A MODERN CONSTRAINED ACETABULAR COMPONENT FOR THE MANAGEMENT OF HIP INSTABILITY

2016 ◽  
Vol 19 (01) ◽  
pp. 1650002 ◽  
Author(s):  
Dror Maor ◽  
Jie Xu ◽  
Kulvir S Mudhar ◽  
Piers J Yates
Keyword(s):  
High Risk ◽  
Aseptic Loosening ◽  
Hip Replacement ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Radiological Findings ◽  
Hip Instability ◽  
Constrained Liner ◽  
Constrained Acetabular Component

The incidence of dislocation after primary THR has been quoted up to 2.25%, and between 2% and 20% for revision THR. We report clinical and radiological findings in 76 patients treated with a constrained liner for those considered at high-risk for dislocation, intraoperative instability or recurrent dislocations. Mean follow up was 12 months. Post operatively there were two cases of recurrent dislocation, one aseptic loosening and nine cases of deep infection. These results support that these liners have been used to treat, or in some cases prevent, instability after total hip replacement.

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

2021 ◽  
pp. 112070002110107
Author(s):  
Eustathios Kenanidis ◽  
Panagiotis Kakoulidis ◽  
Panagiotis Anagnostis ◽  
Michael Potoupnis ◽  
Eleftherios Tsiridis
Keyword(s):  
High Risk ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Consecutive Series ◽  
Revision Thas ◽  
Hip Stability ◽  
Functional Scores ◽  
Revision Tha ◽  
The Mean

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

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

2019 ◽  
pp. 112070001987361 ◽  
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.

scholarly journals Trilogy-Constrained Acetabular Component for Recurrent Dislocation

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Annette Vest Andersen ◽  
Anne Grete Kjersgaard ◽  
Søren Solgaard
Keyword(s):  
Femoral Component ◽  
Revision Surgery ◽  
Hip Replacement ◽  
Recurrent Dislocation ◽  
Harris Hip Score ◽  
Acetabular Liner ◽  
Radiologic Evaluation ◽  
Acetabular Shell ◽  
Constrained Liner ◽  
Constrained Acetabular Component

32 patients received a Trilogy- or Trilogy-Longevity-constrained acetabular liner for recurrent dislocations after total hip replacement. The constrained liner was inserted into a well-fixed Trilogy acetabular shell with snap fit. At 1.8-year followup (range 3–63 months), 4 patients had suffered further dislocation(s) (12%), and one patient had revision surgery for a loosened acetabular shell. Radiologic evaluation detected no definitively loose components, but one patient with progressing radiolucent lines around the femoral component and one patient with an acetabular cyst were found, as well as a patient with a loose locking ring (but otherwise no failure). The nineteen patients who were available for the present followup had a mean Harris Hip Score of 81. The constrained liner is an effective method of dealing with recurrent dislocations in well-fixed components.

Early results of a high friction surface coated uncemented socket in revision hip arthroplasty

2019 ◽  
Vol 30 (6) ◽  
pp. 739-744 ◽  
Author(s):  
Vinay Chacko ◽  
Pranshu Agrawal ◽  
Martyn L Porter ◽  
Tim N Board
Keyword(s):  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Revision Arthroplasty ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Revision Hip Arthroplasty ◽  
Radiolucent Lines ◽  
Early Results ◽  
And Migration

Background: Revision hip arthroplasty with high friction trabecular metal sockets has resulted in good medium-term results. Many manufacturers have therefore introduced higher friction coatings to their implants to meet a growing demand for similar implants. The Pinnacle Gription was introduced in 2007 as an evolution of the standard Pinnacle socket. This study aimed to assess the early results of this socket in a revision setting. Methods: Between August 2009 and December 2016, the Gription socket was used in 146 revision hip replacements. The mean age was 63 (19–88) years. Defects were classified as Paprosky Grade 2 in 71(2A [28], 2B [19], 2C [24]) and grade 3 in 20 (3A [18], 3B [2]). Bearing combinations were ceramic-on-ceramic in 23, metal-on-polyethylene in 71, ceramic-on-polyethylene in 52. Screws were used in 112 cases, impaction bone grafting in 34 and metal augments in 1 case. Radiographs were analysed for progressive radiolucent lines and migration. Results: Mean follow-up was 43.5 (range 25–62) months. There were 6 re-revisions (2 for deep infection, 2 for recurrent dislocation and 2 for aseptic loosening). None of the other cases had evidence of socket migration or progressive radiolucent lines. There were no intraoperative or postoperative periprosthetic fractures. The crude survivorship for all-cause failure was 95.8% and the survivorship for aseptic loosening was 98.6%. at 43.5 months follow-up. Conclusions: This is the largest reported series of Gription socket use in revision arthroplasty and demonstrates encouraging early results. We therefore advocate the continued cautious use of this implant.

