% CI, 1.13 to 4.49; p = 0.021]) ( Fig. 3 )" now reads "and HR for ≥2 weeks = 0.44 [95% CI, 0.22 to 0.88; p = 0.021]) ( Fig. 3 )." Finally, on page 1466, in the upper right corner of Figure 3 , under "32mm vs 36mm," the second line that had read "2Wks+: HR=2.25 (1.13, 4.49), p=0.021" now reads "2Wks+: HR=0.44 (0.22, 0.88), p= 0.021."
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Parkville, Victoria, Australia.,Traumaplasty Melbourne, Victoria, Australia
| | - Sophia Rainbird
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Carl Holder
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - James Stoney
- Department of Orthopaedics, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
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Blumenfeld TJ. How Prescient Can We Be?: Commentary on an article by Cody C. Wyles, MD, et. al.: "Creation of a Total Hip Arthroplasty Patient-Specific Dislocation Risk Calculator". J Bone Joint Surg Am 2022; 104:1129. [PMID: 36149245 DOI: 10.2106/jbjs.22.00384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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12
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Hoskins W, Rainbird S, Dyer C, Graves SE, Bingham R. In Revision THA, Is the Re-revision Risk for Dislocation and Aseptic Causes Greater in Dual-mobility Constructs or Large Femoral Head Bearings? A Study from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res 2022; 480:1091-1101. [PMID: 34978538 PMCID: PMC9263451 DOI: 10.1097/corr.0000000000002085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 11/17/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dislocation is one of the most common causes of a re-revision after a revision THA. Dual-mobility constructs and large femoral head bearings (≥ 36 mm) are known options for mitigating this risk. However, it is unknown which of these choices is better for reducing the risk of dislocation and all-cause re-revision surgery. It is also unknown whether there is a difference between dual-mobility constructs and large femoral head bearings according to the size of the acetabular component. QUESTIONS/PURPOSES We used data from a large national registry to ask: In patients undergoing revision THA for aseptic causes after a primary THA performed for osteoarthritis, (1) Does the proportion of re-revision surgery for prosthesis dislocation differ between revision THAs performed with dual-mobility constructs and those performed with large femoral head bearings? (2) Does the proportion of re-revision surgery for all aseptic causes differ between revision THAs performed with dual-mobility constructs and those performed with large femoral head bearings? (3) Is there a difference when the results are stratified by acetabular component size? METHODS Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed for 1295 first-revision THAs for aseptic causes after a primary THA performed for osteoarthritis. The study period was from January 2008-when the first dual-mobility prosthesis was recorded-to December 2019. There were 502 dual-mobility constructs and 793 large femoral head bearings. There was a larger percentage of women in the dual-mobility construct group (67% [334 of 502]) compared with the large femoral head bearing group (51% [402 of 793]), but this was adjusted for in the statistical analysis. Patient ages were similar for the dual-mobility construct group (67 ± 11 years) and the large femoral head group (65 ± 12 years). American Society of Anesthesiologists (ASA) class and BMI distributions were similar. The mean follow-up was shorter for dual-mobility constructs at 2 ± 1.8 years compared with 4 ± 2.9 years for large femoral head bearings. The cumulative percent revision (CPR) was determined for a diagnosis of prosthesis dislocation as well as for all aseptic causes (excluding infection). Procedures using metal-on-metal bearings were excluded. The time to the re-revision was described using Kaplan-Meier estimates of survivorship, with right censoring for death or database closure at the time of analysis. The unadjusted CPR was estimated each year of the first 5 years for dual-mobility constructs and for each of the first 9 years for large femoral head bearings, with 95% confidence intervals using unadjusted pointwise Greenwood estimates. The apparent shorter follow-up of the dual-mobility construct group relates to the more recent increase in dual-mobility numbers recorded in the registry. The results were adjusted for age, gender, and femoral fixation. Results were subanalyzed for acetabular component sizes < 58 mm and ≥ 58 mm, set a priori on the basis of biomechanical and other registry data. RESULTS