1
|
Khatod M, Chan PH, Prentice HA, Fasig BH, Paxton EW, Reddy NC, Kelly MP. Can Dual Mobility Cups Reduce Revision and Dislocation Risks? An Analysis of 107,528 Primary Total Hip Arthroplasties in the United States. J Arthroplasty 2024; 39:1279-1284.e1. [PMID: 38042378 DOI: 10.1016/j.arth.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Dual mobility acetabular cups (DMC) were designed to increase the effective femoral head size and improve stability with the goal of reducing revision risk at the potential cost of polyethylene thickness. We sought to evaluate revision risk following primary elective total hip arthroplasty with DMC compared to highly cross-linked polyethylene (XLPE). METHODS A cohort study was conducted using data from a Kaiser Permanente's total joint arthroplasty registry. Patients ≥18 years who underwent primary elective total hip arthroplasty using DMC, unipolar Metal-on-XLPE (MoXLPE), or unipolar Ceramic-on-XLPE (CoXLPE) were identified (2010 to 2021). The final sample comprised 2,219 DMC, 48,251 MoXLPE, and 57,058 CoXLPE. Multiple Cox proportional hazard regressions were used to evaluate aseptic revision and any dislocation regardless of revision within 6 years follow-up. RESULTS In adjusted analyses, no differences in aseptic revision risk were observed for MoXLPE (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 0.72 to 1.51) or CoXLPE (HR = 0.98, 95% CI = 0.69 to 1.40) compared to DMC. No differences in dislocation risk were observed for MoXLPE (HR = 1.42, 95% CI = 0.93 to 2.15) or CoXLPE (HR = 1.25, 95% CI = 0.84 to 1.87) compared to DMC. CONCLUSIONS In a US-based cohort, 6-year aseptic revision risk of DMC was similar to metal or ceramic femoral head unipolar constructs. Furthermore, no difference in dislocation risk was observed. Continued longer-term follow-up may reveal if there is a reduced risk of dislocation that comes at the cost of increased late revision. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Monti Khatod
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Los Angeles, California
| | - Priscilla H Chan
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Heather A Prentice
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Brian H Fasig
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California
| | - Nithin C Reddy
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, San Diego, California
| | - Matthew P Kelly
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Harbor City, California
| |
Collapse
|
2
|
Bhattacharjee S, Ahlawat A, Prasad A, Das RK. Total Hip Arthroplasty in Ochronotic Arthropathy: A Case Report. J Orthop Case Rep 2023; 13:86-91. [PMID: 38162346 PMCID: PMC10753665 DOI: 10.13107/jocr.2023.v13.i12.4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/04/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Total hip arthroplasty (THA) is a common procedure used to treat various hip conditions. However, patients with ochronotic arthropathy, a rare genetic disorder characterized by the abnormal accumulation of homogentisic acid, are at a higher risk of post-surgical dislocation and instability due to poor bone quality and joint degeneration. Case Report This case study features a 52-year-old male patient diagnosed with ochronotic arthropathy who underwent bilateral THA with the use of a dual mobility cup (DMC). Ochronotic arthropathy had caused significant joint degeneration and stiffness, leading to considerable functional impairment. Conclusion The application of a DMC in THA for patients with ochronotic arthropathy has shown promising outcomes. The DMC offers increased range of motion and improved stability, effectively reducing the risk of post-surgical dislocation and implant failure. This case study highlights the potential of DMC as a viable solution for addressing the challenges posed by poor bone quality in patients with ochronotic arthropathy undergoing THA.
Collapse
Affiliation(s)
- Sujoy Bhattacharjee
- Department of Orthopaedics, Sarvodaya Hospital Research Centre, Robotic Joint Replacement Unit, Sector 8, Faridabad, Haryana, India
| | - Akhil Ahlawat
- Department of Orthopaedics, Sarvodaya Hospital Research Centre, Robotic Joint Replacement Unit, Sector 8, Faridabad, Haryana, India
| | - Avijeet Prasad
- Department of Orthopaedics, Sarvodaya Hospital Research Centre, Robotic Joint Replacement Unit, Sector 8, Faridabad, Haryana, India
| | - Rajib Kumar Das
- Department of Orthopaedics, Sarvodaya Hospital Research Centre, Robotic Joint Replacement Unit, Sector 8, Faridabad, Haryana, India
| |
Collapse
|
3
|
Ciolli G, Mesnard G, Deroche E, Gunst S, Batailler C, Servien E, Lustig S. Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Pers Med 2022; 13:jpm13010081. [PMID: 36675742 PMCID: PMC9867154 DOI: 10.3390/jpm13010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Instability is a common complication following total hip arthroplasty (THA). The dual mobility cup (DMC) allows a reduction in the dislocation rate. The goal of this systematic review was to clarify the different uses and outcomes according to the indications of the cemented DMC (C-DMC). Methods: A systematic review was performed using the keywords "Cemented Dual Mobility Cup" or "Cemented Tripolar Cup" without a publication year limit. Of the 465 studies identified, only 56 were eligible for the study. Results: The overall number of C-DMC was 3452 in 3426 patients. The mean follow-up was 45.9 months (range 12-98.4). In most of the cases (74.5%) C-DMC was used in a revision setting. In 57.5% DMC was cemented directly into the bone, in 39.6% into an acetabular reinforcement and in 3.2% into a pre-existing cup. The overall dislocation rate was 2.9%. The most frequent postoperative complications were periprosthetic infections (2%); aseptic loosening (1.1%) and mechanical failure (0.5%). The overall revision rate was 4.4%. The average survival rate of C-DMC at the last follow-up was 93.5%. Conclusions: C-DMC represents an effective treatment option to limit the risk of dislocations and complications for both primary and revision surgery. C-DMC has good clinical outcomes and a low complication rate.
