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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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Gerber CD, Lee A, De Silva V, Yatsonsky D, Georgiadis GM. Malseated Liner in Modular Dual Mobility Total Hip Replacement: A Report of Three Cases. Cureus 2024; 16:e60437. [PMID: 38883007 PMCID: PMC11179678 DOI: 10.7759/cureus.60437] [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: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Modular dual mobility total hip arthroplasty (THA) can be associated with complications if the liner is malseated, which can be unappreciated intraoperatively. A meticulous surgical technique is needed to ensure that the liner is perfectly seated. In addition, a malseated liner can be missed if the postoperative films are not carefully reviewed by the surgeon. We present three cases of THA associated with a malseated modular dual mobility liner. In one case, the malpositioned liner was appreciated intraoperatively, but it was wedged in place and could not be removed. The entire shell needed to be revised. In two other cases, malseating was not detected intra-operatively. Both were appreciated postoperatively, and early revision surgery was needed.
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Affiliation(s)
- Caleb D Gerber
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Anderson Lee
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Vihan De Silva
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - David Yatsonsky
- Department of Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA
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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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Wood MJ, Al-Jabri T, Zaghloul A, Lanting B, Giannoudis PV, Hart AJ. Periprosthetic acetabular fractures as a complication of total hip arthroplasty. Injury 2023; 54:111058. [PMID: 37748235 DOI: 10.1016/j.injury.2023.111058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Periprosthetic acetabular fractures are rare but potentially devastating complications of total hip arthroplasty. As the number of total hip arthroplasties performed annually increases, so has the incidence of periprosthetic fractures, with the topic being spotlighted more frequently in the orthopaedic community. There is a particular sparsity of literature regarding periprosthetic acetabular fractures, with periprosthetic femoral fractures after total hip arthroplasty being traditionally far more commonly reported. This article aims to provide an up-to-date review of the epidemiology, risk factors, diagnostic challenges, classifications, and management strategies for periprosthetic acetabular fractures after total hip arthroplasty.
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Affiliation(s)
- Matthew J Wood
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Talal Al-Jabri
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - Ahmed Zaghloul
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Brent Lanting
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Alister James Hart
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom; Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, HA7 4LP, United Kingdom
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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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Steele JR, Shenoy A, Pekmezian A, Wright T, Padgett DE. Evaluation of Mechanically-Assisted Crevice Corrosion of Different Modular Dual Mobility Constructs. J Arthroplasty 2023:S0883-5403(23)00392-3. [PMID: 37088224 DOI: 10.1016/j.arth.2023.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Modular dual mobility (MDM) acetabular component use is rising in total hip arthroplasty. However, concern of mechanically-assisted crevice corrosion (MACC) at the shell-liner interface remains. We investigated shell-liner corrosion using retrieval analyses and corrosion chamber testing. METHODS We analyzed fretting and corrosion on 10 matched pairs of two commercial modular dual mobility constructs (MDM1 and MDM2). Also, pristine pairs of Ti6Al4V shells and CoCrMo liners from three commercial dual mobility systems (MDM1, MDM2, MDM3) were tested in vitro to model MACC performance. Three pairs of each were placed into an electrochemical chamber with stepwise increasing cyclic compression loads, while measuring currents generated at the shell-liner taper. Onset fretting loads and fretting currents were calculated. RESULTS Corrosion damage scores on retrieved components were low, but higher in the MDM2 to MDM1 liners (P = 0.006), specifically outside the taper region (P = 0.00003). Fretting currents were higher in the MDM2 than in MDM1 or MDM3 (P = 0.011). Onset loads were also higher in the MDM2 (P = 0.001). CONCLUSION Among retrieved liners, MDM2 tapers seem prone to non-mechanical corrosion modes. Higher onset loads and fretting currents in MDM2 tapers indicate greater MACC resistance, but higher severity once corrosion begins. Differences among the devices were likely due to taper design and surface finish. Currents in all three were <5 μA, much lower than those observed with head-neck tapers. Our findings suggest that among the types of corrosion observed in these MDM designs, mechanically driven corrosion may not be the most significant.