Open Capsulorrhaphy with Suture Anchors for Recurrent Anterior Dislocation of the Shoulder

1998 ◽  
Vol 26 (5) ◽  
pp. 625-629 ◽  
Author(s):  
Andrea Ferretti ◽  
Angelo De Carli ◽  
Michele Calderaro ◽  
Fabio Conteduca
Keyword(s):  
Surgical Technique ◽  
Suture Anchor ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Anterior Dislocation ◽  
Suture Anchors ◽  
Rating Systems ◽  
Lost To Follow Up ◽  
Recurrent Anterior Dislocation

Forty of 42 consecutive open capsulorrhaphies with suture anchors for treatment of traumatic recurrent anterior dislocation of the shoulder were reviewed after a minimum follow-up of 2 years. Two patients were lost to follow-up. Follow-up was conducted according to the rating systems of Rowe and the Society of American Shoulder and Elbow Surgeons. The surgical outcome was satisfactory in 38 patients (95%). Eighteen of the 22 patients who were involved in competitive overhead or collision sports before surgery returned to their preoperative sports levels. One patient, whose operation was unsuccessful, experienced recurrent dislocation. In one patient, a deep infection that occurred as a complication of the surgical technique healed after suture anchor removal. Although a longer follow-up is necessary, this technique appears to have encouraging results as it avoids the risks related to the use of screws and staples.

scholarly journals Salvaging Unstable or Recurrent Dislocating Total Hip Arthroplasty with the Constrained Acetabular Component

2002 ◽  
Vol 10 (2) ◽  
pp. 165-169 ◽  
Author(s):  
DA Stanton ◽  
WJ Bruce ◽  
JA Goldberg ◽  
W Walsh
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Total Hip ◽  
Hip Replacements ◽  
The Mean ◽  
Acetabular Components ◽  
Constrained Acetabular Component

Purpose. To review cases of implantation of constraining acetabular components for unstable or recurrent dislocating total hip arthroplasty at the Department of Orthopaedics, Concord Hospital, Sydney. Methods. A retrospective analysis was performed on prospectively collected data of 13 consecutively enrolled patients. Results. From 1989 to 2000, 13 constraining acetabular components were implanted into 13 patients as a revision procedure. The surgical approach for the implantation of the constrained liner was posterolateral in 11 cases; a modified Hardinge approach was applied in 2 cases. The mean clinical follow-up duration was 43 months (range, 14–121 months) and the mean age at the time of surgery was 73 years (range, 52–84 years). No patients were lost to follow-up. Indications for using the constrained acetabular component were recurrent dislocation in revision hip replacements (n=8), and intra-operative instability (n=5). There were no episodes of dislocation of the constrained arthroplasty. In 7 cases, the constrained component was implanted into a previously well-fixed shell. Conclusion. We recommend the judicious use of the constrained component in cases of hip instability during or after total hip arthroplasty when other methods are not successful.

scholarly journals Favourable clinical outcomes following cemented arthroplasty after metal-on-metal total hip replacement: a retrospective study with a mean follow-up of 10 years

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Weiguang Yu ◽  
Meiji Chen ◽  
Xianshang Zeng ◽  
Mingdong Zhao ◽  
Xinchao Zhang ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Recurrent Dislocation ◽  
High Rate ◽  
Functional Score ◽  
Long Term Outcomes ◽  
Total Hip ◽  
Metal On Metal

Abstract Background Given the unexpected high rate of failure following metal-on-metal total hip replacement (MoM-THR), it is expected that more MoM-THR patients will experience revision. The long-term outcomes regarding the primary MoM-THR revised to cemented THR (CTHR) remain controversial. The purpose of this retrospective review was to evaluate the long-term outcomes of patients who underwent conversion from MoM-THR to CTHR. Methods A total of 220 patients (220 hips) who underwent a conversion of primary MoM-THR to CTHR from March 2006 to October 2016 were retrospectively reviewed. The primary outcomes were the functional outcomes assessed using the Harris hip scores (HHS) and major radiographic outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every two years after revision. Results Mean follow-up was 10.1 years (5–13 years). Distinct improvements were detected in the mean HHS between the preoperative and last follow-up analysis (62.35[±8.49] vs. 84.70[±14.68], respectively, p < 0.001). The key orthopaedic complication rate was 18.2% (27/148). Seven (4.7%) cases experienced a CTHR failure at a mean of 3.4 (±1.2) years after revision MoM-THR, mostly attributed to recurrent dislocation. Conclusion CTHR might yield an acceptable functional score and a low rate of the key orthopaedic complications.

Uncemented Custom-Made Femoral Components

2002 ◽  
Vol 12 (4) ◽  
pp. 365-370 ◽  
Author(s):  
B. Mohan ◽  
J.R. Nixon ◽  
E. Doran
Keyword(s):  
Titanium Alloy ◽  
Aseptic Loosening ◽  
Failure Rate ◽  
Hip Replacement ◽  
Average Duration ◽  
Femoral Prosthesis ◽  
Younger Patients ◽  
Custom Made ◽  
Fit And Fill

We present our experience of total hip replacement (THR) in younger patients using a custom-made smooth titanium alloy femoral prosthesis. Measurements made from pre-operative marker radiographs allowed creation of templates and subsequent computer analysis to mill the stem prior to surgery. Fifty-one such cementless implants were carried out in 43 patients between January 1993 and June 1996 with follow-up to an average of 47 months. Sixteen hips have required revision to date; 13 of these operations were for aseptic loosening. Two more were awaiting revision, giving an overall failure rate of 35.3 %. The average duration from primary operation to revision was 47 months. Thus, even though the concept of an uncemented custom-made femoral component is attractive, the failure rate was found to be unacceptably high. This device may achieve “fit and fill”, but adequate bone on- or in-growth was not achieved. On the basis of these data we have discontinued the use of this implant since 1996.

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