Revision for Recurrent Dislocation of Total Hip Replacement

2009 ◽  
Vol 19 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Mark Rogers ◽  
Ashley W. Blom ◽  
Andrew Barnett ◽  
Alexia Karantana ◽  
Gordon C. Bannister
Keyword(s):  
Total Hip Replacement ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Recurrent Dislocation ◽  
Anterior Dislocation ◽  
Operative Strategy ◽  
Total Hip ◽  
Transgluteal Approach ◽  
Revision Tha

Background and purpose Dislocation is one of the commonest complications of total hip arthroplasty with an incidence of between 0.5 and 9.2%. Despite this, little is known of the outcome of treatment strategies for dislocation. The aim of this study was to establish the optimal strategy for the operative management of recurrent dislocation following THA taking account of the surgical approach employed in the replacement that became unstable and the direction of the instability that followed. Methods We reviewed 70 patients who underwent revision surgery for recurrent dislocation after total hip arthroplasty (THA), 38 through the transgluteal (Hardinge) and 32 through the posterior approach. 52 of these followed primary and 18 followed revision THA for reasons other than instability. We recorded the surgical approach, the direction of dislocation and the operative strategy employed for each case. Results We achieved stability in 75% of patients who dislocated after primary and 50% after revision THA. 77% of dislocations performed initially through the transgluteal approach were anterior and 88% through the posterior approach were posterior. Following the transgluteal approach, we stabilised anterior dislocation in 54% of cases. Following the posterior approach we stabilised posterior dislocation in 79%. The most successful operative strategy overall was cup augmentation which conferred stability in 90% of cases. Interpretation Instability after primary total hip replacement is easier to treat (75% chance of success) than after revision total hip replacement (50% chance of success). Although previous studies have shown that the posterior approach has a slightly higher risk of dislocation, this study has shown that achieving stability after a posterior dislocation is more likely than after an anterior dislocation. The outcome of revision for instability depends on the surgical approach used initially, and the direction of dislocation.

A Proximal Referencing System for the Charnley Low Friction Arthroplasty

2002 ◽  
Vol 12 (3) ◽  
pp. 303-307
Author(s):  
M.D.A. Fletcher ◽  
J.C.J. Webb ◽  
T. Maung
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Total Hip Replacement ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Recurrent Dislocation ◽  
Soft Tissue Balance ◽  
Low Friction ◽  
Total Hip

Dislocation is a serious complication of total hip arthroplasty occurring in up to 9% of cases. Recurrent dislocation accounts for 4% of revisions in the Swedish Hip Arthroplasty Study. Soft tissue balancing is one of the factors, independent of the surgical approach used, that is involved in producing a stable total hip replacement. We describe a proximal referencing system for use with the Charnley low friction arthrosplasty (LFA), which optimises this factor. The dislocation rate, using this method, is 0.3% (in 333 cases performed by a single surgeon over a 5 year period). This system should prove valuable to orthopaedic surgeons in training, ensuring they achieve correct soft tissue balance in total hip arthroplasty.

Does surgical approach affect early outcomes following primary total hip replacement in obese patients?

2019 ◽  
pp. 112070001988264
Author(s):  
John Zhang ◽  
Michael C Wyatt ◽  
Chris M Frampton ◽  
Geoffrey Anderson
Keyword(s):  
Multivariate Analysis ◽  
Femoral Head ◽  
Total Hip Replacement ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Total Hip

Aim: The aim of this study was to assess whether obese patients undergoing primary total hip replacement (THR) via a posterior approach had superior revision rates and Oxford Hip Scores (OHS) compared to those via a lateral approach. Patients and methods: This is a retrospective cohort study using prospective data from the New Zealand Joint Registry applying STROBE and RECORD guidelines. Patients undergoing THR since 2010 were stratified by body mass index (BMI) into obese (BMI 30–39 kg/m2), and morbidly obese (BMI ⩾40 kg/m2) groups. All-cause revision rates, and 6-month OHS post-surgery were compared between groups. Multivariate analysis was performed. Results: 12,109 unilateral THRs in obese patients were identified. The mean follow-up was 2.8 years (range 0.01–6.95 years). Univariate analysis in the BMI ⩾ 40 group showed the posterior approach had a significantly lower all-cause revision rate (0.99/100 observed component years (ocys); 95% CI, 0.65–1.44/100 ocys) than the lateral approach (1.71/100 ocys (95% CI, 0.98–2.77/100 ocys), p < 0.05). There was no significant difference in dislocation rates between the surgical approaches. OHS was statistically higher in the posterior approach group in BMI 30–39 patients ( p < 0.001) but not clinically significant. Multivariate analysis showed femoral head size significantly influenced all-cause revision rates and mitigated against the increased risk associated with the surgical approach. Conclusion: The choice of surgical approach in obese patients conveys no advantage in overall revision rates in the short-term. Choosing an appropriate size of femoral head may be of greater importance than choice of surgical approach for obese patients in primary THR.

SHALL IT BE BETTER, AS AN APPROACH FOR THR, POSTERIORLY OR LATERALLY; A CLINICO-FUNCTIONAL AND GAIT ANALYTICAL OUTCOME ANALYSIS, IN A PROSPECTIVE STUDY, IN THE SOUTH-INDIAN POPULATION.

