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

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.

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Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1064 ◽

2016 ◽

Vol 6 (1) ◽

pp. 17-20 ◽

Cited By ~ 1

Author(s):

Samuel S Wellman ◽

David E Attarian ◽

Taylor R McClellan ◽

Roberto D Calderon ◽

Paul F Lachiewicz

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Dislocation Rate ◽

Revision Total Hip Arthroplasty ◽

Short Term ◽

Dual Mobility ◽

Total Hip ◽

Increased Risk

ABSTRACT Patients undergoing a revision total hip arthroplasty (THA) are at increased risk for dislocation. The literature suggests dual-mobility components may decrease the frequency of dislocation. We conducted a retrospective study of one type of dual mobility acetabular component implanted in 82 revision THA cases that were considered at increased risk for dislocation. Of the 82 hips, 58 had a mean follow-up of 12 months (3–28 months). The indication for revision was instability in 18 hips (31%), adverse metal-on-metal reaction in 13 hips (22%), reimplantation for infection in 11 hips (19%), and aseptic loosening of the acetabular component in 9 hips (16%). In the course of follow-up, 6 hips developed a deep infection requiring reoperation. There were no early hip dislocations. McClellan TR, Calderon RD, Bolognesi MP, Attarian DE, Lachiewicz PF, Wellman SS. Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component. The Duke Orthop J 2016;6(1):17-20.

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

Hip International ◽

10.1177/1120700019863002 ◽

2019 ◽

Vol 30 (6) ◽

pp. 739-744 ◽

Cited By ~ 1

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.

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

Hip International ◽

10.1177/1120700019873617 ◽

2019 ◽

pp. 112070001987361 ◽

Cited By ~ 3

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.

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

The Bone & Joint Journal ◽

10.1302/0301-620x.103b11.bjj-2021-0022.r1 ◽

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.

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Outcome and complications after dual mobility total hip replacement

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-11-08-0116 ◽

2012 ◽

Vol 25 (06) ◽

pp. 511-517 ◽

Cited By ~ 6

Author(s):

A. Autefage ◽

T. Dembour ◽

J.-L. Chancrin ◽

P. Guillaumot

Keyword(s):

Aseptic Loosening ◽

Acetabular Component ◽

Acetabular Fracture ◽

Hip Prosthesis ◽

Perioperative Complications ◽

Greater Trochanter ◽

Dual Mobility ◽

Total Hip ◽

Trochanter Fracture

SummaryObjectives: To report the clinical and radiographic outcome of a canine total hip prosthesis with a dual mobility acetabular component, with a minimum of six months follow-up.Methods: The outcome of dogs that underwent primary cemented unilateral dual mobility hip prosthesis surgery by one of the authors for hip dysplasia or trauma, and which had a minimum of six months clinical and radiologic follow-up, was evaluated.Results: Fifty dogs were included in the study. Follow-up ranged from six to 38 months (mean 14.4 months). Perioperative complications were acetabular collapse (n = 1) and greater trochanter fracture (n = 1), both of which were successfully managed perioperatively. Postoperative complications were aseptic loosening of the acetabular component (n = 2; both surgically revised), implant sepsis (n = 3; all explanted), acetabular fracture (n = 1; conservatively managed), greater trochanter fracture (n = 1; conservatively managed) and sciatic neurapraxia (n = 1). No cases of postoperative luxation or femoral implant aseptic loosening were encountered. Outcome was poor for three cases (3 implant sepsis), fair for three cases (including 1 acetabular component loosening and 1 acetabular fracture), and good or excellent for 44 cases (88%).Clinical significance: There were not any cases of postoperative coxofemoral luxation observed in this series of 50 dogs with dual mobility hip prosthesis. Studies with more patients and longer follow-up are needed to confirm the satisfactory results observed to date with this implant.

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Mid-term outcomes of tantalum cup– a single centre study

Arthroplasty ◽

10.1186/s42836-021-00099-z ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Rajesh Bawale ◽

Baseem Choudhry ◽

Srinivasa Samsani

Keyword(s):

Hip Arthroplasty ◽

Deep Infection ◽

Revision Hip Arthroplasty ◽

Trabecular Metal ◽

Level Of Evidence ◽

Porous Tantalum ◽

Midterm Outcome ◽

Cementless Cup ◽

The Mean

Abstract Introduction The cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications. Methods The midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available. Results The mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up. Conclusion The mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments. Level of evidence IV.

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Second-generation uncemented total hip arthroplasty: a minimum 20-year follow-up

Bone & Joint Open ◽

10.1302/2633-1462.21.bjo-2020-0157.r1 ◽

2021 ◽

Vol 2 (1) ◽

pp. 33-39

Author(s):

Jeffrey R. McLaughlin ◽

Kyla R. Lee ◽

Mary Ann Johnson

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Femoral Component ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Second Generation ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Acetabular Components

Aims We present the clinical and radiological results at a minimum follow-up of 20 years using a second-generation uncemented total hip arthroplasty (THA). These results are compared to our previously published results using a first-generation hip arthroplasty followed for 20 years. Methods A total of 62 uncemented THAs in 60 patients were performed between 1993 and 1994. The titanium femoral component used in all cases was a Taperloc with a reduced distal stem. The acetabular component was a fully porous coated threaded hemispheric titanium shell (T-Tap ST). The outcome of every femoral and acetabular component with regard to retention or revision was determined for all 62 THAs. Complete clinical follow-up at a minimum of 20 years was obtained on every living patient. Radiological follow-up was obtained on all but one. Results Two femoral components (3.2%) required revision. One stem was revised secondary to a periprosthetic fracture one year postoperatively and one was revised for late sepsis. No femoral component was revised for aseptic loosening. Six acetabular components had required revision, five for aseptic loosening. One additional acetabular component was revised for sepsis. Radiologically, all femoral components remained well fixed. One acetabular was judged loose by radiological criteria. The mean Harris Hip Score improved from 46 points (30 to 67) preoperatively to 89 points (78 to 100) at final follow-up. With revision for aseptic loosening as the endpoint, survival of the acetabular component was 95% (95% confidence interval (CI) 90 to 98) at 25 years. Femoral component survival was 100%. Conclusion The most significant finding of this report was the low prevalence of aseptic loosening and revision of the femoral component at a mean follow-up of 22 years. A second important finding was the survival of over 90% of the hemispheric threaded ring acetabular components. While these shells remain controversial, in this series they performed well. Cite this article: Bone Jt Open 2021;2(1):33–39.