There was no difference in the proportion of re-revision for prosthesis dislocation between dual-mobility constructs and large femoral head bearings (hazard ratio 1.22 [95% CI 0.70 to 2.12]; p = 0.49). At 5 years, the CPR of the re-revision for prosthesis dislocation was 4.0% for dual mobility constructs (95% CI 2.3% to 6.8%) and 4.1% for large femoral head bearings (95% CI 2.7% to 6.1%). There was no difference in the proportion of all aseptic-cause second revisions between dual-mobility constructs and large femoral head bearings (HR 1.02 [95% CI 0.76 to 1.37]; p = 0.89). At 5 years, the CPR of dual-mobility constructs was 17.6% for all aseptic-cause second revision (95% CI 12.6% to 24.3%) and 17.8% for large femoral head bearings (95% CI 14.9% to 21.2%). When stratified by acetabular component sizes less than 58 mm and at least 58 mm, there was no difference in the re-revision CPR for dislocation or for all aseptic causes between dual-mobility constructs and large femoral head bearings. CONCLUSION Either dual-mobility constructs or large femoral head bearings can be used in revision THA, regardless of acetabular component size, as they did not differ in terms of re-revision rates for dislocation and all aseptic causes in this registry study. Longer term follow-up is required to assess whether complications develop with either implant or whether a difference in revision rates becomes apparent. Ongoing follow-up and comparison in a registry format would seem the best way to compare long-term complications and revision rates. Future studies should also compare surgeon factors and whether they influence decision-making between prosthesis options and second revision rates. Nested randomized controlled trials in national registries would seem a viable option for future research. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Parkville, Australia
- Traumaplasty Melbourne, East Melbourne, Australia
| | - Sophia Rainbird
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Chelsea Dyer
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephen E. Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Nayar SK, Kostakos TA, Savvidou O, Vlasis K, Papagelopoulos PJ. Outcomes of Hip Reconstruction for Metastatic Acetabular Lesions: A Scoping Review of the Literature. Curr Oncol 2022; 29:3849-3859. [PMID: 35735416 PMCID: PMC9222161 DOI: 10.3390/curroncol29060307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Management of metastatic periacetabular lesions remains a challenging area of orthopaedics. This study aims to evaluate and summarize the currently available reconstructive modalities, including their indications and outcomes. (2) Methods: A scoping review was carried out in accordance with PRISMA guidelines. Medline, EMBASE, and Cochrane were searched for relevant articles. (3) Results: A total of 18 papers met inclusion criteria encompassing 875 patients. The most common primary malignancy was breast (n = 230, 26.3%). Reconstruction modalities used were total hip arthroplasty (n = 432, 49.1%), the Harrington procedure (n = 374, 42.5%), modular hemipelvic endoprotheses (n = 63, 7.2%) and a reverse ice-cream cone prosthesis (n = 11, 1.25%). (4) Conclusions: Advances in implant design including use of dual mobility or flanged cups, tantalum implants, and modular hemipelvic endoprostheses allow for larger acetabular defects to be addressed with improved patient outcomes. This armamentarium of reconstruction options allows for tailoring of the procedure performed depending on patient factors and extent of periacetabular disease.
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Affiliation(s)
| | | | - Olga Savvidou
- Department of Anatomy, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (O.S.); (K.V.); (P.J.P.)
| | - Konstantinos Vlasis
- Department of Anatomy, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (O.S.); (K.V.); (P.J.P.)
| | - Panayiotis J. Papagelopoulos
- Department of Anatomy, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (O.S.); (K.V.); (P.J.P.)
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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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Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts. J Clin Med 2022; 11:jcm11071918. [PMID: 35407525 PMCID: PMC9000212 DOI: 10.3390/jcm11071918] [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] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 02/05/2023] Open
Abstract
Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a “forgotten” joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient’s abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others.