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Affiliation(s)
- John R Steele
- Adult Reconstruction and Joint Replacement Division, 535 East 70(th) Street, Hospital for Special Surgery, New York, NY 10021 USA; Towson Orthopaedic Associates, 8322 Bellona Ave Suite 100, Orthopaedic Institute at St. Joseph's Medical Center, Towson, MD 21204 USA
| | - Aarti Shenoy
- Department of Biomechanics, 535 East 70(th) Street, Hospital for Special Surgery, New York, NY 10021 USA.
| | - Ashley Pekmezian
- Department of Biomechanics, 535 East 70(th) Street, Hospital for Special Surgery, New York, NY 10021 USA
| | - Timothy Wright
- Department of Biomechanics, 535 East 70(th) Street, Hospital for Special Surgery, New York, NY 10021 USA
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Division, 535 East 70(th) Street, Hospital for Special Surgery, New York, NY 10021 USA
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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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Di Martino A, Brunello M, Bordini B, Rossomando V, Tassinari L, D’Agostino C, Ruta F, Faldini C. Unstable Total Hip Arthroplasty: Should It Be Revised Using Dual Mobility Implants? A Retrospective Analysis from the R.I.P.O. Registry. J Clin Med 2023; 12:jcm12020440. [PMID: 36675369 PMCID: PMC9864424 DOI: 10.3390/jcm12020440] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Total hip arthroplasty (THA) is one of the most common surgical procedures in orthopedics; however, it is subjected to different kinds of failures, one of them being dislocation. Many different prosthetic designs have been developed to overcome this problem, such as dual mobility coupling. The main purpose of this article is to determine whether there are differences regarding the revision surgery of unstable THA comparing the risk of failure between dual mobility cup (DMC) implants, standard implants, and among different head sizes. A registry-based population study has been conducted by analyzing data collected by the Emilia Romagna Registry of Orthopedic Prosthetic Implants (RIPO), including a total of 253 implants failed for dislocation and instability that were operated on by cup revision surgery between 2000 and 2019. The selected population has been divided into two groups based on the insert type: standard and DMC. The age at revision surgery was significantly lower in the standard cup group with respect to DMC (p = 0.014 t-test), with an average age of 71.2 years (33-96 years range) for the standard cups and 74.8 years (48-92 years range) for the DMC group. The cumulative survival of DMC implants was 82.0% at 5-years, decreasing to 77.5% at a 10-year follow-up, which is not significantly different from standard cups (p = 0.676, Log-Rank test). DMC implants showed a significantly lower risk of re-revision for dislocation compared to standard cups (p = 0.049). Femoral heads ≥36 mm had a higher overall survival compared to smaller femoral heads (p = 0.030). This study demonstrated that DMC or femoral heads ≥36 mm are a valid choice to manage THA instability and to reduce the revision rate for dislocation at a mid-term follow-up; in those selected and targeted patients, these options should be taken into consideration because they are associated with better outcomes.
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Affiliation(s)
- Alberto Di Martino
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-0516366924
| | - Matteo Brunello
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valentino Rossomando
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Leonardo Tassinari
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Claudio D’Agostino
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Federico Ruta
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
| | - Cesare Faldini
- I Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neurimotor Science-DIBINEM, University of Bologna, 40136 Bologna, Italy
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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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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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11
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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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12
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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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13
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Grace TR, Goh GS, Lee GC, Kamath AF, Kurtz SM, Courtney PM. Dual Mobility Reduces Dislocations-Why I Use It in All Revisions. J Arthroplasty 2021; 36:S63-S69. [PMID: 33526395 DOI: 10.1016/j.arth.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Instability remains the most common complication after revision total hip arthroplasty (THA) and presents a unique treatment dilemma for the orthopedic surgeon. Dual mobility (DM) bearing articulations have been used in France since the 1970s, but have only become more widely adopted in the United States over the last decade. The purpose of this symposium was to discuss the role for DM bearings in revision THA. METHODS We reviewed the existing literature on outcomes after DM bearing articulations in revision THA. We also report several case examples of the use of DM in difficult revision THA cases, including acetabular bone loss, failed constrained liner, and adverse local tissue reaction. Finally, we briefly discuss the limitations associated with the use of DM. RESULTS Several large retrospective series demonstrate that DM bearings reduce the incidence of dislocation after revision THA when compared with conventional single bearing THA. Specific complications related to DM bearings including polyethylene wear, loosening, intraprosthetic dislocation, and corrosion remain a concern, but appear to have drastically improved over time with modern implant designs. CONCLUSION Contemporary DM designs have been established as an effective bearing option to reduce instability in revision THA, although concerns do exist. High-quality prospective studies are necessary to further define the role this bearing option has in the coming years.
