scholarly journals A double mobility acetabular implant for primary hip arthroplasty in patients at high risk of dislocation

2014 ◽  
Vol 96 (8) ◽  
pp. 597-601 ◽  
Author(s):  
NL Vasukutty ◽  
RG Middleton ◽  
P Young ◽  
C Uzoigwe ◽  
B Barkham ◽  
...  
Keyword(s):  
High Risk ◽  
Acetabular Component ◽  
Polyethylene Wear ◽  
Large Diameter ◽  
Wear Rates ◽  
Total Hip ◽  
Hip Function ◽  
The Mean ◽  
Acetabular Implant

Introduction Dislocation following total hip replacement continues to be a problem for which no completely satisfactory solution has been found. Several methods have been proposed to reduce the incidence of hip dislocations with varying degrees of success, including elevated rim liners, constrained liners and large diameter bearings. We present our experience with the double mobility acetabular component in patients at high risk of instability. Methods This was a retrospective review of 65 primary total hip arthroplasties in 55 patients (15 men, 40 women), performed between October 2005 and November 2009. The majority (80%) of patients had at least two and 26% had at least three risk factors for instability. The mean age was 76 years (range: 44–92 years). The patients were followed up for a mean duration of 60 months (range: 36–85 months). Results Fourteen patients died and one was lost to follow-up, leaving fifty hips for final assessment. Until the final follow-up appointment, no patients had dislocation and none required revision surgery. The mean Oxford hip score improved from 45.0 to 26.5 (p<0.0001). The mean Merle d’Aubigné pain score improved from 1.4 to 4.9 (p<0.0001), the walking score from 2.3 to 3.1 (p<0.07) and the absolute hip function score from 5.4 to 10.8 (p<0.0001). There were no clinical or radiographic signs of loosening. Conclusions The double mobility acetabular component was successful at preventing dislocation during early to medium-term follow-up. However, as data are still lacking with regard to polyethylene wear rates at the additional bearing surface, it would be prudent to restrict the use of this implant to selected patients at high risk of instability.

Excellent results of large-diameter ceramic-on-ceramic bearings in total hip arthroplasty

2018 ◽  
Vol 100-B (11) ◽  
pp. 1434-1441 ◽  
Author(s):  
W. G. Blakeney ◽  
Y. Beaulieu ◽  
B. Puliero ◽  
M. Lavigne ◽  
A. Roy ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Short Form ◽  
Large Diameter ◽  
Ucla Activity Score ◽  
Total Hip ◽  
Ceramic On Ceramic

Aims This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing. Patients and Methods Of the 276 hips (246 patients) included in this study, 264 (96%) were reviewed at a mean of 67 months (48 to 79) postoperatively. Procedures were performed with a mini posterior approach. Clinical and radiological outcomes were recorded at regular intervals. A noise assessment questionnaire was completed at last follow-up. Results There were four re-operations (1%) including one early revision for insufficient primary fixation (0.4%). No hip dislocation was reported. The mean University of California, Los Angeles (UCLA) activity score, 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS) score, SF-12 Physical Component Summary (PCS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Forgotten Joint Score (FJS) were 6.6 (2 to 10), 52.8 (25.5 to 65.7), 53.0 (27.2 to 66.5), 7.7 (0 to 63), and 88.5 (23 to 100), respectively. No signs of loosening or osteolysis were observed on radiological review. The incidence of squeaking was 23% (n = 51/225). Squeaking was significantly associated with larger head diameter (p < 0.001), younger age (p < 0.001), higher SF-12 PCS (p < 0.001), and UCLA scores (p < 0.001). Squeaking did not affect patient satisfaction, with 100% of the squeaking hips satisfied with the surgery. Conclusion LDH CoC THAs have demonstrated excellent functional outcomes at medium-term follow-up, with very low revision rate and no dislocations. The high incidence of squeaking did not affect patient satisfaction or function. LDH CoC with a monoblock acetabular component has the potential to provide long term implant survivorship with unrestricted activity, while avoiding implant impingement, liner fracture at insertion, and hip instability. Cite this article: Bone Joint J 2018;100-B:1434–41.

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.

Wear of XLPE Liner against Zirconium Heads in Cementless Total Hip Arthroplasty for Patients under 40 Years of Age

2017 ◽  
Vol 27 (6) ◽  
pp. 532-536 ◽  
Author(s):  
Motoki Sonohata ◽  
Masaru Kitajima ◽  
Shunsuke Kawano ◽  
Masaaki Mawatari
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Wear ◽  
Japanese Orthopaedic Association ◽  
Young Patients ◽  
Stress Shielding ◽  
Developmental Dysplasia ◽  
Total Hip ◽  
The Mean