Collapse
Affiliation(s)
- Gianluca Ciolli
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Sacred Heart Catholic University, 00168 Rome, Italy
| | - Guillaume Mesnard
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Correspondence:
| | - Etienne Deroche
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Stanislas Gunst
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- LIBM—EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69622 Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| |
Collapse
|
4
|
Antoniadis A, Wegrzyn J. Direct Cementation of Dual Mobility Cups Into the Bony Acetabulum in Primary Total Hip Arthroplasty: Clinical and Radiographic Outcomes at a Minimum 5-Year Follow-Up. J Arthroplasty 2022; 38:1120-1125. [PMID: 36566998 DOI: 10.1016/j.arth.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cemented dual mobility cups (DMCs) are commonly used in combination with acetabular reinforcement devices. Indeed, according to literature, direct cementation of metal-backed acetabular components into the bony acetabulum remains controversial as this technique is potentially associated with increased rates of aseptic loosening. Therefore, this study aimed to evaluate the clinical and radiographic outcomes of DMC cemented into the bony acetabulum in primary total hip arthroplasty (THA). METHODS A total of 49 THA (48 patients, mean age 78 years [range, 51 to 91]) performed with direct cementation of a DMC into the bony acetabulum were prospectively included in our total joint registry and retrospectively reviewed. The clinical outcome was assessed using the Harris hip score (HHS). The radiographic outcome included measurement of component positioning and occurrence and progression of demarcation around the cemented DMC. Complications were reported with a particular attention to cemented fixation failure and aseptic loosening. RESULTS At a 7-year mean follow-up (range, 5 to 8), the pre-to postoperative HHS improved from 47 (range, 30 to 58) to 92 points (range, 80 to 98) (P < .01). Nonprogressive and focalized demarcations were observed in 7 THA (14%). Importantly, no progressive demarcation or DMC aseptic loosening was observed. CONCLUSION Direct cementation of DMC into the bony acetabulum ensured a stable fixation with no progressive demarcation or aseptic loosening at midterm follow-up. Therefore, this technique can be selectively considered in primary THA, especially in elderly or frail patients to avoid potential mechanical failure of press-fit fixation due to altered bone quality or additional morbidity related to the use of acetabular reinforcement devices.
Collapse
Affiliation(s)
- Alexander Antoniadis
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julien Wegrzyn
- Department of Orthopaedic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
5
|
Patetta MJ, Kayupov E, Karam JA, Chmell SJ. Fourth-Generation Ceramic Head Fracture in Dual Mobility Total Hip Arthroplasty: A Case Report. J Orthop Case Rep 2022; 12:98-101. [PMID: 35611291 PMCID: PMC9091388 DOI: 10.13107/jocr.2022.v12.i01.2638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Rare cases of Biolox® delta ceramic head fractures in ceramic-on-polyethylene bearings have been reported in the literature. Virtually none of these catastrophic injuries have been documented in dual mobility constructs. CASE REPORT We report a case of fourth-generation delta ceramic head fracture 4.5 years after implantation in a dual mobility total hip replacement constructs as a result of a ground-level fall. The patient underwent revision arthroplasty with another delta ceramic dual mobility construct and was able to return to work in custodial services 2 weeks after the revision procedure. CONCLUSION In summary, we presented an extremely uncommon case of a fractured fourth generation, Biolox® delta ceramic head in a dual mobility total hip arthroplasty (THA), as a result of a ground-level fall. The patient underwent successful revision surgery to another dual mobility delta ceramic THA. Despite substantial advances in ceramic materials, catastrophic failure of 4th generation ceramic head components can still occur even in dual mobility constructs and require revision arthroplasty surgery.
