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

Iatrogenic Intraprosthetic Dislocation of Dual Mobility Cup. Case Study

2021 ◽  
Vol 23 (1) ◽  
pp. 51-57
Author(s):  
Kamil Kurczyński ◽  
Artur Pepłoński ◽  
Piotr Cieślik ◽  
Marta Burbul(
Keyword(s):  
Closed Reduction ◽  
Rare Complication ◽  
Medical Institute ◽  
Dual Mobility Cup ◽  
Acetabular Cup ◽  
Dual Mobility ◽  
First Case ◽  
The Military ◽  
Intraprosthetic Dislocation

Intra-prosthetic dislocation of the dual-mobile acetabular cup is a rare complication. Most often, it is the result of wear of the polyethylene liner. It can also occur during a closed reduction of a dislocated dual-mobile cup. It is extremely important to recognize this complication immediately in order to avoid the consequences. This paper presents the first case of iatrogenic intraprosthetic dislocation at the Traumatology and Orthopaedics Department of the Military Medical Institute, our management of the case and suggestions for treating patients with a dislocation of the dual-mobile acetabular cup.

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 Cemented Dual Mobility Cup for Primary Total Hip Arthroplasty in Elder Patients with High-Risk Instability

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 23
Author(s):  
José María Lamo-Espinosa ◽  
Jorge Gómez-Álvarez ◽  
Javier Gatica ◽  
Álvaro Suárez ◽  
Victoria Moreno ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Demographic Data ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Total Hip ◽  
Elder Patients

Several studies have shown that double mobility (DM) cups reduce postoperative dislocations. Does the cemented dual mobility cup reduce dislocations in a specific cohort of elder patients with a high dislocation risk? Our hypothesis is that this implant is optimal for elder patients because it reduces early dislocation. We have retrospectively reviewed elder patients who underwent total hip arthroplasty (THA) with cemented double mobility cup between March 2009 and January 2018. The inclusion criteria were patients (>75 years) who were operated on for primary THA (osteoarthritis or necrosis) with a cemented dual mobility cup and a high-risk instability (at least two patient-dependent risk factors for instability). The exclusion criteria were revision surgeries or hip fracture. In all the cases, the same surgical approach was performed with a Watson Jones modified approach in supine position. We have collected demographic data, instability risk factors. Patients were classified using the Devane’s score, Merle d’Aubigné score and the patient’s likelihood of falling with the Morse Fall Scale. Surgical and follow-up complications were collected from their medical history. Sixty-eight arthroplasties (68 patients) were included in the study. The median age was 81.7 years (SD 6.4), and the American Society of Anesthesiologists (ASA) score showed a distribution: II 27.94%, III 63.24% and IV 8.82%. Devane’s score was less than five in all of the cases. At least two patient-dependent risk factors for instability (87% had three or more) were present in each case. The median follow-up time was 49.04 months (SD 22.6). Complications observed were two cases of infection and one case of aseptic loosening at 15 months which required revision surgery. We did not observe any prosthetic dislocation. The cemented dual mobility cup is an excellent surgical option on primary total hip arthroplasties for elder patients with high-risk instability.

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

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.

Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring?

2018 ◽  
Vol 43 (5) ◽  
pp. 1097-1105 ◽  
Author(s):  
Thomas Neri ◽  
Bertrand Boyer ◽  
Jean Geringer ◽  
Alexandre Di Iorio ◽  
Jacques H. Caton ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Intraprosthetic Dislocation

Intraprosthetic Dislocation of Modular Dual-Mobility Total Hip Arthroplasty Components During Closed Reduction: A Report of Two Cases

2017 ◽  
Vol 01 (04) ◽  
pp. 205-210
Author(s):  
Ovninder Johal ◽  
Blake Eyberg ◽  
Russell Meldrum ◽  
J. Walker
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Closed Reduction ◽  
Hip Dislocation ◽  
Dual Mobility ◽  
Total Hip ◽  
Unique Mode ◽  
Mode Of Failure ◽  
Hip Disease ◽  
Intraprosthetic Dislocation

AbstractDual-mobility bearing total hip arthroplasty offers several advantages over traditional prosthesis designs in the treatment of degenerative hip disease. Over decades of use, they have shown proven benefits in both durability and stability. However, despite their practical and theoretical advantages, they present a unique mode of failure not seen with other implants. In this report, the authors present two patients who sustained intraprosthetic dislocation of their dual-mobility total hip arthroplasty components during closed reduction of a hip dislocation.

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