2021 ◽  
pp. 71-75
Author(s):  
Arun Kumar C ◽  
Ganashree S ◽  
Arivoli S ◽  
Aswath C A ◽  
Rakesh Kumar B ◽  
...  
Keyword(s):  
Prospective Study ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Harris Hip Score ◽  
South Indian Population ◽  
Total Hip ◽  
South Indian

Introduction: Hip resurfacing arthroplasty (HRA) or Total hip replacement (THR), as it is popularly called, attempts to mollify these basic clinical problems, in patients with a hip arthritic problem, which may be of a sequela to age-related degeneration, osteonecrosis, systemic disorder like Rheumatoid arthritis (RA) or Ankylosing spondylosis (AS) or as a result of trauma and or an old infection. The basic pathology, is an unfavourable and abrading hip diarthrodial joint. The endeavour of the study was, to establish the efcacy of the Posterior vs Lateral approach for THA/THR, by studying their outcomes in primary THR. This prospective study was undertaken at Che Materials And Methods: ttinad Hospital and Research Institute (CARE), Kelambakkam, Chengalpattu district, Tamilnadu, In the Department of Orthopaedics from Jan 2017 to Dec 2020 (48 months). The Functional outcome of hip surgery was measured using the Harris Hip Score, Oxford hip score and the WOMAC. Rivermead visual gait analysis (RVGA) method was used post-operatively to assess the gait. The Biomechanical outcomes of Abductor Gait Component, were individually assessed by EMG studies. The Harris Hip Score, The Oxford Hip S Results: core and WOMAC score, when the lateral approach was compared to the posterior approach pre-op and post-op in the 12 months minimum follow-up period, the laterally approached group faired better. The VAS score was equivocal. The comprehensive RVGA assessment also showed marginally better results for the laterally approached group as was the case with the Trendelenburg test score. The EMG studies for the Gluteus Maximus, Medius and the lateral rotators of hip also favoured the outcomes for the laterally approach hips. The supremacy of the Lateral Approach, ove Conclusion: r Posterior Approach, cannot be adjudged in a short-term follow-up study. It is thus opined that the Lateral Approach may be statistically and data wise superior, but the patient satisfaction, which is a major factor, is almost the same in both the approach groups. The follow-up needs to be atleast for a decade for us to be able to come to any meaningful conclusion. With regards to surgery like the Total hip replacement, which have a longevity factor exceeding 10 years, studies have to be followed up for periods in excess of 10 years.

scholarly journals Comparison of short-term outcomes between minimal invasive superpath approach and conventional posterior approach in total hip arthroplasty: a randomized controlled trial

2021 ◽  
Vol 7 (3) ◽  
pp. 431
Author(s):  
Carlos B. Branco ◽  
Rita M. Sousa ◽  
Diogo Sousa ◽  
Joao Reis ◽  
Andre Guimaraes ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Harris Hip Score ◽  
Short Term ◽  
Total Hip ◽  
The Third ◽  
Posterior Group ◽  
Approach Group

<p><strong>Background:</strong> The objective of current study was to compare the short-term outcomes between a cohort of patients that undergone total hip replacement by a superpath technique at the beginning of the surgeon's learning curve, and a cohort of patients that undergone a total hip replacement by a conventional posterior approach.</p><p><strong>Methods:</strong> A cohort of 22 patients was prospectively and randomly selected for being part of a superpath approach group or a conventional posterior approach group. Clinical evaluation was performed in two primary end-points - the third post-operative day and the first month after surgery - using physical exams as the “20 meter walking test” and the “30 seconds sit to stand test”, the Harris hip score, the visual analogue scale for pain. Radiological evaluation was also performed.</p><p><strong>Results:</strong> 11 patients underwent the superpath approach and 11 patients underwent the conventional posterior approach. The surgery time was 78.2 min in the superpath group and 59.4 min in the posterior group. The average hospital stay was 3.4 days in the superpath group and 5.3 days in the posterior group. When assessing pain improvement through VAS, it was found that both on the third postoperative day and on the first postoperative month, patients in the superpath group showed greater improvement. There were no differences in functional results with statistical significance. No complications were seen in both groups.</p><p><strong>Conclusions:</strong> Despite the longer surgical time seen with the superpath approach, it managed to significantly decrease the length of hospital stay and obtained better results in improving pain in the short term.</p>

scholarly journals Does surgical approach influence the natural history of the unstable total hip replacement?

2021 ◽  
Author(s):  
Charles-Antoine Dion ◽  
Tom Schmidt-Braekling ◽  
Amedeo Falsetto ◽  
Cheryl Kreviazuk ◽  
Paul E. Beaulé ◽  
...  
Keyword(s):  
Natural History ◽  
Total Hip Replacement ◽  
Surgical Approach ◽  
Hip Replacement ◽  
Total Hip ◽  
History Of

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.

scholarly journals Symptomatic trochanteric non-union following total hip replacement treated with reattachment combined with two-stage revision surgery of the femoral stem

2019 ◽  
Vol 101 (6) ◽  
pp. e133-e135
Author(s):  
E Drampalos ◽  
L Bayam ◽  
J Oakley ◽  
M Hemmady ◽  
J Hodgkinson
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Femoral Stem ◽  
The Other ◽  
Artificial Joint ◽  
Two Stage ◽  
Non Union ◽  
Total Hip ◽  
Second Stage

We present a case of symptomatic trochanteric non-union following total hip replacement treated initially with a Dall-Miles grip plate. After failure of this treatment, the patient had a two-stage revision. Trochanteric non-union is one of the well-described complications after total hip replacement. It is frequently difficult to treat, while potentially causing weakness, altered gait and instability of the artificial joint. We believe that reattachment of the trochanter combined with a staged revision of the femoral stem using a posterior approach for the second stage could be a valuable technique to be added to the orthopaedic armamentarium for recurrent and symptomatic trochanteric non-unions after primary total hip replacement, particularly after failure to treat with all the other techniques described in literature.

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