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Hoskins W, Rainbird S, Lorimer M, Graves SE, Bingham R. What Can We Learn From Surgeons Who Perform THA and TKA and Have the Lowest Revision Rates? A Study from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res 2022; 480:464-481. [PMID: 34677162 PMCID: PMC8846272 DOI: 10.1097/corr.0000000000002007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/17/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term implant survivorship in THA and TKA involves a combination of factors related to the patient, the implants used, and the decision-making and technical performance of the surgeon. It is unclear which of these factors is the most important in reducing the proportion of revision surgery. QUESTIONS/PURPOSES We used data from a large national registry to ask: In patients receiving primary THA and TKA for a diagnosis of osteoarthritis, do (1) the reasons for revision and (2) patient factors, the implants used, and the surgeon or surgical factors differ between surgeons performing THA and TKA who have a lower revision rate compared with all other surgeons? METHODS Data were analyzed for all THA and TKA procedures performed for a diagnosis of osteoarthritis from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from September 1, 1999, when collection began, to December 31, 2018. The AOANJRR obtains data on more than 98% of joint arthroplasties performed in Australia. The 5-year cumulative percent revision (CPR) was identified for all THAs and TKAs performed for a diagnosis of osteoarthritis with 95% confidence intervals (overall CPR); the 5-year CPR with 95% CIs for each surgeon was calculated for THA and TKA separately. For surgeons to be included in the analysis, they had to have performed at least 50 procedures and have a 5-year CPR. The 5-year CPR with 95% CIs for each THA and TKA surgeon was compared with the overall CPR. Two groups were defined: low revision rate surgeons (the upper confidence level for a given surgeon at 5 years is less than 3.84% for THA and 4.32% for TKA), and all other surgeons (any surgeon whose CPR was higher than those thresholds). The thresholds were determined by setting a cutoff at 20% above the upper confidence level for that class. The approach we used to define a low revision rate surgeon was similar to that used by the AOANJRR for determining the better-performing prostheses and is recommended by the International Prosthesis Benchmarking Working Group. By defining the groups in this way, a significant difference between these two groups is created. Determining a reason for this difference is the purpose of presenting the proportions of different factors within each group. The study group for THA included 116 low revision rate surgeons, who performed 88,392 procedures (1619 revised, 10-year CPR 2.7% [95% CI 2.6% to 2.9%]) and 433 other surgeons, who performed 170,094 procedures (6911 revised, 10-year CPR 5.9% [95% CI 5.7% to 6.0%]). The study group for TKA consisted of 144 low revision rate surgeons, who performed 159,961 procedures (2722 revised, 10-year CPR 2.6% [95% CI 2.5% to 2.8%]) and 534 other surgeons, who performed 287,232 procedures (12,617 revised, 10-year CPR 6.4% [95% CI 6.3% to 6.6%]). These groups were defined a priori by their rate of revision, and the purpose of this study was to explore potential reasons for this observed difference. RESULTS For THA, the difference in overall revision rate between low revision rate surgeons and other surgeons was driven mainly by fewer revisions for dislocation, followed by component loosening and fracture in patients treated by low revision rate surgeons. For TKA, the difference in overall revision rate between low revision rate surgeons and other surgeons was driven mainly by fewer revisions for aseptic loosening, followed by instability and patellofemoral complications in patients treated by low revision rate surgeons. Patient-related factors were generally similar between low revision rate surgeons and other surgeons for both THA and TKA. Regarding THA, there were differences in implant factors, with low revision rate surgeons using fewer types of implants that have been identified as having a higher-than-anticipated rate of revision within the AOANJRR. Low revision rate surgeons used a higher proportion of hybrid fixation, although cementless fixation remained the most common choice. For surgeon factors, low revision rate surgeons were more likely to perform more than 100 THA procedures per year, while other surgeons were more likely to perform fewer than 50 THA procedures per year. In general, the groups of surgeons (low revision rate surgeons and other surgeons) differed less in terms of years of surgical experience than they did