Introduction Total hip arthroplasty (THA) in the young is challenging. The purpose of this study was to retrospectively determine the clinical, radiographic, and polyethylene wear rate of relatively young patients. Methods We evaluated the outcome of consecutive patients receiving primary THA who were under 40 years of age with a minimum 10-year follow-up. Indications for THA in these patients were osteoarthritis due to developmental dysplasia of the hip joint (9 hips), osteonecrosis of the femoral head (7 hips), juvenile idiopathic arthritis (2 hips), and osteoarthritis due to Perthes disease (1 hip). All THA were performed with a cross-linked ultra-high-molecular-weight polyethylene (XLPE) liner against zirconium heads with cementless implants. Results The average Japanese Orthopaedic Association hip score significantly improved from 42 to 93 points at the latest follow-up. The mean steady wear was 0.015 mm/year (maximum 0.033 mm/year), and the mean creep wear was 0.111 mm (maximum 0.4 mm). Osteolysis was observed around 1 acetabular component and 2 stems. 1 femoral component had subsidence over 5 mm. All of the femoral components achieved fixation with an optimal interface with spot welds at the latest follow-up. Stress shielding was observed in all hips. Conclusions THA using an XLPE liner against zirconium heads appeared to have improved THA longevity. However, the imaging findings in some cases were suggestive of wear debris. A rigorous continual follow-up is required for relatively young patients undergoing THA.

Revision of Failed Cemented Total Hip Arthroplasty Using the Charnley Technique and Implants

1997 ◽  
Vol 7 (1) ◽  
pp. 17-27 ◽  
Author(s):  
G. CH. Babis ◽  
TH. Pantazopoulos ◽  
TH. Ioannidis ◽  
G. Hartofilakidis
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Acetabular Component ◽  
Bone Stock ◽  
Total Hip ◽  
The Mean ◽  
Hip Arthroplasties ◽  
Cemented Total Hip Arthroplasty

The authors present the results of 57 revisions in 54 patients performed for aseptic loosening of cemented total hip arthroplasties. The Charnley technique and implants were used in all cases. The mean follow-up was 8 years and 6 months with a minimum of 5 years. The failure rate for the femoral component was 15% and for the acetabular component it was 19.1%. The cumulative success rate at 8 years was 81.7% for the femoral component and 83.4% for the acetabular component. The Charnley technique and implants were found efficient for revision of cemented total hip arthroplasties in the long term, but there are limitations to their use in the presence of severely compromised bone stock.

Total Hip Arthroplasty in Patients 21 Years and Younger Using Highly Cross-Linked Polyethylene: Excellent Survivorship at Five Years

2018 ◽  
Vol 02 (02) ◽  
pp. 092-096
Author(s):  
Muyibat Adelani ◽  
Frank Bohnenkamp ◽  
Gail Pashos ◽  
John Clohisy ◽  
Adam Sassoon
Keyword(s):  
Los Angeles ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Wear ◽  
Short Form ◽  
Young Patients ◽  
Wear Rates ◽  
Total Hip ◽  
Radiographic Outcomes

AbstractThe survivorship of contemporary total hip arthroplasty has improved substantially as a result of the success of highly cross-linked polyethylene. Nevertheless, there is limited information on its performance in extremely young patients. The purpose of this study is to evaluate the (1) clinical and radiographic outcomes, (2) polyethylene wear rates, and (3) mid-term survivorship of total hip arthroplasty in patients 21 years or younger using highly cross-linked polyethylene. After Institutional Review Board approval, the authors identified 45 patients aged 21 years or younger (56 hips) who underwent primary total hip arthroplasty with highly cross-linked polyethylene at their institution by the senior author between 2000 and 2009. Patients were followed for a minimum of 2 years, or until revision. At a mean follow-up of 57 months, modified Harris Hip Scores, Western Ontario McMaster Universities Arthritis Index scores, Short Form-12 physical function scores, and University of California, Los Angeles activity scores improved significantly in all patients. There was no radiographic evidence of osteolysis in any patient. The mean linear polyethylene wear rate was 0.02 mm per year. Survivorship was 98% with one revision for acetabular loosening at 71 months. Total hip arthroplasty in patients 21 years or younger with highly cross-linked polyethylene had excellent clinical and radiographic outcomes at mid-term follow-up. Longer-term data are needed in this patient population to confirm continued survivorship in the extremely young. The level of evidence used for this study was level III.

Medial Placement of a Cementless Acetabular Component in a Modern Alumina-on-Alumina THA

2007 ◽  
Vol 330-332 ◽  
pp. 1243-1246
Author(s):  
Jeong Joon Yoo ◽  
Hee Joong Kim ◽  
Young Min Kim ◽  
Kang Sup Yoon ◽  
Kyung Hoi Koo ◽  
...  
Keyword(s):  
Acetabular Component ◽  
Polyethylene Wear ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Bearing Surface ◽  
The Mean ◽  
Acetabular Components ◽  
Cementless Acetabular Component ◽  
Acetabular Wall

