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Dubin JA, Bains SS, Chen Z, Hameed D, Moore MC, Mont MA, Nace J, Delanois RE. Single center evaluation of outcomes of modular dual mobility liners during revision total hip arthroplasty: A five-year follow-up. J Orthop 2023; 43:75-78. [PMID: 37559883 PMCID: PMC10407033 DOI: 10.1016/j.jor.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Revision total hip arthroplasty (rTHA) is at increased risk for postoperative instability when compared to primary cases, which has been mitigated to some extent with the introduction of dual mobility (DM) reconstructions. These constructs were designed to lower dislocation rates and to improve impingement-free range of motion. As a follow-up to our prior institutional study, we expanded on a cohort of DM reconstructions compared to non-DM constructs. We examined a modular dual mobility system in rTHA to measure loosening of the acetabular component, as well as revision and dislocation rates in comparison to an historical cohort of single articulation prostheses.Materials/Methods: This retrospective cohort study from a single center included 254 patients who underwent rTHA with a dual mobility liner by three fellowship-trained surgeons between January 1, 2014 and December 1, 2019. This was a follow-up to an historical cohort of revisions performed with a single articulation prosthesis (n = 120) from the same surgeons performed between January 1, 2011 and December 23, 2013. The inclusion criteria included consecutively performed rTHAs that had a minimum follow-up of 2 years. We excluded patients who had femoral revisions and head/liner revisions only. The average follow-up in the dual mobility cohort and the single articulation cohort was 5 years (range, 2-10 years) and 2.5 years (range, 1.5-4.3 years), respectively. The primary outcomes were dislocation, aseptic loosening, and re-revision rates. Secondary outcomes were radiographic analyses of cup migration and osteolysis. RESULTS There were 4 out of 256 (1.6%) dislocations from the dual mobility cohort compared to 7 out of 120 (5.8%), P < 0.001 from the single articulation cohort. The rates of aseptic loosening were 3.2% (8 out of 254) and 4.2% (5 out of 120), P = 0.124, respectively, between the cohorts. The re-revision rate was 5.9% for the DM liners and 8.3% in the control cohort, P = 0.38. Radiographic analyses revealed no cup migration and osteolysis in any of the patients that had no dislocations. CONCLUSION The dual mobility articulations in rTHA demonstrated improved results in terms of lower dislocations rates when compared to a single articulation prostheses. Our center uses these articulations for revisions and surgeons should consider the use of these bearings when performing rTHA.
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Affiliation(s)
- Jeremy A. Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Mallory C. Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Michael A. Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Fiedler B, Patel V, Lygrisse KA, Kelly ME, Turcotte JJ, MacDonald J, Schwarzkopf R. The effect of reduced bone mineral density on elective total hip arthroplasty outcomes. Arch Orthop Trauma Surg 2023; 143:5993-5999. [PMID: 36920526 DOI: 10.1007/s00402-023-04830-0] [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: 03/25/2022] [Accepted: 02/28/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Reduced bone mineral density (BMD) and disruption of normal bony architecture are the characteristics of osteopenia and osteoporosis and in patients undergoing total hip arthroplasty (THA) may cause failure of trabecular ingrowth. The purpose of this study is to evaluate the impact of reduced BMD on outcomes following primary elective THA. METHODS A retrospective chart review of 650 elective THAs with a DEXA scan in their electronic health record (EHR) from 2011 to 2020 was conducted at an urban, academic center and a regional, health center. Patients were separated into three cohorts based on their t-score and the World Health Organizations definitions: normal (t-score ≥ - 1), osteopenia (t-score < - 1.0 and > - 2.5), and osteoporosis (t-score ≤ - 2.5). Demographic and outcome data were assessed. Subsidence was assessed for patients with non-cemented THAs. Regression models were used to account for demographic differences. RESULTS 650 elective THAs, of which only 11 were cemented, were included in the study. Patients with osteopenia and osteoporosis were significantly older than those without (p = 0.002 and p < 0.0001, respectively) and had a lower BMI (p < 0.0001 and p < 0.0001, respectively). PFx was significantly greater in patients with osteoporosis when compared to those with normal BMD (6.5% vs. 1.0%; p = 0.04). No such difference was found between osteoporotic and osteopenic patients. The revision rate was significantly higher for osteoporotic patients than osteopenic patients (7.5% vs. 1.5%; p = 0.04). No such difference was found between the other comparison groups. CONCLUSION Patients with osteoporosis were older with reduced BMI and had increased PFx after non-cemented elective THA. Understanding this can help surgeons formulate an appropriate preoperative plan for the treatment of patients with osteoporotic bone undergoing elective THA.
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Affiliation(s)
- Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Vaidehi Patel
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - Katherine A Lygrisse
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA
| | - McKayla E Kelly
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Justin J Turcotte
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - James MacDonald
- Adult Reconstructive Division, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 E 17th St, New York, NY, 10003, USA.