Collapse
Affiliation(s)
- Michael J. Patetta
- Department of Orthopaedic Surgery, Department of Orthopaedics, University of Illinois at Chicago, 835 S. Wolcott Avenue, Chicago 60612, Illinois,Address of Correspondence: Dr. Michael J. Patetta, Department of Orthopaedics, University of Illinois at Chicago, 835 S. Wolcott Avenue., E270 MSS MC 844, Chicago 60612, Illinois. E-mail:
| | - Erdan Kayupov
- Department of Orthopaedic Surgery, Department of Orthopaedics, University of Illinois at Chicago, 835 S. Wolcott Avenue, Chicago 60612, Illinois
| | - Joseph A. Karam
- Department of Orthopaedic Surgery, Department of Orthopaedics, University of Illinois at Chicago, 835 S. Wolcott Avenue, Chicago 60612, Illinois
| | - Samuel J. Chmell
- Department of Orthopaedic Surgery, Department of Orthopaedics, University of Illinois at Chicago, 835 S. Wolcott Avenue, Chicago 60612, Illinois
| |
Collapse
|
6
|
Alberio RL, Rusconi M, Martinetti L, Monzeglio D, Grassi FA. Total Hip Arthroplasty (THA) for Femoral Neck Fractures: Comparison between Standard and Dual Mobility Implants. Geriatrics (Basel) 2021; 6:geriatrics6030070. [PMID: 34287327 PMCID: PMC8293229 DOI: 10.3390/geriatrics6030070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
The purpose of this retrospective study is to compare the short-term clinical and radiological results between standard and dual mobility THA for femoral neck fractures (FNF) in older patients. The hypothesis is that the dual mobility cup (DMC) has the same outcomes but a lower dislocation rate than the standard THA. The study population included 56 patients (mean age 77.7 years, range 71–85) that underwent THA for displaced FNF. Patients were divided in two comparable groups for baseline characteristics (age, sex and comorbidities): 28 patients underwent THA with a standard cup (SC) and 28 THA with DMCs. The clinical records and radiograms were reviewed to search relevant data in their postoperative history. Two postoperative dislocations occurred in the SC group and none in the DMC group. At an average follow up of 23 months (12–40), 48 patients were available for the final evaluation. The WOMAC score for all patients averaged 6.26 (0–46) and was slightly better in the DMC group (4.94 vs. 7.58; p-value = 0.41); scores were significantly better in presence of neurological comorbidities (p-value = 0.04), in the absence of diabetes (p-value = 0.04) and in the case of psychiatric disorders (p-value = 0.02). Radiographic evaluation at one year showed signs of osteointegration in 42/48 (87.5%) acetabular components (20 DMCs, 22 SC). According to our experience, DMCs proved to be a valid option for the treatment of displaced FNF in older patients, since it allowed them to achieve short-term outcomes comparable to conventional THA, while decreasing the incidence of postoperative dislocations.
Collapse
Affiliation(s)
- Riccardo L. Alberio
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
| | - Mattia Rusconi
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
- Correspondence:
| | - Loris Martinetti
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
| | - Diego Monzeglio
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
| | - Federico A. Grassi
- Orthopaedics and Traumatology Unit, Hospital “Maggiore della Carità”, 28100 Novara, NO, Italy; (R.L.A.); (D.M.); (F.A.G.)
- Department of Health Sciences, University of East Piedmont, 28100 Novara, NO, Italy;
| |
Collapse
|
7
|
Jinnai Y, Homma Y, Baba T, Zhuang X, Kaneko K, Ishijima M. Use of Dual Mobility Acetabular Component and Anterior Approach in Patients With Displaced Femoral Neck Fracture. J Arthroplasty 2021; 36:2530-2535. [PMID: 33744082 DOI: 10.1016/j.arth.2021.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the antidislocation effect of total hip arthroplasty (THA) via the direct anterior approach (DAA) with dual mobility cup (DMC) for displaced femoral neck fracture (FNF) has already been reported, the clinical result of DMC-DAA-THA for displaced FNF in terms of mortality, complications, and walking ability are still unclear. METHODS 106 cases with DMC-DAA-THA for displaced FNF were investigated of dislocation; perioperative complications; 3-, 6-, and12-month mortality rate; and pre/early postoperative walking ability. The walking ability was stratified into the following four categories: (1) use of a wheelchair (no walking), (2) walking alongside a support (including walkers designed for the elderly), (3) walking using one stick, and (4) unaided walking. RESULTS There was no dislocation withing one-year postoperative. The 3-, 6-, and 12-month mortality rate was 2.8%, 4.7%, and 5.7%. Total complications occurred in 14 cases (14.7%). Although there was no revision surgery, two cases (1.9%) of intraoperative fracture treated without additional fixation, and one case of postoperative fracture was occurred. Among patients with preinjury walking category 2, 3, and 4 (total 94 cases), the number of patients who recovered same walking category at two-week postoperation was 56 cases (59.6%). CONCLUSIONS Our study demonstrated that DMC-DAA-THA for displaced FNF offered quick recovery of walking ability with no dislocation and low one-year mortality rate. We believe that the combination of early postoperative recovery due to the minimal invasiveness of the DAA and decreased dislocation rate due to increased range of motion by DMC and adequate soft tissue tension by DAA contributed to null dislocation.
