Resection of the proximal femur during one-stage revision for infected hip arthroplasty

2021 ◽  
Vol 103-B (11) ◽  
pp. 1678-1685
Author(s):  
Hussein Abdelaziz ◽  
Michael Schröder ◽  
Calvin Shum Tien ◽  
Kahled Ibrahim ◽  
Thorsten Gehrke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Arthroplasty ◽  
Proximal Femur ◽  
Sinus Tract ◽  
Revision Hip Arthroplasty ◽  
Time Interval ◽  
Dual Mobility ◽  
One Stage ◽  
Increased Risk ◽  
Femoral Resection

Aims One-stage revision hip arthroplasty for periprosthetic joint infection (PJI) has several advantages; however, resection of the proximal femur might be necessary to achieve higher success rates. We investigated the risk factors for resection and re-revisions, and assessed complications and subsequent re-revisions. Methods In this single-centre, case-control study, 57 patients who underwent one-stage revision arthroplasty for PJI of the hip and required resection of the proximal femur between 2009 and 2018 were identified. The control group consisted of 57 patients undergoing one-stage revision without bony resection. Logistic regression analysis was performed to identify any correlation with resection and the risk factors for re-revisions. Rates of all-causes re-revision, reinfection, and instability were compared between groups. Results Patients who required resection of the proximal femur were found to have a higher all-cause re-revision rate (29.8% vs 10.5%; p = 0.018), largely due to reinfection (15.8% vs 0%; p = 0.003), and dislocation (8.8% vs 10.5%; p = 0.762), and showed higher rate of in-hospital wound haematoma requiring aspiration or evacuation (p = 0.013), and wound revision (p = 0.008). The use of of dual mobility components/constrained liner in the resection group was higher than that of controls (94.7% vs 36.8%; p < 0.001). The presence and removal of additional metal hardware (odds ratio (OR) = 7.2), a sinus tract (OR 4), ten years’ time interval between primary implantation and index infection (OR 3.3), and previous hip revision (OR 1.4) increased the risk of proximal femoral resection. A sinus tract (OR 9.2) and postoperative dislocation (OR 281.4) were associated with increased risk of subsequent re-revisions. Conclusion Proximal femoral resection during one-stage revision hip arthroplasty for PJI may be required to reduce the risk of of recurrent or further infection. Patients with additional metalware needing removal or transcortical sinus tracts and chronic osteomyelitis are particularly at higher risk of needing proximal femoral excision. However, radical resection is associated with higher surgical complications and increased re-revision rates. The use of constrained acetabular liners and dual mobility components maintained an acceptable dislocation rate. These results, including identified risk factors, may aid in preoperative planning, patient consultation and consent, and intraoperative decision-making. Cite this article: Bone Joint J 2021;103-B(11):1678–1685.

scholarly journals Efficiency of the One-Stage Revision Hip Arthroplasty in Chronic Periprosthetic Joint Infection with Sinus Tract

2021 ◽  
Vol 27 (2) ◽  
pp. 9-22
Author(s):  
V. A. Artyukh ◽  
S. A. Bozhkova ◽  
A. A. Boyarov ◽  
Ju. V. Muravyova ◽  
A. A. Kochish
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Soft Tissues ◽  
Joint Infection ◽  
Sinus Tract ◽  
Revision Hip Arthroplasty ◽  
One Stage ◽  
Significant Difference ◽  
The One

Background. Chronic periprosthetic joint infection (PJI) remains the one among the most severe complications of total hip arthroplasty. Presence of sinus tract assosiated with polymicrobial infection development, complexity of bacteriological diagnostics  and  damage  of  soft  tissues  lead  to  constrictions  of  one-stage  revision  hip  arthroplasty  (RHA). The  aim of this studywas to assess the influence of draining sinus tract on the outcomes of one-stage RHA in patients with chronic hip PJI.Materials and Methods.A prospective cohort comparative study included 78 patients who underwent one-stage RHA in 2017-2020. Two groups were formed: 48 (61.54%) patients without sinus tract (WST) and 30 (38.45%) patients with sinus tract (ST).Results. The presence of a sinus tract significantly increased the duration of a one-stage RHA in groups of ST and WST (230 and 197.5 min respectively, p = 0.02), as well as blood loss (850 ml and 700 ml, respectively, p = 0.046). Sinus tract was a reliable symptom of soft tissue local infectious inflammation (86.67%, p = 0.00031), fasciitis (36.67%, p = 0.012), purulent cavity (66.67%, p = 0.00027). The structure of the pathogens was comparable. Monobacterial infections predominated in the WST group (82.98%) and in the ST group (77.78%, p = 0.08). In most cases staphylococci were isolated. The median follow-up was 20 months for both groups. The PJI was healed in 93.0% (n = 28) patients in WST group and 82.2% (n = 43) in ST PJI (p>0.05). Postoperative evaluation in the WST and ST groups: HHS 92 and 90 points (p = 0.79), EQ-5D-5L – 0.82 and 0.78 points (p = 0.84) respectively. The proportion of patients who were indicated revision surgery with no PJI association in the ST group exceeded this indicator more than twice according to the WST group — 25 and 11.62%, respectively (p>0.05).Conclusion.As a result of the study, there was no statistically significant difference between the outcomes of one-stage RHA in patients with and without sinus tract. Factors such as the anamnesis morbi, the soft tissues condition at the surgical site and the pathogenic microflora characteristics should be taken into account in order to achieve favourable outcomes of surgical treatment.