in terms of the number of cases they performed each year, although low revision rate surgeons, on average, had more years of experience and performed more cases per year. Regarding TKA, there were more differences in implant factors than with THA, with low revision rate surgeons more frequently performing patellar resurfacing, using an AOANJRR-identified best-performing prosthesis combination (with the lowest rates of revision), using fewer implants that have been identified as having a higher-than-anticipated rate of revision within the AOANJRR, using highly crosslinked polyethylene, and using a higher proportion of cemented fixation compared with other surgeons. For surgeon factors, low revision rate surgeons were more likely to perform more than 100 TKA procedures per year, whereas all other surgeons were more likely to perform fewer than 50 procedures per year. Again, generally, the groups of surgeons (low revision rate surgeons and other surgeons) differed less in terms of years of surgical experience than they did in terms of the number of cases they performed annually, although low revision rate surgeons, on average, had more years of experience and performed more cases per year. CONCLUSION THAs and TKAs performed by surgeons with the lowest revision rates in Australia show reductions in all of the leading causes of revision for both THA and TKA, in particular, causes of revision related to the technical performance of these procedures. Patient factors were similar between low revision rate surgeons and all other surgeons for both THA and TKA. Low revision rate THA surgeons were more likely to use cement fixation selectively. Low revision rate TKA surgeons were more likely to use patella resurfacing, crosslinked polyethylene, and cemented fixation. Low revision rate THA and TKA surgeons were more likely to use an AOANJRR-identified best-performing prosthesis combination and to use fewer implants identified by the AOANJRR as having a higher-than-anticipated revision rate. To reduce the rate of revision THA and TKA, surgeons should consider addressing modifiable factors related to implant selection. Future research should identify surgeon factors beyond annual case volume that are important to improving implant survivorship. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Wayne Hoskins
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
- Traumaplasty Melbourne, East Melbourne, Australia
| | - Sophia Rainbird
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Michelle Lorimer
- Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Australia
| | - Stephen E. Graves
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
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Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation. INTERNATIONAL ORTHOPAEDICS 2022; 46:789-795. [DOI: 10.1007/s00264-021-05280-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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Konno K, Hagiwara S, Nakamura J, Suzuki T, Eguchi Y, Ohtori S. An Anatomic Study of the Relationship Between the Iliocapsularis Muscle and Iliofemoral Ligament in Total Hip Arthroplasty. Arthroplast Today 2021; 12:57-61. [PMID: 34765713 PMCID: PMC8571414 DOI: 10.1016/j.artd.2021.09.010] [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: 06/28/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background The preservation of soft tissues is an important factor for preventing dislocation after total hip arthroplasty. Anatomical studies have revealed that the inferior iliofemoral ligament (ILFL) contributes significantly to the native stability of the hip. This study aimed to investigate the anatomical structures of the iliocapsularis muscle (ICM) and ILFL from a surgical perspective. Methods In total, we assessed 50 hip specimens from 25 embalmed cadavers. The size and location of ICM and ILFL (at the upper, middle, and lower parts of the femoral head) were assessed in a neutral position. The ratio of ICM and ILFL widths to the femoral head was evaluated. Results The mean ICM and ILFL widths were 7.5 and 14.6, 12.0 and 14.2, and 12.8 and 15.2 mm at the upper, middle, and lower levels, respectively. The mean ICM thicknesses were 1.3, 9.0, and 9.1 mm at the upper, middle, and lower levels, respectively. The distributions of ICM and ILFL from the lateral edge of the femoral head were 21.1%–37.4% and 4.9%–36.5%, 9.5%–35.6% and 7.9%–38.7%, and 11.0%–38.7% and 9.5%–42.4% at the upper, middle, and lower levels, respectively. Conclusion ICM and ILFL were located at the anterolateral side of the femoral head, and the medial edge of the ILFL corresponded to that of the ICM. ICM can serve as a landmark for preserving ILFL in total hip arthroplasty using the anterior approach.
