In Revision THA Is the Re-revision Risk for Dislocation and Aseptic Causes Greater in Dual-mobility Constructs or Large Femoral Head Bearings? A Study from the Australian Orthopaedic Association National Joint Replacement Registry

SummaryThe treatment of femoral head necrosis of adults is still rather problematic. Conservative treatment has been reported relatively unsuccessful and surgical treatment does not show convincing results either. The most effective seems to be a surgical treatment in early stages of the disease, however, the diagnosis still remains relatively complicated. For the late stages (2B and above) the most effective treatment option is represented by core decompression and vascular grafting. However, drilling and plombage (especially when using press-fit technique) seems to be successful, although not excellent. The authors describe their own method of drilling and plombage of the necrotic zone of the femoral head in 41 patients with X-ray detected necrotic changes of the femoral head. The pain measured by VAS was seen to decrease after surgery in all patients significantly. The Jacobs score was also observed to have increased (from fair to good outcome). We have not observed any large femoral head collapse after surgery, moreover, in some cases an improvement of the round shape of the femoral head was seen. It is important to mention that in all cases femoral heads with existing necrotic changes (flattening or collapse) were treated. Although the clinical improvement after surgery was not significantly high, the method we describe is a safe and simple method of diminishing pain in attempt to prepare the femoral head for further treatment in a future, without significant restriction of the indication due to necrosis (osteochondroplasty, resurfacing, THR).

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Reply to the Letter to the Editor: Is the Survivorship of Birmingham Hip Resurfacing Better Than Selected Conventional Hip Arthroplasties in Men Younger Than 65 Years of Age? A Study from the Australian Orthopaedic Association National Joint Replacement Registry

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000001902 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

James Stoney ◽

Stephen E. Graves ◽

Richard N. de Steiger ◽

Sophia Rainbird ◽

Thu-Lan Kelly BMath ◽

...

Keyword(s):

Joint Replacement ◽

Hip Resurfacing ◽

Joint Replacement Registry ◽

Birmingham Hip Resurfacing ◽

Letter To The Editor ◽

Hip Arthroplasties ◽

Better Than

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Evaluation of total hip arthroplasty devices using a total joint replacement registry

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.3228 ◽

2012 ◽

Vol 21 ◽

pp. 53-59 ◽

Cited By ~ 6

Author(s):

Elizabeth W. Paxton ◽

Christopher F. Ake ◽

Maria C.S. Inacio ◽

Monti Khatod ◽

Danica Marinac-Dabic ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Joint Replacement ◽

Total Joint Replacement ◽

Joint Replacement Registry ◽

Total Hip ◽

Total Joint Replacement Registry

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Is large femoral head a better option than a conventional femoral head primary total hip arthroplasty in Indian population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210622 ◽

2021 ◽

Vol 7 (2) ◽

pp. 295

Author(s):

Hiranya Kumar Seenappa ◽

Karthik Mittemari Naraynamurthy ◽

Rasiq Rashid ◽

Shivraj Nadagouda ◽

Vamshhikrishna Chand

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Age Group ◽

Neck Of Femur ◽

Large Femoral Head ◽

Total Hip ◽

Modified Harris Hip Score ◽

Primary Total Hip Arthroplasty

Background: Study aimed to assess and compare the functional outcome in patients underwent the large femoral head THA and conventional femoral head THA.Methods: It is a comparative prospective cross sectional study conducted among the patients undergoing primary total hip arthroplasty through postero-lateral approach at department of orthopaedics Vydehi institute of medical sciences, Bengaluru during the period of July 2017 to July 2019. Patients aged between 18-80years of both genders undergoing Primary THA for Osteoarthritis (OA), Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Post traumatic arthritis, Avascular necrosis (AVN), Acute fracture neck of femur, Non-union fracture neck of femur (NOF). Patients undergoing primary total hip arthroplasty in Intertrochanteric fracture, Acetabular fracture and patients undergoing Revision Hip Arthroplasty were excluded from study. Patients were grouped as the ones treated with large femoral head THA and conventional femoral head THA.Results: This series consisted of 36 patients with 44 diseased hips treated with primary total hip arthroplasty (THA). Out of 36 patients, 9 patients (25%) belonged to an age group of below 30 years of age, 10 patients (27.8%) belonged to the age group between 31-40 years of age, 8 patients (22.2%) belonged to the age group 41-51 years of age and 9 patients (25%) belonged to age group of 51-60 years of age. The mean level of Modified Harris Hip score and improvement of movements in all planes was found to be statistically significantly in the patients treated with large femoral head primary THA compared to those treated with conventional method. (p<0.001)Conclusions: Study has shown improved functional outcome (Modified harris hip score) and range of movement in the patients treated with the large femoral head primary THA as compared to those treated with a conventional femoral head.

