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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_10 | Pages 18 - 18
1 Oct 2020
Nunley RM Barrack RL Lawrie CM
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Introduction

Modular dual mobility (MDM) prostheses are increasingly utilized for total hip arthroplasty (THA) to mitigate the risk of postoperative instability in high risk patients. Short-term reports on clinical outcomes are favorable but there are few studies on young active patients. This study quantified proximal femoral stress shielding and metal ion release in MDM combined with modern cementless stem design in young active patients.

Methods

This was a prospective study of patients between 18 and 65 years of age, with a body mass index (BMI) < 35 kg/m2 and University of California at Los Angeles (UCLA) activity score > 6, who received a modular cobalt-chromium acetabular liner, highly crosslinked polyethylene mobile bearing, and cementless titanium femoral stem for their primary THA. DEXA scans were performed at 6 weeks postoperatively as a baseline, then again at 6 months, 1 year, 2 years and 5 years postoperatively as were metal ions.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 23 - 23
1 Oct 2019
Lawrie CM Barrack TR Abu-Amer W Adelani MA Clohisy JC Barrack RL Nunley RM
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Introduction

The utility and yield of the current practice of routine screening of asymptomatic patients after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) is unclear. The purpose of this prospective survey study was to determine the utility of the routine on year follow up visit primary THA and TKA.

Methods

We prospectively enrolled all patients undergoing primary THA and TKA. At one-year follow-up, patients were asked to complete a survey that asked about satisfaction with the and if they thought the visit was worthwhile. Surgeons also completed a survey which asked if any intervention was done, if any problems were diagnosed/avoided, and if the visit was worthwhile. Data was analyzed and compared between patients and surgeons, and was also compared to the need for any additional interventions


The Bone & Joint Journal
Vol. 101-B, Issue 4 | Pages 365 - 371
1 Apr 2019
Nam D Salih R Nahhas CR Barrack RL Nunley RM

Aims

Modular dual mobility (DM) prostheses in which a cobalt-chromium liner is inserted into a titanium acetabular shell (vs a monoblock acetabular component) have the advantage of allowing supplementary screw fixation, but the potential for corrosion between the liner and acetabulum has raised concerns. While DM prostheses have shown improved stability in patients deemed ‘high-risk’ for dislocation undergoing total hip arthroplasty (THA), their performance in young, active patients has not been reported. This study’s purpose was to assess clinical outcomes, metal ion levels, and periprosthetic femoral bone mineral density (BMD) in young, active patients receiving a modular DM acetabulum and recently introduced titanium, proximally coated, tapered femoral stem design.

Patients and Methods

This was a prospective study of patients between 18 and 65 years of age, with a body mass index (BMI) < 35 kg/m2 and University of California at Los Angeles (UCLA) activity score > 6, who received a modular cobalt-chromium acetabular liner, highly crosslinked polyethylene mobile bearing, and cementless titanium femoral stem for their primary THA. Patients with a history of renal disease and metal hardware elsewhere in the body were excluded. A total of 43 patients (30 male, 13 female; mean age 52.6 years (sd 6.5)) were enrolled. All patients had a minimum of two years’ clinical follow-up. Patient-reported outcome measures, whole blood metal ion levels (ug/l), and periprosthetic femoral BMD were measured at baseline, as well as at one and two years postoperatively. Power analysis indicated 40 patients necessary to demonstrate a five-fold increase in cobalt levels from baseline (alpha = 0.05, beta = 0.80). A mixed model with repeated measures was used for statistical analysis.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 11 - 11
1 Oct 2018
Nam D Salih R Riegler V Nunley RM Clohisy JC Lombardi AV Berend KR Barrack RL
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Introduction

Despite well-fixed implants, persistent pain following total hip arthroplasty (THA) remains a concern. Various surgical approaches have been advocated, yet whether patient-reported pain differs amongst techniques has not been investigated. This study's purposes were to determine differences in patient-reported pain based on surgical approach (direct anterior –DA versus posterolateral-PL) or PL approach incision length. Our hypothesis was that no differences in patient-reported pain would be present.

Methods

A retrospective, IRB-approved investigation from 2 centers was performed. 7 fellowship trained arthroplasty surgeons (3 DA, 3 PL, 1 both) enrolled patients undergoing primary THA for non-inflammatory arthritis. PL approach patients were categorized based on incision length (6–8cm, 8–12cm, 12–15cm). Exclusion criteria were a prior hip surgery, revision procedure, or limited postoperative mobility. All THAs were performed using a cementless titanium, proximally coated, tapered femoral stem and hemispherical acetabular component. All patients had a minimum of 1-year clinical follow-up with radiographically well-fixed components.

A pain-drawing questionnaire was administered in which patients identify the location and intensity of pain on an anatomic diagram. Independent Student's t-tests and Chi-square analyses were performed (p<0.05 = significant). Power analysis indicated 800 patients in each cohort would provide adequate power to detect a 4% difference in patient-reported pain (alpha = 0.05, beta = 0.80).