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Affiliation(s)
- Kenta Konno
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Takane Suzuki
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedics Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan
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Hoskins W, Bingham R, Dyer C, Rainbird S, Graves SE. A Comparison of Revision Rates for Dislocation and Aseptic Causes Between Dual Mobility and Large Femoral Head Bearings in Primary Total Hip Arthroplasty With Subanalysis by Acetabular Component Size: An Analysis of 106,163 Primary Total Hip Arthroplasties. J Arthroplasty 2021; 36:3233-3240. [PMID: 34088570 DOI: 10.1016/j.arth.2021.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dual mobility (DM) and large femoral head bearings (≥36 mm) both decrease the risk of dislocation in total hip arthroplasty (THA). There is limited comparable data in primary THA. This study compared the revision rates for dislocation and aseptic causes between DM and large femoral heads and subanalyzed by acetabular component size. METHODS Data from the Australian Orthopedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for osteoarthritis from January 2008 (the year of first recorded DM use) to December 2019. All DM and large femoral head bearings were identified. The primary outcome measure was the cumulative percent revision (CPR) for dislocation and for all aseptic causes. The results were adjusted by age, sex, and femoral fixation. A subanalysis was performed stratifying acetabular component diameter <58 m and ≥58 mm. RESULTS There were 4942 DM and 101,221 large femoral head bearings recorded. There was no difference in the CPR for dislocation (HR = 0.69 (95% CI 0.42, 1.13), P = .138) or aseptic causes (HR = 0.91 (95% CI 0.70, 1.18), P = .457). When stratified by acetabular component size, DM reduced the CPR for dislocation in acetabular component diameter <58 mm (HR = 0.55 (95% CI 0.30, 1.00), P = .049). There was no difference for diameter ≥58 mm. There was no difference in aseptic revision when stratified by acetabular component diameter. CONCLUSION There is no difference in revision rates for dislocation or aseptic causes between DM and large femoral heads in primary THA. When stratified by acetabular component size, DM reduces dislocation for acetabular component diameter <58 mm. LEVEL OF EVIDENCE Level III.
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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
| | - Roger Bingham
- Traumaplasty.Melbourne, East Melbourne, Victoria, Australia; Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Chelsea Dyer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Sophia Rainbird
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Hoskins W, Rainbird S, Peng Y, Graves SE, Bingham R. Hip Hemiarthroplasty for Fractured Neck of Femur Revised to Total Hip Arthroplasty: Outcomes Are Influenced by Patient Age Not Articulation Options. J Arthroplasty 2021; 36:2927-2935. [PMID: 33941411 DOI: 10.1016/j.arth.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip hemiarthroplasty is the most common arthroplasty option for fractured neck of femur (FNOF). Revision to total hip arthroplasty (THA) is occasionally required. This study aimed to assess the outcome of hemiarthroplasty revised to THA and to assess the impact of femoral head size, dual mobility (DM), and constrained liners. METHODS All aseptic 1st revisions reported to the Australian Joint Replacement Registry after hemiarthroplasty performed for FNOF when a THA was used as the revision procedure were included from September 1999 to December 2019. The primary outcome measure was the cumulative percent revision for all-causes and dislocation. The impact of prosthesis factors on revision THA was assessed: standard head THA (≤32 mm), large head THA (≥36 mm), DM, and constrained liners. Outcomes were compared using Kaplan Meyer and competing risk. RESULTS There were 96,861 hemiarthroplasties performed, with 985 revised to THA. The most common reasons for 1st revision were loosening (49.3%), fracture (17.7%), and dislocation (11.0%). Of the hemiarthroplasty procedures revised to THA, 76 had a 2nd revision. The most common reasons for 2nd revision were fracture (27.6%), dislocation (26.3%), loosening (23.7%), and infection (18.4%). Femoral head size, DM, or constrained liner use did not alter the incidence of all-cause 2nd revision. This did not change when solely looking at patients still alive. A 2nd revision was more likely in patients aged <75 years. CONCLUSION The outcome of hemiarthroplasty performed for FNOF revised to THA is influenced by patient age, not by the articulation used.