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Risk forecasting of the femoral head dislocation and its prophylaxis at total hip joint replacement

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-59872018179-85 ◽

2018 ◽

Vol 0 (1) ◽

pp. 79-85

Author(s):

Volodymyr Filipenko ◽

Vera Kolesnichenko ◽

Volodymyr Mezentsev ◽

Oleh Ovchynnikov

Keyword(s):

Femoral Head ◽

Hip Joint ◽

Joint Replacement ◽

Hip Joint Replacement ◽

Total Hip ◽

Risk Forecasting

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Spontaneous Early Intraprosthetic Dislocation of 22 mm Skirted Femoral Head in Dual Mobility Hip Prosthesis: A Case Report

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i03.2062 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

Gur Aziz Singh Sidhu ◽

Amit Kotecha ◽

Sanjay Mulay ◽

Neil Ashwood

Keyword(s):

Case Report ◽

Femoral Head ◽

Revision Surgery ◽

Hip Prosthesis ◽

Weight Bearing ◽

Femoral Stem ◽

Acetabular Cup ◽

Dual Mobility ◽

Metal Head ◽

Intraprosthetic Dislocation

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. Keywords: Intraprosthetic dislocation, dual mobility cup, dislocation, total hip replacement.

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Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease

The Bone & Joint Journal ◽

10.1302/0301-620x.104b1.bjj-2021-0855.r1 ◽

2022 ◽

Vol 104-B (1) ◽

pp. 134-141

Author(s):

Peter H. J. Cnudde ◽

Jonatan Nåtman ◽

Nils P. Hailer ◽

Cecilia Rogmark

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Hip Arthroplasty ◽

Neurological Disease ◽

Dislocation Rate ◽

Dual Mobility ◽

Increased Risk ◽

National Patient ◽

Neck Fracture

Aims The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods We undertook a longitudinal cohort study linking the Swedish Hip Arthroplasty Register with the National Patient Register, including patients with a neurological disease presenting with a femoral neck fracture and treated with HA, a conventional THA (cTHA) with femoral head size of ≤ 32 mm, or a dual-mobility component THA (DMC-THA) between 2005 and 2014. The dislocation rate at one- and three-year revision, reoperation, and mortality rates were recorded. Cox multivariate regression models were fitted to calculate adjusted hazard ratios (HRs). Results A total of 9,638 patients with a neurological disease who also underwent unilateral arthroplasty for a femoral neck fracture were included in the study. The one-year dislocation rate was 3.7% after HA, 8.8% after cTHA < 32 mm), 5.9% after cTHA (= 32 mm), and 2.7% after DMC-THA. A higher risk of dislocation was associated with cTHA (< 32 mm) compared with HA (HR 1.90 (95% confidence interval (CI) 1.26 to 2.86); p = 0.002). There was no difference in the risk of dislocation with DMC-THA (HR 0.68 (95% CI 0.26 to 1.84); p = 0.451) or cTHA (= 32 mm) (HR 1.54 (95% CI 0.94 to 2.51); p = 0.083). There were no differences in the rate of reoperation and revision-free survival between the different types of prosthesis and sizes of femoral head. Conclusion Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing HA or DMC-THA. Most patients with a neurological disease are not eligible for THA and should thus undergo HA, whereas those eligible for THA could benefit from a DMC-THA. Cite this article: Bone Joint J 2022;104-B(1):134–141.

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