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Affiliation(s)
- Trevor R Grace
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Gwo-Chin Lee
- Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, Department of Orthopaedic Surgery, Philadelphia, PA
| | - Atul F Kamath
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH
| | - Steven M Kurtz
- Exponent Inc and Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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14
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Pai FY, Ma HH, Chou TFA, Huang TW, Huang KC, Tsai SW, Chen CF, Chen WM. Risk factors and modes of failure in the modern dual mobility implant. A systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:541. [PMID: 34126990 PMCID: PMC8204435 DOI: 10.1186/s12891-021-04404-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background The aims of this meta-analysis were to: (1) validate the outcome of modern dual mobility (DM) designs in patients who had undergone primary and revision total hip arthroplasty (THA) procedures and (2) to identify factors that affect the outcome. Methods We searched for studies that assessed the outcome of modern DM-THA in primary and revision procedures that were conducted between January, 2000 to August, 2020 on PubMed, MEDLINE, Cochrane Reviews and Embase. The pooled incidence of the most common failure modes and patient reported outcomes were evaluated in patients who have received: (1) primary THA, (2) revision THA for all causes or (3) for recurrent dislocation. A meta-regression analysis was performed for each parameter to determine the association with the outcome. The study design of each study was assessed for potential bias and flaws by using the quality assessment tool for case series studies. Results A total of 119 studies (N= 30016 DM-THAs) were included for analysis. The mean follow-up duration was 47.3 months. The overall implant failure rate was 4.2% (primary: 2.3%, revision for all causes: 5.5%, recurrent dislocation: 6.0%). The most common failure modes were aseptic loosening (primary: 0.9%, revision for all causes: 2.2%, recurrent dislocation: 2.4%), septic loosening (primary:0.8%, revision for all causes: 2.3%, recurrent dislocation: 2.5%), extra-articular dislocation (primary:0.6%, revision for all causes:1.3%, recurrent dislocation:2.5%), intra-prosthetic dislocation (primary:0.8%, revision for all causes:1.0%, recurrent dislocation:1.6%) and periprosthetic fracture (primary:0.9%, revision for all causes:0.9%, recurrent dislocation:1.3%). The multi-regression analysis identified younger age (β=-0.04, 95% CI -0.07 – -0.02) and female patients (β=3.34, 95% CI 0.91–5.78) were correlated with higher implant failure rate. Age, gender, posterolateral approach and body mass index (BMI) were not risk factors for extra-articular or intra-prosthetic dislocation in this cohort. The overall Harris hip score and Merle d’Aubigné score were 84.87 and 16.36, respectively. Level of evidence of this meta-analysis was IV. Conclusion Modern dual-mobility designs provide satisfactory mid-term implant survival and clinical performance. Younger age and female patients might impact the outcome after DM-THA. Future research directions should focus on, (1) long-term outcome of modern dual-mobility design, including specific concerns such as intra-prosthetic dislocation and elevated metal ion, and (2) cost-effectiveness analysis of dual-mobility implant as an alternative to conventional THA for patients who are at high risk of dislocation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04404-4.