scholarly journals Intraprosthetic dislocation after a revision hip replacement: a case report

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Allan R Sekeitto ◽  
Kaeriann van der Jagt ◽  
Nkhodiseni Sikhauli ◽  
Lipalo Mokete ◽  
Dick R van der Jagt
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
General Anaesthesia ◽  
Hip Arthroplasty ◽  
Muscle Relaxant ◽  
Rare Complication ◽  
Revision Hip Arthroplasty ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Intraprosthetic Dislocation

ABSTRACT BACKGROUND: The dual mobility cup (DMC) was initially design in 1974. It was designed to offer additional stability in total hip arthroplasty (THA) and to prevent dislocations. The dissociation of a DMC has been termed an intraprosthetic dislocation (IPD) and is a rare complication. It is defined as separation of the articulation between the polyethylene and head articulation in the DMC. As the utilisation of DMCs in orthopaedic surgery increases, we can expect an increase in this rare complication. We report a case of an IPD in the setting of revision hip arthroplasty in a 72-year-old female. CASE REPORT: The report is on a 72-year-old female patient who underwent revision hip arthroplasty. The articulation utilised was of the dual mobility type. Some eight months later she dislocated her hip. An attempted closed reduction under general anaesthesia with muscle relaxant was unsuccessful. Thereafter she was taken to surgery to perform an open reduction of the hip. Intra-operatively it was found that the dual mobility head had dissociated, with the polyethylene component remaining in the metal liner. A revision of the components was performed. DISCUSSION: We postulate on the mechanisms of dissociation of the dual mobility head. We review the current literature related to IPD and discuss the risk factors associated with this rare complication. CONCLUSION: The diagnosis of IPD is an indication for revision surgery of the DMC. When utilising a DMC, care should be taken to mitigate against the known risk factors for IPD. All dual mobility dislocations should be reduced under general anaesthesia with muscle relaxant Level of evidence: Level 4.. Keywords: intraprosthetic dislocation, dual mobility cup, revision hip arthroplasty

scholarly journals CONSTRAINED LINERS AND DUAL MOBILITY SYSTEMS FOR PREVENTION OF INSTABILITY IN REVISION HIP ARTHROPLASTY

2018 ◽  
Vol 24 (3) ◽  
pp. 22-33
Author(s):  
N. N. Efimov ◽  
D. V. Stafeev ◽  
S. A. Lasunskii ◽  
V. M. Mashkov ◽  
D. G. Parfeev ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Deep Infection ◽  
Revision Hip Arthroplasty ◽  
Dual Mobility ◽  
Locking Mechanism ◽  
Increased Risk ◽  
Inner Diameter

