scholarly journals 1220 Dual Mobility Cups in Primary and Revision Thas – A Single UK Centre Outcome Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A C F Yiu ◽  
R Thambipillai ◽  
M B Toteja ◽  
A Unnithan
Keyword(s):  
Average Length ◽  
Range Of Movement ◽  
Dual Mobility ◽  
Revision Thas ◽  
Primary Arthroplasty ◽  
Patient Reported ◽  
Dual Mobility Cups ◽  
The Uk ◽  
Good Range

Abstract Aim Total Hip Arthroplasty has been challenged with instability and dislocation (5%) and restricted movements. Risks are further increased in trauma and revision cases (7-14%). Dual Mobility (DM) prosthesis is one solution to these issues and has shown to reduce the rate of dislocation in multiple USA and France studies. Its uses remain limited in the UK due to unfamiliarity. DM implants contain a small femoral head mobile within a polyethylene liner which articulates with a supra-hemispheric metallic acetabular shell. Increased coverage of the shell reduces intra-prosthetic dislocation. The highly crosslinked polyethylene helps to reduce wear while the extra arc of motion improved range of movement. Our centre started using DM prosthesis since 2018 and this study demonstrates our outcomes. Method Retrospective study of all DM replacement from January 2018 – May 2020. Allowing a minimum follow up of 6 months. Data was collected from an electronic database. Results 54 cases were identified (35 elective cases and 19 trauma cases). 34 cases were revision surgery, and 21 cases were primary arthroplasty. The average age was 75, average length of surgery was 3 hours and average stay in hospital was 9 days. No dislocation was noted in this study. All patients reported good range of movement in follow ups with no complaints of instability. Conclusions DM prosthesis provides excellent outcomes with no dislocation and good patient reported satisfaction at our center. This result is supported by various systematic reviews. The reduction of complications is also economically advantageous. Use of Dual Mobility prosthesis should be encouraged in UK.

Minimum 7-Year Outcomes of Dual Mobility Acetabular Cups in Total Hip Arthroplasty Patients

2020 ◽  
Vol 04 (02) ◽  
pp. 090-093
Author(s):  
John M. Tarazi ◽  
Hytham S. Salem ◽  
Joseph O. Ehiorobo ◽  
Nipun Sodhi ◽  
Luke J. Garbarino ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Study Cohort ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Total Hip ◽  
Patient Reported ◽  
Dual Mobility Cups ◽  
Metallic Liner

AbstractModular dual mobility cups have been developed to potentially address postoperative hip instability, which can occur in nearly 20% of all revision total hip arthroplasty (THA) patients. By having a prosthetic construct that contains two points of articulation between the femoral head and liner and between the liner and shell, joint stability can be increased. The purpose of this study was to report on dual mobility cup survivorships, patient satisfaction outcomes, complications, and radiographic outcomes at a minimum 7-year follow-up. A high-volume academic surgeon performed a total of 143 consecutive dual mobility primary THAs on patients who had a minimum follow-up of 7 years (range, 7–8.5 years). The study cohort consisted of 77 females (54%) and 66 males (46%) who had a mean age of 65 years (range, 34–90 years). Aseptic, septic, and all-cause survivorship was determined by Kaplan-Meier analysis. Harris Hip Scores (HHS), postoperative complications, and radiographs were also assessed. No cup failures were observed. Overall, septic survivorship was 99.3% (95% confidence interval [CI]: 0.98–1.0) and all-cause survivorship was 98.6% (95% CI: 0.97–1.0). Two patients (1.4%) required revision surgery unrelated to the use of a modular dual mobility cup. Of these, one patient experienced femoral stem loosening and the other developed a periprosthetic infection that was treated with a two-stage revision. The mean total HHS was above 95 points at the most recent follow-up. Three patients (2.3%) experienced medical complications, including two deep vein thromboses and one for nonfatal pulmonary embolism. Radiographic evidence revealed incomplete seating of the metallic liner in one patient. Dual mobility cups were developed in an attempt to decrease the rate of instability following THA. The results from this study indicate that excellent clinical and patient-reported outcomes can be achieved at 7-year follow-up in patients who undergo THA with a dual mobility cup. Therefore, dual mobility cups appear to be an appropriate treatment option for primary THA.