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Affiliation(s)
- Fu-Yuan Pai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsan-Wen Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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15
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Abstract
Pelvic discontinuity (PD) has been a considerable challenge for the hip revision arthroplasty surgeon. However, not all PDs are the same. Some occur during primary cup insertion, resembling a fresh periprosthetic fracture that separates the superior and inferior portions of the pelvis, while others are chronic as a result of gradual acetabular bone loss due to osteolysis and/or acetabular implant loosening.In the past, ORIF, various types of cages, bone grafts and bone cement were utilized with little success. Today, the biomechanics and biology of PD as well as new diagnostic tools and especially a variety of new implants and techniques are available to hip revision surgeons. Ultraporous cups and augments, cup-cage constructs and custom triflange components have revolutionized the treatment of PD when used in various combinations with ORIF and bone grafts. For chronic PD the cup-cage construct is the most popular method of reconstruction with good medium-term results.Dislocation continues to be the leading cause of failure in all situations, followed by infection. Ultimately, surgeons today have a big enough armamentarium to select the best treatment approach. Case individualization, personal experience and improvisation are the best assets to drive treatment decisions and strategies. Cite this article: EFORT Open Rev 2021;6:459-471. DOI: 10.1302/2058-5241.6.210022.
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Affiliation(s)
- George C. Babis
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio Hospital, Greece
| | - Vasileios S. Nikolaou
- 2nd Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Konstantopouleio Hospital, Greece
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16
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French JMR, Bramley P, Scattergood S, Sandiford NA. Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:343-353. [PMID: 34150328 PMCID: PMC8183148 DOI: 10.1302/2058-5241.6.200146] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Modular dual-mobility (MDM) constructs can be used to reduce dislocation rates after total hip replacement (THR). However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. This systematic review reports outcomes following THR using MDM components. It was registered with PROSPERO and conducted in line with Cochrane and PRISMA recommendations.Sixteen articles were included overall, with meta-analysis performed on relevant subsets using a random intercept logistic regression model. Estimated median incidence of ARMD requiring revision surgery within study follow-up period was 0.3% (95% CI 0.1 - 1.8%, from 11 cohort studies containing 1312 cases).Serum metal ion levels were mildly raised in 7.9% of cases, and significantly raised in 1.8%, but there was no correlation with worse clinical hip function scores within studies. Dislocation rate was 0.8%. Revision rate was 3.3%.There are mixed reports of wear on the backside of the metal liner from the acetabular shell and screw heads. Both implant design and component malseating are implicated, but currently it is unclear to what extent each factor is responsible.Studies were poor quality with high risk of confounding, especially from trunnion corrosion. We have made recommendations for further work. In the meantime, surgeons should be aware of the potential risk of ARMD when considering using an MDM prosthesis, and, if selecting one, must ensure proper seating of the liner and screws intraoperatively. Cite this article: EFORT Open Rev 2021;6:343-353. DOI: 10.1302/2058-5241.6.200146.
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Affiliation(s)
- Jonathan M R French
- Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Paul Bramley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sean Scattergood
- Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
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17
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Pujol O, Mimendia I, Martin-Dominguez L, Amat C, Barro V. Simultaneous bilateral dual mobility total hip arthroplasty dislocation in a patient with hepatic encephalopathy: A case report. Int J Surg Case Rep 2021; 80:105705. [PMID: 33662911 PMCID: PMC7937745 DOI: 10.1016/j.ijscr.2021.105705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Dislocation is a severe complication after total hip arthroplasty (THA). It is one of the most common reasons for failure and revision surgery. This is the first case of a documented simultaneous bilateral dual mobility (DM) THA dislocation. CASE PRESENTATION A forty-nine-year-old man presented with bilateral hip pain, immobility and deformity. X-ray images demonstrated simultaneous bilateral posterior THA dislocation. Previously, the patient had presented atraumatic dislocations recurrently. When he was thoroughly re-interrogated, he complained of uncontrolled and generalized muscle contractions, which were compatible with myoclonus due to hepatic encephalopathy (HE). Multidisciplinary treatment was performed satisfactorily to control myoclonus symptomatology and to prevent dislocation. CLINICAL DISCUSSION Patient's most important risk factor was a neuromuscular disorder, which we initially gave little notice and undervalued. HE is a serious but reversible syndrome, observed in patients with liver dysfunction. It leads to a wide spectrum of neuropsychiatric abnormalities. Management is based on prevention of episodes, avoiding the underlying triggers. Due to the high risk for dislocation of our patient, we decided to use DM cups bilaterally. This system has demonstrated lower rates of dislocation. CONCLUSION This case report reminds us that a careful evaluation through meticulous history and physical examination are mandatory when faced with recurrent instability. Furthermore, prevention of dislocation is vastly preferable to treating this challenging complication. High-risk patients should be identified, and appropriate surgical approach, technique and implants have to be collectively used to reach a strategy that mitigates and ideally prevents dislocation.