Collapse
Affiliation(s)
- Yuta Jinnai
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Xu Zhuang
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
8
|
Sidhu GAS, Kotecha A, Mulay S, Ashwood N. Spontaneous Early Intraprosthetic Dislocation of 22 mm Skirted Femoral Head in Dual Mobility Hip Prosthesis: A Case Report. J Orthop Case Rep 2021; 11:6-9. [PMID: 34239819 PMCID: PMC8241259 DOI: 10.13107/jocr.2021.v11.i03.2062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: There is a trend for increasing use of dual mobility hip designs for both primary and revision hip arthroplasty settings. It provides dual articular surfaces along with increased jump distance to increase the stability of construct. However, this design has some unique complications of its own which surgeons should be aware of especially intraprosthetic dislocation (IPD). Case Report: A 76-year-old lady presented to clinic with painful hip hemiarthroplasty after fracture neck of femur. She underwent revision surgery with dual mobility uncemented acetabular cup and femoral stem was retained as it was well fixed. She was mobilizing well and around 5 weeks post her surgery, developed pain in hip region and difficulty in weight-bearing. Radiographs showed eccentric position of femoral neck in the socket. A diagnosis of IPD was established and revision surgery was planned. Intraoperatively, metal head had dislocated from the polyethylene head and both components were resting in the acetabular socket. No macroscopic erosion of acetabulum was noticed. The polyethylene component and femoral head were retrieved. With previous failed dual mobility, decision was made to achieve stability with larger head size and lipped liner posteriorly. Conclusion: IPD is a rare occurrence and unique complication to dual mobility implants. This report highlights that patients can have IPD without fall or trauma.
Collapse
Affiliation(s)
- Gur Aziz Singh Sidhu
- Department of Trauma and Orthopaedics, Queens Hospital Burton, University Hospitals of Derby and Burton, United Kingdom
| | - Amit Kotecha
- Department of Trauma and Orthopaedics, Queens Hospital Burton, University Hospitals of Derby and Burton, United Kingdom
| | - Sanjay Mulay
- Department of Trauma and Orthopaedics, Queens Hospital Burton, University Hospitals of Derby and Burton, United Kingdom
| | - Neil Ashwood
- Department of Trauma and Orthopaedics, Queens Hospital Burton, University Hospitals of Derby and Burton, United Kingdom
| |
Collapse
|
9
|
Abstract
INTRODUCTION Dual-mobility cups (DMC) are currently used in patients having risk factors of instability. Most of the studies report the use of DMC in patients having a single high-risk variable. The aim of the study was to analyse a continuous series of patients treated with primary total hip arthroplasty (THA) and DMC with different high risk for dislocation. METHODS This is a retrospective study analysing the outcomes of primary THA with DMC in patients at high-risk of dislocation. The sample consisted of 215 patients having 1 of 3 aetiologies or risk factors: (1) young subjects (<55 years); (2) osteonecrosis of the femoral head (ONFH); and (3) femoral neck fracture (FNF). RESULTS With a mean follow-up duration of 70 ± 24.7 months, the findings showed the following: 2 patients had dislocated their hip following motor vehicle accidents; 1 patient had a traumatic femoral peri-prosthetic fracture; and 1 patient had an acute infection. No intra-prosthetic dislocation or aseptic loosening were encountered. No radiolucent lines were observed on the acetabular side. The mean modified Hip Harris Score was 96.6 ± 7.4%. Out of 186 patients, 170 (90.1%) would label their operated hip as a "forgotten hip". 78 out of the 84 patients (92.8%) who used to practice oriental sitting and/or ablution for prayers were able to return to their usual daily activities of extreme hip position and 74 out of the 84 patients (88%) described their operated hip as "a forgotten hip". No correlation was found between any of the studied variables. DISCUSSION The findings of this series of patients at high risk of dislocation showed excellent clinical and radiological results with very few complications. The use of DMC seems to counteract the impact of some aetiologies/risk factors that could lead to higher instability. Most patients practising extreme hip positions resumed their usual practices.
Collapse
Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Hanane Barakat
- Department of Anesthesiology, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon.,Center of Evidence-based Anatomy, Sports & Orthopedic Research, Beirut, Lebanon
| |
Collapse
|
10
|
Kurczyński K, Pepłoński A, Cieślik P, Burbul M. Iatrogenic Intraprosthetic Dislocation of Dual Mobility Cup. Case Study. Ortop Traumatol Rehabil 2021; 23:51-57. [PMID: 33709946 DOI: 10.5604/01.3001.0014.7568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Intra-prosthetic dislocation of the dual-mobile acetabular cup is a rare complication. Most often, it is the result of wear of the polyethylene liner. It can also occur during a closed reduction of a dislocated dual-mobile cup. It is extremely important to recognize this complication immediately in order to avoid the consequences. This paper presents the first case of iatrogenic intraprosthetic dislocation at the Traumatology and Orthopaedics Department of the Military Medical Institute, our management of the case and suggestions for treating patients with a dislocation of the dual-mobile acetabular cup.