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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
| | - Sophia Rainbird
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Yi Peng
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Roger Bingham
- Traumaplasty.Melbourne, East Melbourne, Victoria, Australia; Department of Orthopaedics, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Midterm Outcomes After Reconstruction of Superolateral Acetabular Defects Using Flying Buttress Porous Tantalum Augments During Revision Total Hip Arthroplasty. J Arthroplasty 2021; 36:2936-2941. [PMID: 33840542 DOI: 10.1016/j.arth.2021.03.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/06/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Porous tantalum augments are versatile tools in reconstructing complex acetabular defects during revision total hip arthroplasty (THA). This study examines the clinical and radiographic outcomes of porous tantalum augments placed in the type I (flying buttress) configuration at two to 17-year follow-up in the largest cohort to-date in the literature. METHODS We retrospectively analyzed 59 consecutive revision THAs involving the use of flying buttress augments between 2003 and 2018. The mean patient age and follow-up duration were 63.9 ± 11.6 years (range, 35-87) and 8 years (range, 2-17), respectively. The Oxford hip score was used to assess clinical outcome. The modified Moore classification was used to assess acetabular augment and shell osseointegration. Kaplan-Meier survival analysis with 95% confidence interval (CI) was used to assess implant survivorship. RESULTS The mean Oxford hip score improved from 15.9 ± 6.2 preoperatively to 35.0 ± 6.5 at a mean follow-up of eight years (P < .0001). Radiographic assessment using the modified Moore classification demonstrated five signs of osseointegration in 49 hips (83.1%), four signs in six hips (10.2%), three signs in one hip (1.7%), and one sign in one hip (1.7%). Kaplan-Meier analysis demonstrated ten-year survivorship of 88.9% (95% CI 74.4-95.4) with all-cause revision as end point and 94.3% (95% CI 83.1-98.2) with revision for acetabular aseptic loosening as end point. CONCLUSION Treatment of superolateral acetabular defects during revision THA using porous tantalum augments placed in the type I (flying buttress) configuration provides excellent implant survivorship and favorable clinical outcomes at mid-term follow-up. LEVEL OF EVIDENCE Therapeutic Level IV.
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Emerging Concepts in the Surgical Management of Peri-Acetabular Metastatic Bone Disease. ACTA ACUST UNITED AC 2021; 28:2731-2740. [PMID: 34287325 PMCID: PMC8293093 DOI: 10.3390/curroncol28040238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/22/2023]
Abstract
The pelvis is a common site of metastatic bone disease. Peri-acetabular lesions are particularly challenging and can cause severe pain, disability and pathologic fractures. Surgical management of these lesions has historically consisted of cementoplasty for contained lesions and Harrington reconstructions for larger, more destructive lesions. Due to the limitations of these procedures, a number of novel procedures have been developed to manage this challenging problem. Percutaneous techniques—including acetabular screw fixation and cementoplasty augmented with screws—have been developed to minimize surgical morbidity. Recent literature has demonstrated a reliable reduction in pain and improvement in function in appropriately selected patients. Several adjuncts to the Harrington procedure have been utilized in recent years to reduce complication rates. The use of constrained liners and dual mobility bearings have reduced the historically high dislocation rates. Cage constructs and porous tantalum implants are becoming increasingly common in the management of large bony defects and destructive lesions. With novel and evolving surgical techniques, surgeons are presented with a variety of surgical options to manage this challenging condition. Physicians must take into account the patients’ overall health status, oncologic prognosis and anatomic location and extent of disease when developing an appropriate surgical plan.
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