Purpose.Instability is a challenging complication of revision hip arthroplasty and a frequent cause of repeatrevisions. Constrained liners and dual mobility systems have gained major attention among the options of dislocation prophylaxis. The aimof this study is to compare the outcomes of revision hip arthroplasy with use of constrained liners and dual mobility systems. Materials and Methods.We used DePuy Duraloc (inner diameter 28 mm) and Zimmer Trilogy (inner diameter32 mm) systems in the constrained liners group (N 78, mean follow-up — 66.2 month, 54-82), Serf Novae and Biomet Avantage systems in the dual mobility group (N 58, mean follow-up — 17.8 month, 10-41). The two groups were comparable in age, sex and different potential dislocation risk factors, however, dual mobility cups were used more frequently in revisions due to unreduced and recurrent dislocations and in patients with the history of instability following total hip arthroplasty. There were also differences in the structure of primary diagnosis. Results.We observed 14 (17.9%) dislocations, 10 (12.8%) of which occurred within 2 years after surgery, and also3 (3.8%) cases of aseptic loosening of the acetabular component, 4 (5.1%) cases of locking mechanism damage without dislocation and 8 (10.3%) cases of deep infection in the constrained liners group. In the dual mobility group we observed 3 (5.17%) large articulation dislocations, 1 (1.7%) case of aseptic loosening of the acetabular component and 4 (6.9%) cases of deep infection. The difference in dislocation rates in two groups was significant (p<0.05). The analysis of the constrained liners group revealed an increased risk of dislocation in cases when a constrained system was implanted into a retained acetabular component compared to cases with acetabular shell revision (p<0.01; RR = 7.2, 95% CI: 2.05-25.26), as well as a trend for increased risk of dislocation in cases when DePuy Duraloc liners (inner diameter 28 mm) were used compared to Zimmer Trilogy (inner diameter 32 mm) (p= 0.07; RR = 4.97, 95% CI: 1.03-24.04). Conclusion. Dual mobility systems proved to be more effective than constrained liners in revision hip arthroplastyalthough being used more frequently as a treatment rather than prophylaxis of instability. Constrained liners bear a higher risk of dislocations when implanted into retained acetabular components and when used with heads of lesser diameter.

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

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.

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach

2021 ◽  
pp. 155633162110508
Author(s):  
Zachary Berliner ◽  
Cameron Yau ◽  
Kenneth Jahng ◽  
Marcel A. Bas ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Parkinson Disease ◽  
Hip Arthroplasty ◽  
Femoral Fracture ◽  
Categorical Variables ◽  
Patient Specific ◽  
Periprosthetic Femoral Fracture ◽  
Total Hip ◽  
Increased Risk

Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.

The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

2018 ◽  
Vol 02 (04) ◽  
pp. 194-204
Author(s):  
Hari Parvataneni ◽  
Luis Pulido ◽  
Hernan Prieto ◽  
Arnold Silverberg
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Clinical Success ◽  
The United States ◽  
Revision Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Hip Stability

AbstractThe concept of dual mobility (DM) bearings in total hip arthroplasty was first introduced by Professors Gilles Bousquet and Andre Rambert in France in 1974 with the goal of enhancing hip stability. Although DM did not receive U.S. Food and Drug Administration approval for commercial use in the United States until 2009, there has been a surge in popularity of DM implants over the past several years, evidenced by the American Joint Replacement Registry data. The enthusiasm for DM stems from a growing body of literature that supports its use across a range of patient populations, most notably revision hip arthroplasty and high-risk primary scenarios. DM has been shown to effectively reduce the risk of dislocation while also exhibiting excellent survivorship. DM does incur some unique risks, namely, intraprosthetic dissociation, but many of the early concerns with DM have not been realized in the literature and do not seem to negatively impact its long-term survivorship. The exact indications for DM have yet to be defined and remain a matter of debate. It should be considered as an alternative for any primary or revision hip arthroplasty at high risk for postoperative instability. In this article, the authors review the current literature regarding the clinical success of DM implants for a variety of indications, all of which predispose to hip instability. The history, basic biomechanics, modern designs, and unique complications are also discussed.

Prevalence, Risk Factors, and Management of Proximal Femoral Remodeling in Revision Hip Arthroplasty

2013 ◽  
Vol 28 (5) ◽  
pp. 877-881 ◽  
Author(s):  
Jared R.H. Foran ◽  
Nicholas M. Brown ◽  
Craig J. Della Valle ◽  
Brett R. Levine ◽  
Scott M. Sporer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Arthroplasty ◽  
Revision Hip Arthroplasty

scholarly journals Revision Hip Arthroplasty: Epidemiology, Causes, Risk Factors (foreign literature review)

2015 ◽  
pp. 83-89 ◽  
Author(s):  
A. V. Kaminskiy ◽  
L. O. Marchenkova ◽  
A. V. Pozdnyakov
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Hip Arthroplasty ◽  
Significant Risk ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Foreign Literature ◽  
Primary Hip Arthroplasty

Publications related to revision hip arthroplasty were analyzed. Data of National Registers from different countries were presented, problems of epidemiology and prognostication of need in revision arthroplasty were highlighted, the causes (demographic, clinical, surgical, rehabilitation) and the most significant risk factors that conditioned the failure of primary hip arthroplasty were described.

Risk factors for mortality following one-stage septic hip arthroplasty — a case–control study

2021 ◽  
Author(s):  
Sophia-Marlene Busch ◽  
Mustafa Citak ◽  
Mustafa Akkaya ◽  
Felix Prange ◽  
Thorsten Gehrke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Arthroplasty ◽  
Case Control Study ◽  
Case Control ◽  
One Stage ◽  
Control Study
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