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Hanusrichter Y, Gebert C, Frieler S, Dudda M, Hardes J, Streitbuerger A, Jeys L, Wessling M. Beyond type III Paprosky acetabular defects: are partial pelvic replacements with iliosacral fixation successful? Int Orthop 2023; 47:2253-2263. [PMID: 37145143 DOI: 10.1007/s00264-023-05823-9] [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] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Supra-acetabular bone loss close beyond the sciatic notch is one of the most challenging defect types for stable anatomical reconstruction in revision arthroplasty. Using reconstruction strategies from tumour orthopaedic surgery, we adapted tricortical trans-iliosacral fixation options for custom-made implants in revision arthroplasty. The aim of the present study was to present the clinical and radiological results of this extraordinary pelvic defect reconstruction. METHODS Between 2016 and 2021, 10 patients with a custom-made pelvic construct using tricortical iliosacral fixation (see Fig. 1) were included in the study. Follow-up was 34 (SD 10; range 15-49) months. Postoperatively CT scans evaluating the implant position were performed. Functional outcome and the clinical results were recorded. RESULTS Implantation was possible as planned in all cases in 236 (SD 64: range 170-378) min. Correct centre of rotation (COR) reconstruction was possible in nine cases. One sacrum screw crossed a neuroforamen in one case without clinical symptoms. During the follow-up period, four further operations were required in two patients. There were no individual implant revisions or aseptic loosening recorded. The Harris Hip Score increased significantly from 27 Pts. to 67 Pts. with a mean improvement of 37 (p < 0.005). EQ-5D developed from 0.562 to 0.725 (p = 0.038) as a clear improvement in quality of life. CONCLUSION Custom-made partial pelvis replacement with iliosacral fixation offers a safe solution in "beyond Paprosky type III defects" for hip revision arthroplasty. Due to meticulous planning, precise implantation with good clinical outcome can be achieved. Furthermore, the functional outcome and patient satisfaction increased significantly showing promising early results with a relatively low complication rate.
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Affiliation(s)
- Yannik Hanusrichter
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter, NRW, Germany.
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.
| | - Carsten Gebert
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter, NRW, Germany
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Sven Frieler
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter, NRW, Germany
- Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, RUB, Bochum, Germany
| | - Marcel Dudda
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
- Department of Trauma Surgery, University Hospital Essen, Essen, Germany
- Department of Orthopedics and Trauma Surgery BG-Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Germany
| | - Jendrik Hardes
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
- Department of Trauma Surgery, University Hospital Essen, Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, Essen, Germany
| | - Arne Streitbuerger
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
- Department of Trauma Surgery, University Hospital Essen, Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, Essen, Germany
| | - Lee Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK
- Faculty of Health Sciences, Aston University, Birmingham, UK
| | - Martin Wessling
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Lothar-Gau-Str. 11, 58300, Wetter, NRW, Germany
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
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Siddiqi A, Warren J, Anis HK, Barsoum WK, Bloomfield MR, Briskin I, Brooks PJ, Higuera CA, Kamath AF, Klika A, Krebs O, Krebs VE, Mesko NW, Molloy RM, Mont MA, Murray TG, Muschler GF, Patel P, Stearns KL, Strnad GJ, Suarez JC, Piuzzi NS. Do patient-reported outcome measures improve after aseptic revision total hip arthroplasty? Hip Int 2023; 33:267-279. [PMID: 34554849 DOI: 10.1177/11207000211036320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to determine patient-reported outcome measures (PROMs) changes in: (1) pain, function and global health; and (2) predictors of PROMs in patients undergoing aseptic revision total hip arthroplasty (rTHA) using a multilevel model with patients nested within surgeon. METHODS A prospective cohort of 216 patients with baseline and 1-year PROMs who underwent aseptic rTHA between January 2016 and December 2017 were analysed. The most common indication for rTHA was aseptic loosening, instability, and implant failure. The PROMs included in this study were HOOS Pain and HOOS Physical Function Short-form (PS), Veterans RAND-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (MCS). Multivariable linear regression models were constructed for predicting 1-year PROMs. RESULTS Mean 1-year PROMs improvement for aseptic revisions were 30.4 points for HOOS Pain and 22.1 points for HOOS PS. Predictors of better pain relief were patients with higher baseline pain scores. Predictors of better 1-year function were patients with higher baseline function and patients with a posterolateral hip surgical approach during revision. Although VR-12 PCS scores had an overall improvement, nearly 50% of patients saw no improvement or had worse physical component scores. Only 30.7% of patients reported improvements in VR-12 MCS. CONCLUSIONS Overall, patients undergoing aseptic rTHA improved in pain and function PROMs at 1 year. Although global health assessment improved overall, nearly half of aseptic rTHA patients reported no change in physical/mental health status. The associations highlighted in this study can help guide the shared decision-making process by setting expectations before aseptic revision THA.
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Affiliation(s)
| | - Ahmed Siddiqi
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jared Warren
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hiba K Anis
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael K Barsoum
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Isaac Briskin
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, OH, USA
| | - Peter J Brooks
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Carlos A Higuera
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul F Kamath
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alison Klika
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Olivia Krebs
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Viktor E Krebs
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nathan W Mesko
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert M Molloy
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Michael A Mont
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Trevor G Murray
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - George F Muschler
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Preetesh Patel
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kim L Stearns
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gregory J Strnad
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Nicolas S Piuzzi
- Orthopaedic Department, Cleveland Clinic Foundation, Cleveland, OH, USA
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