Collapse
Affiliation(s)
- Kamil Kurczyński
- Klinka Traumatologii i Ortopedii, Wojskowy Instytut Medyczny, Warszawa / Department of Musculoskeletal Traumatology and Orthopaedics, Military Medical Institute, Warsaw, Poland
| | - Artur Pepłoński
- Klinka Traumatologii i Ortopedii, Wojskowy Instytut Medyczny, Warszawa / Department of Musculoskeletal Traumatology and Orthopaedics, Military Medical Institute, Warsaw, Poland
| | - Piotr Cieślik
- Klinka Traumatologii i Ortopedii, Wojskowy Instytut Medyczny, Warszawa / Department of Musculoskeletal Traumatology and Orthopaedics, Military Medical Institute, Warsaw, Poland
| | - Marta Burbul
- Klinka Traumatologii i Ortopedii, Wojskowy Instytut Medyczny, Warszawa / Department of Musculoskeletal Traumatology and Orthopaedics, Military Medical Institute, Warsaw, Poland
| |
Collapse
|
11
|
Klemt C, Smith EJ, Oganesyan R, Limmahakhun S, Fitz D, Kwon YM. Outcome of Dual Mobility Constructs for Adverse Local Tissue Reaction Associated Abductor Deficiency in Revision Total Hip Arthroplasty. J Arthroplasty 2020; 35:3686-3691. [PMID: 32654942 DOI: 10.1016/j.arth.2020.06.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Treatment of adverse local tissue reaction (ALTR) is challenging owing to high complications and poor outcomes after a revision surgery. As dislocation is the most common cause of reoperation, it is often necessary to use advanced articulations such as dual mobility. This study aims to evaluate the outcome and complication rates after revision surgery with dual mobility constructs, compared to constrained and conventional articulations in the setting of significant abductor deficiency due to ALTR. METHODS Out of a total of 338 revision total hip arthroplasties for ALTR, 234 patients with a significant tissue necrosis and abductor muscle insufficiency (grade 3) were evaluated. The complication rates after revisions were compared between 42 hips with dual mobility implants, 24 hips with constrained liners, 104 hips with large diameter heads (36-40 mm), and 64 hips with small diameter heads (≤32 mm). RESULTS After an average of 4 years of follow-up (2.8-8.6), the dual mobility articulation had no dislocation, compared to 4.1% and 15.5% for constrained liner and conventional articulations, respectively (P < .001). Utilization of dual mobility and constrained liner cup also did not increase the risk of nondislocation complications, including periprosthetic joint infection and periprosthetic fracture (P = .18 and .52). CONCLUSIONS This study demonstrates significantly lower dislocation rates for dual mobility when compared to conventional articulations and comparable to constrained liners in cases of severe abductor deficiency due to ALTR, suggesting that dual mobility implants are viable surgical treatment alternatives to constrained liners to minimize dislocation during revision total hip arthroplasty in the setting of significant abductor deficiency due to ALTR.
Collapse
Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Evan J Smith
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ruben Oganesyan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Fitz
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
12
|
Abstract
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: EFORT Open Rev 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
Collapse
Affiliation(s)
- Georgios Tsikandylakis
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
| | - Soren Overgaard
- The Danish Hip Arthroplasty Register, Aarhus, Denmark
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
- The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| |
Collapse
|
13
|
Kenanidis E, Zagalioti SCC, Milonakis N, Tsapakis EM, Tsiridis E. A Catastrophic Cascade of Postoperative Complications Following Hemiarthroplasty for Femoral Neck Fracture in a Middle-Aged Patient With Schizophrenia. Cureus 2020; 12:e9044. [PMID: 32782863 PMCID: PMC7410513 DOI: 10.7759/cureus.9044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The treatment of a patient with schizophrenia suffering a subcapital hip fracture may be challenging, mainly due to the high risk of postoperative medical and surgical complications. Mechanical complications from the implant are also frequently encountered following hip arthroplasty in patients with schizophrenia. We report the case of a 57-year-old male patient with schizophrenia who underwent hip hemiarthroplasty for a displaced femoral neck fracture. During the initial postoperative period, the patient developed a cascade of surgical and mechanical complications, leading to multiple revision procedures and a suboptimal outcome. The ideal type of treatment of patients with schizophrenia with subcapital hip fracture is still missing. It is, therefore, important to highlight the high risk of postoperative complications in patients with schizophrenia who present with subcapital fractures subsequently treated with hemiarthroplasty.