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Revision hip arthroplasty using a porous tantalum acetabular component

Hip International ◽

10.1177/1120700020913294 ◽

2020 ◽

pp. 112070002091329

Author(s):

Hannu JA Miettinen ◽

Simo SA Miettinen ◽

Jukka S Kettunen ◽

Jussi Jalkanen ◽

Heikki Kröger

Keyword(s):

Survival Analysis ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Revision Surgery ◽

University Hospital ◽

Revision Hip Arthroplasty ◽

Cumulative Proportion ◽

Kaplan Meier ◽

The Mean

Introduction: Reconstruction of acetabulum in case of bone defects can be challenging. The aim of this retrospective study was to investigate the 10-year survival of trabecular tantalum metal (TM) acetabulum component in revision hip arthroplasty operations and to evaluate complications. Methods: A total of 100 consecutive acetabulum revision hip arthroplasties (100 patients) were operated on between May 2004 and October 2006 at Kuopio University Hospital. The mean follow-up time was 9.4 years and the median was 11.5 years (SD 4.118; range 0.1–13.4 years). Kaplan-Meier survival analysis was performed to study the survival of patients to re-revision surgery. Intra- and postoperative complications and reasons for re-revision were evaluated. Results: The Kaplan-Meier analysis showed a cumulative proportion of revision hip survivorship of 66% at 13.4 years (SE 0.403, 95% CI, 10.886–12.466) based on the need for further re-revision surgery for any major reason. The Kaplan-Meier survival analysis of time to re-revision surgery due acetabular component loosening showed a cumulative proportion of survivorship of 98.9% at 13.4 years (SE 0.136; 95% CI, 12.998–13.529). There were a total of 41/100 complications and the most common complication was dislocation (24/100). Re-revision for any major reason was performed on 18/100 of the revision arthroplasties. The mean time to re-revision was 4.9 years (SD 5.247; range 0.1–13.2 years). Discussion: The trabecular TM acetabular component gives excellent outcomes regarding stability and fixation to the acetabulum in acetabulum revision hip arthroplasty at a minimum of ten years of follow-up. However, acetabular component malposition and the small head size (28 mm) are risk factors for dislocation.

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Allograftinf in the case of revision hip arthroplasty at aseptic loosening of the acetabular component

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-5987202045-11 ◽

2021 ◽

Vol 0 (4) ◽

pp. 5-11

Author(s):

Volodymyr Filipenko ◽

Petro Vorontsov ◽

Husak Valeriia ◽

Arutunan Zorik ◽

Kateryna Samoylova ◽

...

Keyword(s):

Aseptic Loosening ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Revision Hip Arthroplasty

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Early failure of an uncemented femoral stem, as compared to two other stems with similar design, following primary total hip arthroplasty performed with direct anterior approach

Hip International ◽

10.1177/1120700020940671 ◽

2020 ◽

pp. 112070002094067

Author(s):

George A Macheras ◽

Panagiotis Lepetsos ◽

Spyridon P Galanakos ◽

Stamatios A Papadakis ◽

Lazaros A Poultsides ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Population Sample ◽

Femoral Stem ◽

Direct Anterior Approach ◽

Total Hip ◽

Increased Risk

Introduction: An increased risk of early femoral component loosening has been reported using the direct anterior approach (DAA) compared with other common surgical approaches. However, long-term data are scarce. The purpose of this study is: (1) to determine the incidence of early femoral loosening in a high volume, single surgeon’s practice utilising the DAA approach; and (2) to examine the effect of stem design and type of coating on aseptic loosening in the early and mid-term postoperative period. Methods: A retrospective review of 1650 consecutive patients (1800 hips) who underwent total hip arthroplasty (THA) using the DAA between August 2011 and December 2017 was conducted at our institution. 3 types of uncemented femoral stems (Quadra-S, Avenir, TwinSys), with similar design, but different coating, were implanted. Patients were evaluated clinically and radiologically at 4 weeks, 3 months, 1 year, and annually thereafter. Results: After a mean follow-up of 46.4 months, the total incidence of revision for aseptic loosening was 0.44% ( n = 8). All loose stems were Quadra-S, failing to achieve osseointegration, for an overall incidence of 0.96% ( p = 0.002). None of the other stems were loose. Radiolucent lines around the proximal stem portion were visible in 75 Quadra-S stems (4.1%) on radiographs taken at 1 year postoperatively and continued to deteriorate at the latest follow-up. Conclusions: In this specific cohort of patients, the increased rate of femoral stem aseptic loosening was implant-related and was attributed only to a specific type of femoral stem (Quadra-S). No relation to other factors was proven suggesting that the surface characteristics of this femoral stem and the lack of bioactive coating are responsible for the observed early femoral failures. These findings should be confirmed by additional registry work and larger population sample sizes are needed to evaluate the prosthesis performance after implantation through the DAA.

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