Medial placement of a cementless acetabular component into or beyond the medial wall of a shallow, dysplastic acetabulum is a technique to enhance its coverage during difficult total hip arthroplasty (THA). Dysplastic hips almost always need small size of acetabular component, so an accelerated polyethylene wear can occur when a conventional bearing surface is used. Modern alumina-on-alumina couplings can be an alternative for these patients. We evaluated the clinical results of 43 medially placed cementless acetabular components (PLASMACUP®SC) incorporating a modern alumina bearing surface (BIOLOX® forte). Acetabular components were inserted medially beyond the ilioischial line and, therefore, beyond the level of the cortical bone of the cotyloid notch, and followed up for more than 5 years (range, 60 – 93 months). In 14 hips, the medial acetabular wall was perforated purposefully and the medial aspect of the cup was placed beyond both the ilioischial and the iliopubic line on radiographs. The mean Harris hip score improved from 55.3 points preoperatively to 94.5 points postoperatively. Postoperatively, the hip center migrated 12.1 mm medially and 1.5 mm inferiorly. The average amount of cup protrusion beyond the ilioischial and the iliopubic line was 3.1 mm and 1.9 mm, respectively. The average superolateral coverage of the cup was 98.5 percent. During follow-up, no osteolysis or loosening of acetabular components was observed and no revision was required. Medial placement of a cementless acetabular component into or beyond the medial acetabular wall offers predictable clinical results and durable fixation in modern alumina-on-alumina THA.

scholarly journals Early low complication rate of ceramic-on-ceramic total hip arthroplasty by direct anterior approach

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 30 ◽  
Author(s):  
Paul Henri Bauwens ◽  
Camdon Fary ◽  
Elvire Servien ◽  
Sébastien Lustig ◽  
Cécile Batailler
Keyword(s):  
Clinical Outcomes ◽  
Anterior Approach ◽  
Polyethylene Wear ◽  
Direct Anterior Approach ◽  
Late Complications ◽  
Harris Hip Score ◽  
Total Hip ◽  
The Mean ◽  
Ceramic On Ceramic

Introduction: Ceramic-on-ceramic couplings are an alternative bearing surface to reduce the problems related to polyethylene wear and debris. However, ceramic articulations have their own risk of unique complications: fracture, squeaking, or dislocation. Few studies have assessed the outcomes of ceramic-on-ceramic total hip arthroplasties (THA) by direct anterior approach (DAA). The aim was to evaluate the early complications and revision rate of ceramic-on-ceramic THA by DAA. Material: A retrospective single-center study of 116 consecutive THAs was performed by DAA (106 patients) with ceramic-on-ceramic bearing from January 2015 to February 2018 with a minimum 24 months of follow-up. No patients were lost to follow-up. The mean age was of 55.3 years ± 11.3. The same cementless acetabular shell with a Biolox Delta ceramic insert and head were used. The complication and revision rates were collected at the last follow-up. The positioning of the acetabular implant was assessed on standard radiographs. Postoperative clinical outcomes were assessed by the Harris Hip Score. Results: At a mean follow-up of 31.9 months ± 5.5, no THA was revised. Five patients had late complications: 3 squeaking (2.6%) and 2 psoas impingements (1.7%) and were managed conservatively. All patients had satisfactory bony ingrowth of acetabular component, with no radiolucent lines and no osteolysis. Eight patients (6.9%) had an anterior overhang of the cup. The mean overhang for these patients was 4.1 mm. 111 hips (96%) were perceived as forgotten or having no limitations. Conclusion: This ceramic-on-ceramic coupling and shell by DAA produced excellent clinical outcomes and implant survival rate at a minimum two-year follow-up study. No serious complication was observed during the follow-up.

Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation

2021 ◽  
pp. 112070002098846
Author(s):  
JaeWon Yang ◽  
Andrew J Bryan ◽  
Roman Drabchuk ◽  
Matthew W Tetreault ◽  
Tyler E Calkins ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Femoral Fracture ◽  
Acetabular Fracture ◽  
Periprosthetic Femoral Fracture ◽  
Dual Mobility ◽  
Total Hip

Introduction: Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA. Methods: A total of 155 primary THAs with a monoblock, cementless dual-mobility acetabular component were performed in patients at high risk for dislocation. Two patients died prior to their two-year follow-up. The remaining 153 THAs were followed for a mean of 5.1 years (range: 2.1 to 9.3). Results: There were no dislocations; however, four patients underwent revision surgery: one for an early periprosthetic acetabular fracture, one for an early periprosthetic femoral fracture, one for a late periprosthetic femoral fracture, and one for leg-length discrepancy. Intraoperative complications included one periprosthetic acetabular fracture treated with protected weight-bearing and one intraoperative proximal femoral fracture treated with cerclage wiring. Harris Hip Scores improved from a mean of 42.4 points preoperatively to a mean of 82.4 points postoperatively ( p < 0.001). No cups were radiographically loose. At a mean follow-up of 5.1 years, survivorship of the acetabular component was 99.3% (95% CI, 98.1–100%) and survivorship without any reoperation was 97.4% (95% CI, 95.9–100%). Discussion: Although there were no dislocations in this high-risk population, periprosthetic fractures of the femur and acetabulum were common with the implants utilised.

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