Collapse
Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| | | | - Nikolaos Milonakis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC
| | - Evangelia M Tsapakis
- 1st Academic Department of Psychiatry, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Psychiatry, Agios Charalambos Mental Health Clinic, Heraklion, GRC
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC.,Center of Orthopaedic and Regenerative Medicine - Center of Interdisciplinary Research and Innovation, Aristotle University Medical School, Thessaloniki, GRC
| |
Collapse
|
14
|
Abstract
Objective
To evaluate the incidence of prosthetic instability in a consecutive series of 42 cases of total hip arthroplasty using dual mobility cup.
Methods
A retrospective study of 38 patients undergoing primary or revision total hip arthroplasty (THA) using the acetabular dual-mobility cup (DMC) implant between January 2012 and January 2018. The rates of complications and instability after surgery were evaluated.
Results
In total, 42 arthroplasties were performed in 38 patients, with a minimum follow-up of 16 months. The mean age of the sample was 60 years. In 38 cases, we used a cementless DMC, and, in the other 4 cases, a cemented DMC. There were no cases of early or late instability.
Conclusion
The series herein presented proves the good result of the DMC in cases of primary arthroplasty, complex and complicated cases of failed osteosynthesis of proximal femoral fractures, and revision for THA instability. The absence of episodes of prosthetic instability and complications in complex cases of primary and revision THA increases the confidence in this concept.
Collapse
Affiliation(s)
- Raul Frankllim Carvalho Almeida
- Grupo de cirurgia do quadril e joelho, Serviço de Ortopedia e Traumatologia, Hospital Universitário, Universidade Federal do Maranhão, São Luís, Maranhão, Brasil
| |
Collapse
|
15
|
Schmidt A, Batailler C, Fary C, Servien E, Lustig S. Dual Mobility Cups in Revision Total Hip Arthroplasty: Efficient Strategy to Decrease Dislocation Risk. J Arthroplasty 2020; 35:500-507. [PMID: 31563399 DOI: 10.1016/j.arth.2019.08.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) is a challenging surgery with a higher rate of complications than primary arthroplasty, particularly instability and aseptic loosening. The purpose of this study is to compare dual mobility cup (DMC) and standard mobility cup (SMC) in all rTHAs performed at our institution over a decade with a 1 year minimum follow-up. METHODS Two hundred ninety-five rTHAs (acetabular only and bipolar revisions) between 2006 and 2016 were retrospectively reviewed. These were divided into those with a DMC (184 revisions) or SMC (111 revisions). Dislocation and complications requiring re-revision were reported. RESULTS The rTHA mean age was 69 years ± 13.9 (19-92) and the mean follow-up was 2.3 years. Dislocation risk was statistically lower (P = .01) with a DMC (3.8%; 7/184) than with an SMC (13.5%; 15/111). DMC required re-rTHA in 24/184 (13%) for any reason compared to SMC in 19/111 (17.1%) (P = .34). There was no significant difference in early aseptic loosening (P = .28) between the 2 groups. For young patients (≤55 years), results were similar with a lower dislocation rate in the DMC group (P = .24) and no increased risk of early aseptic loosening (P = .49). CONCLUSION This study demonstrates that for all rTHA indications DMC compared to SMC has a significantly decreased risk of postoperative dislocation without risk of early aseptic loosening at medium term follow-up. The use of DMC in rTHA is an important consideration particularly with the predicted increased incidence of both primary and revision THA globally.
Collapse
Affiliation(s)
- Axel Schmidt
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| |
Collapse
|
16
|
Fahad S, Nawaz Khan MZ, Aqueel T, Hashmi P. Comparison of bipolar hemiarthroplasty and total hip arthroplasty with dual mobility cup in the treatment of old active patients with displaced neck of femur fracture: A retrospective cohort study. Ann Med Surg (Lond) 2019; 45:62-65. [PMID: 31372217 PMCID: PMC6660598 DOI: 10.1016/j.amsu.2019.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 01/28/2023] Open
Abstract
Background The standard treatment of displaced femoral neck fracture is arthroplasty. THA is reportedly superior to BHA in terms of hip pain, function and reoperation rate. On the other hand THA has a higher rate of dislocation. Total hip replacement with dual mobility cup increases the range of motion and reduces the chances of dislocation. The aim of this study is to compare the functional outcome, rate of dislocation, complications and mortality between BHA and THA with dual mobility cuff for the treatment of displaced neck of femur fracture. Patients and method This is a non-commercialized retrospective cohort study conducted at our tertiary care level 1 trauma centre. Patients of age group 60 years and above who underwent hip arthroplasty (BHA or THA with dual mobility implant) between 2015 and 2017 for displaced neck of femur fracture with a complete follow up for one year were included. Both groups were assessed for postoperative surgical complications including dislocation, fracture, surgical site infection, and medical complications, one-year mortality and functional outcome were analysed via Harris Hip Score (HHS) at the latest follow up. Results Overall 104 patients were included in the study out of which 77 patients underwent BHA while 27 underwent THA with dual mobility cup. Baseline characteristics were found to be similar in both groups. Mean pre-op HHS for bipolar group was found to be 71.01 while for THA with dual mobility cup group it was 73.52 with the difference being statistically insignificant (P = 0.12). Mean post-op HHS for bipolar group was noted to be 68.82 whereas for THA with dual mobility cup group it was 76.81. The difference was found to be statistically significant with a P-value of <0.01. With regards to post-operative complications and one-year post-operative mortality, no significant difference was noted between both groups. Conclusion In relatively young and active elderly patients with displaced neck of femur fracture, a THA with dual mobility cuff provides better hip functional outcome, does not increase mortality or morbidity as compared to BHA and can be considered as primary treatment modality. The standard treatment of displaced femoral neck fracture is arthroplasty. Total Hip Arthroplasty is reportedly superior to Bipolar Hemiarthroplasty in terms of hip pain, function and reoperation rate. Total Hip Arthroplasty has a higher rate of dislocation rate than Bipolar Hemiarthroplasty. Total Hip Arthroplasty with Dual mobility cup increases the functional outcome and reduces the chances of dislocation.