Dual-mobility bearings for patients with abductor-trochanteric complex insufficiency

2018 ◽  
Vol 28 (5) ◽  
pp. 491-497 ◽  
Author(s):  
Vahit E Ozden ◽  
Goksel Dikmen ◽  
Burak Beksac ◽  
Remzi Tozun
Keyword(s):  
Acetabular Reconstruction ◽  
Dual Mobility Cup ◽  
Survivorship Analysis ◽  
Dual Mobility ◽  
Total Hip ◽  
Kaplan Meier ◽  
Dual Mobility Cups ◽  
The Mean ◽  
Cemented Cup

Introduction: The purpose of this study was to summarise the performance of dual-mobility cup systems for revision total hip arthroplasty in patients with abductor-trochanteric complex deficiency. Methods: We prospectively followed 17 patients (20 hips) with a mean age of 64.5 years (range 33-89 years) who underwent acetabular reconstruction with dual-mobility cups for aseptic loosening in 12 hips, infection treatment as second or single stage in 6 hips, and instability in 2 hips. All of the patients had abductor insufficiency. We evaluated the clinical Harris Hip scores (HHS) and radiographs for migration, loosening, and osteolysis. The survival of the components was calculated according to Kaplan-Meier survivorship analysis, and failure was defined as any dislocation, acetabular component or total hip revision for any reason. Results: The mean duration of follow-up was 38.1 months (range 24-98 months). There were 2 (12.5%) revisions for cemented cup migration after 11 months and 19 months respectively. There were no dislocations. At the last follow-up, the mean HHS increased from 42 points preoperatively to 86 points. The cumulative survival rate of the dual-mobility cup system was 93% (95% confidence interval 88-98.7%) at 5 years, with any revision as the end point. Conclusion: Dual-mobility cups may provide excellent stability in patients with abductor-trochanteric complex insufficiency.

scholarly journals Ankle Arthrodesis Through an Anterior Approach

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0026
Author(s):  
Kathleen Jarrell ◽  
Marek Denisiuk ◽  
Elizabeth McDonald ◽  
Steven Raikin
Keyword(s):  
Anterior Approach ◽  
Average Length ◽  
Ankle Arthrodesis ◽  
Small Subset ◽  
Pain Scores ◽  
Level Of Satisfaction ◽  
Extensor Hallucis Longus ◽  
Patient Reported ◽  
Functional Scores

Category: Ankle Introduction/Purpose: Ankle arthrodesis can be approached anteriorly, laterally, medially, or posteriorly, and debate remains as to which approach is most advantageous. Although an anterior approach using the interval between the extensor hallucis longus and tibialis anterior is commonly performed, there is a paucity of studies showing the clinical outcomes after this procedure. This study aims to evaluate the functional outcomes and patient satisfaction at mid-term follow-up after ankle arthrodesis via an anterior approach. Methods: All isolated primary ankle arthrodeses performed with the anterior approach by a single fellowship-trained foot and ankle surgeon between May of 2011 and December of 2015 were retrospectively included. Chart review was performed and patient reported outcomes were collected including FAAM ADL, FAAM Sports, VAS, and SF-12 scores pre-operatively and at a minimum of two-years post-operatively. At final follow-up, a survey was distributed via phone or email inquiring about level of satisfaction and whether they would undergo the procedure again. A total of 108 patients were included, of which only 45 (41.67%) had pre-operative functional scores, 24 (22.2%) completed both pre- and post-operative functional scores, and 20 patients (18.5%) had satisfaction results. The average length of follow-up was 4.4 years (range: 1.7 – 7.9, SD 1.6). Results: FAAM ADL scores improved from a mean of 48.1 to 67.6, FAAM Sports increased from 18.1 to 34.9, VAS Pain decreased from 73.2 to 44.9, SF-12 MCS changed from 44.2 to 46.7, and SF-12 PCS increased from 31.0 to 42.2. Using a linear mixed effects model and controlling for length of follow-up, all functional and pain score improvements were significant except SF- 12 MCS (Table 1). Overall, 65% of patients were satisfied with their results and 85% of patients would consider the same surgery if needed. Patients who were more satisfied with their surgery were more likely to say that they would consider the same surgery given similar circumstances (p = 0.001). Conclusion: Post-operative functional scores were significantly improved and pain scores were significantly decreased compared to pre-operative scores in a cohort of patients who underwent ankle arthrodesis using an anterior approach. Satisfaction with the surgery was lower than expected given the improvement in functional scores. Further study is indicated to determine methods to improve satisfaction. Our study suggests that an anterior approach to ankle arthrodesis is an effective technique to improve function and pain in patients with ankle arthritis, however satisfaction after surgery is no guarantee. The study is limited by the small subset of patients with pre- and post-operative functional scores.