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Affiliation(s)
- Oriol Pujol
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Iñaki Mimendia
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Carles Amat
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Septic and Reconstructive Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Víctor Barro
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
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18
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Zhang X, Li Z, Wang W, Liu T, Peng W. Mid-term results of revision surgery using double-trabecular metal cups alone or combined with impaction bone grafting for complex acetabular defects. J Orthop Surg Res 2020; 15:301. [PMID: 32762720 PMCID: PMC7412805 DOI: 10.1186/s13018-020-01828-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Revision surgery for complex acetabular defects is still technically challenging. In this study, we discussed and compared the clinical and radiological outcomes of revision surgery between two methods using double-trabecular metal (TM) cups alone or combined with impacting bone grafting (IBG). METHODS The records of 18 patients (18 hips) who underwent revision surgery using double-trabecular metal (double-TM) cups between 2008 and 2016 were retrospectively reviewed. All the patients were diagnosed with Paprosky III acetabular defects. The acetabular defects were reconstructed by double-TM cups alone or in combination with IBG. We used the modified Harris Hip Score (mHHS), University of California, Los Angeles (UCLA), and Short Form 36 (SF-36) to evaluate the clinical outcomes. Pelvis plain X-ray was used to assess hip center of rotation (COR), abduction angle and anteversion angle of acetabular cup, and incorporation of the bone graft to host bone. RESULTS The median follow-up time was 61.0 (IQR 56.0 to 65.8) months. No patients underwent re-revision for loosening or any other reasons. Complications included 3 patients (16.7%) with early dislocation and 3 patients (16.7%) with delayed wound healing. The average mHHS and UCLA preoperatively were 44.1 ± 4.0 (range 35 to 50) and 2.6 ± 0.7 (range 2 to 4), respectively and at the last follow-up were 73.7 ± 4.2 (range 68 to 85) and 7.3 ± 0.5 (range 7 to 8), respectively. The mean SF-36 scores at the last follow-up were improved significantly than preoperative scores, especially in bodily pain category (P < 0.05). The average limb-length discrepancy (LLD) decreased significantly from 24.2 ± 2.6 (range 20 to 32) mm preoperatively to 5.8 ± 1.8 (range 3 to 9) mm at the last follow-up, respectively. However, there was no significant difference between two methods at the last follow-up in terms of mHHS, UCLA, SF-36, LLD, and hip COR (P > 0.05). Radiographic evaluation demonstrated bone graft incorporation in all hips in the follow-up. CONCLUSIONS Defect reconstruction using double-TM cups alone or combined with IBG are practical and reliable treatment options for Paprosky III acetabular defects without pelvic discontinuity. Nevertheless, high postoperative complication rate, especially in terms of dislocation, remains a challenge.
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Affiliation(s)
- Xianghong Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.,Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, 545000, Guangxi, People's Republic of China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Wanchun Wang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
| | - Weiqiu Peng
- Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, 545000, Guangxi, People's Republic of China
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19
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Lutnick E, Kang J, Freccero DM. Surgical Treatment of Femoral Neck Fractures: A Brief Review. Geriatrics (Basel) 2020; 5:E22. [PMID: 32244621 PMCID: PMC7345750 DOI: 10.3390/geriatrics5020022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022] Open
Abstract
Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty.
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Affiliation(s)
- Ellen Lutnick
- Jacobs School of Medicine and Biomedical Sciences, 955 Main St., Buffalo, NY 14203, USA;
| | - Jeansol Kang
- Boston University School of Medicine, Department of Orthopaedics, 850 Harrison Ave. Dowling 2N, Boston, MA 02118, USA;
| | - David M. Freccero
- Boston University School of Medicine, Department of Orthopaedics, 850 Harrison Ave. Dowling 2N, Boston, MA 02118, USA;
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