Collapse
|
17
|
Neri T, Philippot R, Klasan A, Putnis S, Leie M, Boyer B, Farizon F. Dual mobility acetabular cups for total hip arthroplasty: advantages and drawbacks. Expert Rev Med Devices 2018; 15:835-845. [PMID: 30345834 DOI: 10.1080/17434440.2018.1538781] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The dual mobility cup (DMC) concept was proposed by Professor Gilles Bousquet in 1974. Its' aims were to prevent postoperative dislocation, restore the physiological range of motion of the hip, and reduce the stresses at the interface. Since it was created, this design has been modified multiple times to reduce the complication rate, improve implant survival, and expand the indications. AREAS COVERED The objective of this review is to discuss the advantages and disadvantages of this implant based on its 40-year history and also to propose a range of indications based on published results. This will provide surgeons with a complete overview of DMC. EXPERT COMMENTARY Published studies on DMC confirm the low dislocation rate. Improvements made to DMC overtime have greatly reduced the complications related to wear, such as aseptic loosening and intraprosthetic dislocation (IPD). According to the literature, the indications have expanded and are no longer limited to revision surgery only. Long-term studies are needed before we can draw formal conclusions and consolidate these promising results.
Collapse
Affiliation(s)
- Thomas Neri
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France.,c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Remi Philippot
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
| | - Antonio Klasan
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Sven Putnis
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Murilo Leie
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Bertrand Boyer
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
| | - Frederic Farizon
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
| |
Collapse
|
18
|
Tabori-Jensen S, Hansen TB, Bøvling S, Aalund P, Homilius M, Stilling M. Good function and high patient satisfaction at mean 2.8 years after dual mobility THA following femoral neck fracture: a cross-sectional study of 124 patients. Clin Interv Aging 2018; 13:615-621. [PMID: 29674847 PMCID: PMC5898881 DOI: 10.2147/cia.s157671] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims Our aim was to investigate function, health status and satisfaction in patients treated with primary dual mobility (DM) total hip arthroplasty (THA) after displaced femoral neck fracture (FNF). Patients and methods From 2005-2011, 414 consecutive FNF patients received Saturne DM THA. At a minimum of 1-year follow-up, 124 (95 women) were evaluated with Oxford Hip Score (OHS), Harris Hip Score (HHS), health-related quality of life (HRQoL) measure (EQ-5D) and two functional tests: Timed Up and Go (TUG) and Sit to Stand 10 times (STS). The FNF patients were matched 1:2 by age, sex and surgery date with patients receiving THA due to osteoarthrosis (OA group) and 1-year OHS and EQ5D were compared. FNF patients were matched by age and sex with the general population index (GPI) for EQ-5D comparison. Results Patient age at surgery after FNF was mean 74.8 (range 30-92) years. At mean follow-up of 2.8 (range 1.0-7.7) years, mean EQ-5D score was 0.79 (SD 0.15) in the FNF group, which was similar to the matched GPI (p = 0.4), but lower (p = 0.014) compared to the OA group. Mean OHS was 36.4 (SD 9.5) in the FNF group and 38.4 (SD 7.2) in the OA group (p = 0.18). HHS in the FNF group was 78.7 (SD 15.5). Mean TUG time was 13.5 (SD 4.9) secs, and mean STS was 37.9 (SD 15.3) secs. Eighty nine percent (n = 111) of FNF patients were satisfied with the operation result. Conclusion DM THA following displaced FNF provides a good functional result and quality of life in addition to high patient satisfaction.