scholarly journals What Is the Dislocation and Revision Rate of Dual-mobility Cups Used in Complex Revision THAs?

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Niklas Unter Ecker ◽  
Hakan Kocaoğlu ◽  
Akos Zahar ◽  
Carl Haasper ◽  
Thorsten Gehrke ◽  
...  
Keyword(s):  
Revision Rate ◽  
Dual Mobility ◽  
Revision Thas ◽  
Dual Mobility Cups

scholarly journals Concordance among Swedish, German, Danish, and UK EQ-5D-3L Value Sets: Analyses of Patient-Reported Outcomes in the Swedish Hip Arthroplasty Register

2021 ◽  
Vol 10 (18) ◽  
pp. 4205
Author(s):  
Fitsum Sebsibe Teni ◽  
Ola Rolfson ◽  
Jenny Berg ◽  
Reiner Leidl ◽  
Kristina Burström
Keyword(s):  
Hip Arthroplasty ◽  
Arthroplasty Register ◽  
Patient Reported ◽  
Before And After ◽  
Value Sets ◽  
Using Data ◽  
Mean Differences ◽  
The Uk ◽  
Eq Vas

Background: Application of different value sets to health-related quality of life (HRQoL) measured with the EQ-5D-3L may lead to different results due to differences in methods, perspectives, and countries used. Focusing on concordance, this study aimed at understanding the implications of applying EQ-5D-3L value sets from Sweden, Germany, Denmark, and the UK to evaluate HRQoL of patients undergoing total hip replacement (THR) in Sweden before and after surgery. Methods: We performed a longitudinal study of patients in the Swedish Hip Arthroplasty Register from preoperative stage to 1-year follow-up (n = 73,523) using data collected from 2008 to 2016. Eight EQ-5D-3L value sets from the four countries were compared based on a valuation method (visual analogue scale (VAS) or time trade-off (TTO)), perspective (experience-based or hypothetical), and country. Concordance among the value sets with patient-reported EQ VAS score was also assessed. Longitudinal changes in EQ-5D-3L index over the 1-year follow-up were compared across value sets by method, perspective, and country. Results: Value sets based on the same method and perspective showed higher concordance in EQ-5D-3L index at both measurement time points than other comparisons. In the comparisons by perspective, VAS value sets showed higher concordance than TTO value sets. The Swedish VAS and the Danish TTO value sets showed the highest levels of concordance with patient-reported EQ VAS scores. Generally, value sets based on the same method and perspective had the smallest mean differences between changes in EQ-5D-3L indices from preoperative to 1-year postoperative follow-up. Conclusion: Among THR patients value sets based on the same method and perspective, a direct transfer of results across countries could be meaningful. In cases of differences in methods and perspectives among value sets, transfer of value sets across settings would have to consider conversion through crosswalk.

Is there a problem with modular dual mobility acetabular components in revision total hip arthroplasty at mid-term follow-up?

