High Failure Rate of Modular Exchange With a Specific Design of a Constrained Liner in High-Risk Patients Undergoing Revision Total Hip Arthroplasty

Background: The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. Methods: The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. Results: 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801–1.256; p = 0.489). Conclusions: NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

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Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

Hip International ◽

10.1177/1120700019873617 ◽

2019 ◽

pp. 112070001987361 ◽

Cited By ~ 3

Author(s):

Jesús Moreta ◽

Iker Uriarte ◽

Xabier Foruria ◽

Ioar Urra ◽

Urko Aguirre ◽

...

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Recurrent Dislocation ◽

Revision Total Hip Arthroplasty ◽

Dual Mobility ◽

Total Hip ◽

Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

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Freedom Constrained Liner for the Treatment and Prevention of Dislocation in Total Hip Arthroplasty

Scandinavian Journal of Surgery ◽

10.1177/1457496916660035 ◽

2016 ◽

Vol 106 (2) ◽

pp. 165-172 ◽

Cited By ~ 9

Author(s):

M. Karvonen ◽

H. Karvonen ◽

M. Seppänen ◽

A. Liukas ◽

M. Koivisto ◽

...

Keyword(s):

Risk Factors ◽

Total Hip Arthroplasty ◽

Failure Rate ◽

Hip Arthroplasty ◽

Mechanical Failure ◽

University Hospital ◽

Revision Thas ◽

Total Hip ◽

Locking Mechanism ◽

Constrained Liner

Background and Purpose: Dislocation is one of the most common complications following total hip arthroplasty. The aim of our study was to assess failure rate of the Biomet Freedom constrained liner (Biomet, Warsaw, IN, USA) either in revision surgery for recurrent dislocation, or as a preventive method in high dislocation risk patients. Patients and Methods: We assessed retrospectively 105 consecutive surgical procedures in 103 patients where a Freedom constrained liner or cup was used in Turku University Hospital over a 7-year period from 2007 to 2014. The mechanical failure rate of the device was assessed based on medical records. The average age of the patients was 73.4 years. The number of male patients was 53 (51%). Mean follow-up time was 2.5 years. The association between failure of the device and potential risk factors—age, gender, indication, and approach—was analyzed with logistic regression. Results were expressed by odd ratios and 95% confidence intervals. Results: The mechanical failure rate of the Freedom device was 6 out of 105 (5.7%). None of the 11 preventive primary THAs against dislocation failed, 4 out of 52 (7.7%) preventive revision THAs against dislocation failed, and 2 out of 42 (4.8%) of the treated dislocation cases failed. Four out of six failures were dislocations due to impingement and failure of the locking mechanism. Two liners failed because of loosening. The risk factors assessed were not associated with failure of the device. Interpretation: We found out that the mechanical failure rate of a Freedom constrained device was low. These results encourage us to continue using the device.

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Patient-Reported Outcomes Can Be Used to Streamline Post-Total Hip Arthroplasty Follow-Up to High-Risk Patients

The Journal of Arthroplasty ◽

10.1016/j.arth.2017.05.033 ◽

2017 ◽

Vol 32 (11) ◽

pp. 3319-3321

Author(s):

Jie J. Yao ◽

Hilal Maradit Kremers ◽

Cathy D. Schleck ◽

Dirk R. Larson ◽

Jasvinder A. Singh ◽

...

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Reported Outcomes ◽

Total Hip ◽

High Risk Patients ◽

Patient Reported ◽

Risk Patients

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Prevention of heterotopic bone formation with early post operative irradiation in high risk patients undergoing total HIP arthroplasty: Comparison of 10.00 Gy VS 20.00 Gy schedules

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(87)90010-1 ◽

1987 ◽

Vol 13 (3) ◽

pp. 365-369 ◽

Cited By ~ 54

Author(s):

Paul Anthony ◽

Henry Keys ◽

C. McCollister Evarts ◽

Philip Rubin ◽

Carol Lush

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Bone Formation ◽

Hip Arthroplasty ◽

Heterotopic Bone ◽

Heterotopic Bone Formation ◽

Total Hip ◽

High Risk Patients ◽

Risk Patients

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Do Cemented Dual-Mobility Cups Confer Stability for Patients at High Risk of Dislocation in Revision Total Hip Arthroplasty?

The Journal of Hip Surgery ◽

10.1055/s-0038-1661341 ◽

2018 ◽

Vol 02 (02) ◽

pp. 088-091 ◽

Cited By ~ 1

Author(s):

Perry Evangelista ◽

Kamil Okroj ◽

Darren Plummer ◽

Craig Della Valle ◽

Ran Schwarzkopf

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Revision Total Hip Arthroplasty ◽

Acetabular Cup ◽

Metal Shell ◽

Dual Mobility ◽

Total Hip

AbstractDislocation is among the most commonly reported complications following revision total hip arthroplasty. Dual-mobility bearings may lower the risk of dislocation. The authors report the results of a multicenter study evaluating the use of a dual-mobility acetabular cup design that was cemented into a metal shell as part of complex acetabular reconstructions or in cases where the risk of dislocation was felt to be high, such as isolated bearing exchanges. Eighteen patients were identified for being at high risk of dislocation who underwent cementation of a dual-mobility shell that is specifically made for cementation, into a fully porous metal revision acetabular cup (10 patients) or into a well-fixed cup at the time of revision without removal of the existing acetabular component (eight patients). Patients were assessed clinically and radiographically at a minimum of 2 years for the evidence of dislocation, revision surgery, and implant loosening. At a mean of 36 months (range, 25–56 months), one patient died and one was lost to follow-up. There were no known cases of hip dislocation. There was one repeat revision, for a deep infection treated with irrigation and debridement. The mean preoperative Harris Hip Score of 46 (range, 40–79) improved to a mean of 65 points (range, 41–97) at the most recent evaluation. Acetabular components were retained in 8 out of 18 cases and the dual-mobility shell was cemented into it. Cementation of a dual-mobility cup into a shell at the time of a revision surgery is a safe and reliable construct at minimum of 2 years for patients at high risk of dislocation. There were no complications related to the cementation of the cup into the metal shell. Longer follow-up is required to further assess the durability of this construct.

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