Collapse
Affiliation(s)
- Steffan Tabori-Jensen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben B Hansen
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren Bøvling
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West, Holstebro, Denmark
| | - Peter Aalund
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West, Holstebro, Denmark
| | - Morten Homilius
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West, Holstebro, Denmark
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Regional Hospital West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
19
|
Dagnino A, Ursino N, Ripamonti CAM, Fiorentini CE, Scelsi M, D'Ambrosi R, Portinaro NM. Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis. Joints 2017; 5:249-252. [PMID: 29270564 PMCID: PMC5738471 DOI: 10.1055/s-0037-1606619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year.
Collapse
Affiliation(s)
| | - Nicola Ursino
- I.R.C.C.S. Istituto Ortopedico Galeazzi, U.O. CASCO, Milan, Italy
| | | | | | - Michele Scelsi
- I.R.C.C.S. Istituto Ortopedico Galeazzi, U.O. CASCO, Milan, Italy
| | - Riccardo D'Ambrosi
- I.R.C.C.S. Istituto Ortopedico Galeazzi, U.O. CASCO, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Nicola M Portinaro
- Università degli Studi di Milano, Milan, Italy.,Istituto Clinico Humanitas, U.O. Ortopedia Pediatrica, Milan, Italy
| |
Collapse
|
20
|
Wegrzyn J, Tebaa E, Jacquel A, Carret JP, Béjui-Hugues J, Pibarot V. Can Dual Mobility Cups prevent Dislocation in All Situations After Revision Total Hip Arthroplasty? J Arthroplasty 2015; 30:631-40. [PMID: 25443363 DOI: 10.1016/j.arth.2014.10.034] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED The outcome of a single design of dual mobility cup was prospectively evaluated in a continuous series of 994 revision THAs with respect to dislocation and intra-prosthetic dislocation (IPD). At a 7.3-year mean follow-up, the dislocation rate was 1.5% and the IPD rate was 0.2%. The 2 IPD occurred in acetabular-only revisions and were related to a poor head-to-neck ratio with early impingement and wear at the polyethylene mobile component chamfer. Dual mobility cups demonstrated a low dislocation rate in revision THA but did not compensate for potential perioperative technical errors. In addition, IPD did not appear to be a concern with respect to the benefit in term of instability prevention though caution is advised in acetabular-only revision associated with a poor head-to-neck ratio. LEVEL OF EVIDENCE Therapeutic study-Level IV.
Collapse
Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Lyon, France; INSERM UMR 1033, Université de Lyon, Lyon, France
| | - Eloïse Tebaa
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Alexandre Jacquel
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Paul Carret
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Jacques Béjui-Hugues
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Vincent Pibarot
- Department of Orthopedic Surgery-Pavillon T, Hôpital Edouard Herriot, Lyon, France
| |
Collapse
|
21
|
Wegrzyn J, Pibarot V, Jacquel A, Carret JP, Béjui-Hugues J, Guyen O. Acetabular reconstruction using a Kerboull cross-plate, structural allograft and cemented dual-mobility cup in revision THA at a minimum 5-year follow-up. J Arthroplasty 2014; 29:432-7. [PMID: 23849510 DOI: 10.1016/j.arth.2013.05.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/11/2013] [Accepted: 05/28/2013] [Indexed: 02/01/2023] Open
Abstract
The current study aimed to evaluate the outcome of a continuous and prospective series of 61 revision THAs with AAOS grade III and IV acetabular bone defect reconstruction using a Kerboull cross-plate, structural allograft and cemented dual mobility cup (Saturne, Amplitude, Valence, France). At a 7.5-year mean follow-up, no instability was reported after revision. In addition, no failure of the acetabular reconstruction was observed in 98% of the patients with complete allograft osseointegration and no evidence of mechanical rupture of the Kerboull cross-plate and/or loosening of the cemented dual mobility cup. In conclusion, such reconstruction technique demonstrated excellent results at mid-term follow-up in terms of prevention of instability after revision, restoration of the acetabular bone stock, and stable cemented fixation of the dual mobility cup.
Collapse
Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France; INSERM UMR 1033, Université de Lyon, Lyon, France
| | - Vincent Pibarot
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Alexandre Jacquel
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Paul Carret
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Jacques Béjui-Hugues
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France
| | - Olivier Guyen
- Department of Orthopedic Surgery - Pavillon T, Hôpital Edouard Herriot, Lyon, France; LBMC_UMR T 9406 IFSTTAR/Université de Lyon, Lyon, France
| |
Collapse
|
22
|
Mukka SS, Mahmood SS, Sjödén GO, Sayed-Noor AS. Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital. Orthop Rev (Pavia) 2013; 5:48-51. [PMID: 23888200 PMCID: PMC3718234 DOI: 10.4081/or.2013.e10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/19/2013] [Accepted: 04/21/2013] [Indexed: 11/25/2022] Open
Abstract
Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.
Collapse
Affiliation(s)
- Sebastian S Mukka
- Department of Orthopaedics, Sundsvall Teaching Hospital; Department of Surgical and Perioperative Science, Umeå University , Sweden
| | | | | | | |
Collapse
|