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 66-72
Author(s):  
Nicholas M. Hernandez ◽  
Zoe W. Hinton ◽  
Christine J. Wu ◽  
Paul F. Lachiewicz ◽  
Sean P. Ryan ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Revision ◽  
Revision Total Hip Arthroplasty ◽  
Dual Mobility ◽  
Revision Thas ◽  
Revision Tha ◽  
Acetabular Components ◽  
Acetabular Loosening

Aims Modular dual mobility (MDM) acetabular components are often used with the aim of reducing the risk of dislocation in revision total hip arthroplasty (THA). There is, however, little information in the literature about its use in this context. The aim of this study, therefore, was to evaluate the outcomes in a cohort of patients in whom MDM components were used at revision THA, with a mean follow-up of more than five years. Methods Using the database of a single academic centre, 126 revision THAs in 117 patients using a single design of an MDM acetabular component were retrospectively reviewed. A total of 94 revision THAs in 88 patients with a mean follow-up of 5.5 years were included in the study. Survivorship was analyzed with the endpoints of dislocation, reoperation for dislocation, acetabular revision for aseptic loosening, and acetabular revision for any reason. The secondary endpoints were surgical complications and the radiological outcome. Results The overall rate of dislocation was 11%, with a six-year survival of 91%. Reoperation for dislocation was performed in seven patients (7%), with a six-year survival of 94%. The dislocations were early (at a mean of 33 days) in six patients, and late (at a mean of 4.3 years) in four patients. There were three intraprosthetic dissociations. An outer head diameter of ≥ 48 mm was associated with a lower risk of dislocation (p = 0.013). Lumbrosacral fusion was associated with increased dislocation (p = 0.004). Four revision THAs (4%) were further revised for aseptic acetabular loosening, and severe bone loss (Paprosky III) at the time of the initial revision was significantly associated with further revision for aseptic acetabular loosening (p = 0.008). Fourteen acetabular components (15%) were re-revised for infection, and a pre-revision diagnosis of reimplantation after periprosthetic joint infection (PJI) was associated with subsequent PJI (p < 0.001). Two THAs had visible metallic changes on the backside of the cobalt chromium liner. Conclusion When using this MDM component in revision THA, at a mean follow-up of 5.5 years, there was a higher rate of dislocation (11%) than previously reported. The size of the outer bearing was related to the risk of dislocation. There was a low rate of aseptic acetabular loosening. Longer follow-up of this MDM component and evaluation of other designs are warranted. Cite this article: Bone Joint J 2021;103-B(7 Supple B):66–72.

The impact of insurance company mandated compression stocking trial on rate of intervention in patients with symptomatic venous reflux disease

2011 ◽  
Vol 26 (6) ◽  
pp. 235-236 ◽  
Author(s):  
D Calcagno ◽  
J A Rossi
Keyword(s):  
Average Length ◽  
Venous Intervention ◽  
Insurance Companies ◽  
Compression Stocking ◽  
Insurance Company ◽  
Compression Stockings ◽  
Patient Reported ◽  
Cast Doubt ◽  
The Impact

Objective Insurance companies have criteria for a venous intervention to be a covered procedure, including symptoms, vein size, and a trial of conservative therapy with compression stockings. The goal of this study was to see the impact of such mandated stocking use on ultimate intervention. Method A retrospective review was done of prospectively gathered data entered in the electronic medical record. Two-hundred consecutive new patients evaluated at our vein center were included. Results Forty-four of the 200 patients did not require any procedures and 39 patients had procedures scheduled for small or asymptomatic venous changes that did not meet insurance criteria. This left 117 patients with venous symptoms in whom evaluation concluded that a corrective procedure could be performed. These interventions included largely radiofrequency ablation and phlebectomy. Of these 117 patients, 48 had previously used compression stockings. In the remaining 69 patients, stockings were provided on the day of initial consultation and these 69 patients served as the subjects for this review. At three month follow up, one patient reported the stockings help enough that she did not want to pursue correction. Two patients had continued pain and were planning correction once other unrelated issues resolved. Three patients said they never wore the stockings. Sixty-one patients had procedures performed. The average length of stocking use in patients who chose corrective procedures was 103 days. One patient could not be reached. Conclusion Of the patients that reported they used the stockings as prescribed, one chose chronic stocking therapy and 63 patients either had procedures or were planning procedures. Use of prescription stockings was effective in avoiding intervention in one of 64 cases (2%), despite an average trial of 103 days. These results cast doubt on the merits of the use of an insurance company mandated stocking trial.

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