Background. Published simulator studies for metal/UHMWPE bearings couples showed that increasing the femoral head diameter by 1 mm increases wear by approximately 10% due to increased contact area. Therefore, there are concerns about increased wear with
Aims. Instability remains a challenging problem in both primary and
revision total hip arthroplasty (THA).
Aims. Prior studies have identified that malseating of a modular
Dislocation and instability remain leading cause of failure following THA. We present a single-surgeon 10-year experience with use of
Dislocation is still one of the more common reasons for revision of THR.Registry and large institutional data has demonstrated the effectiveness of
Aims.
Background.
In metal-on-metal (MoM) hip replacements or resurfacings, mechanical induced corrosion can lead to a local inflammatory response, pseudo tumours and elevated serum metal ions, requiring revision surgery. The size and diametral clearance of Anatomic (ADM) and Modular (MDM)
Dislocation remains among the most common complications of, and reasons for, revision of both primary and revision total hip arthroplasties in the United States. We have advocated identifying the primary cause of instability to plan appropriate treatment (Wera, Della Valle, et al., JOA 2012). Once implant position, leg length, and offset have been optimised and sources of impingement have been removed, the surgeon can opt for a large femoral head, a
Introduction. Enhanced stability using
Introduction. Patients undergoing primary total hip arthroplasty (THA) with prior lumbar spine fusion (LSF) are at high risk for instability with reported incidence of dislocation as high as 8.3%. The use of
Treatment of recurrent dislocation: approximately: 1/3 of failures (probably higher in the absence of a clear curable cause). In the US: most popular treatment option: constrained liners with high redislocation and loosening rates in most reports. Several interfaces leading to various modes of failures. In Europe:
Introduction. Dual-mobility bearings increase the stable range of motion of total hip arthroplasty (THA) but are limited by the mechanical effects of a large diameter metal on polyethylene bearing which may cause high rates of wear from the surfaces of the polyethylene bearing and the head-stem taper. Improved polyethylene (PE) has reduced concern over bearing wear but the effects on the taper junction are unknown. We aimed to better understand the effect of
Aims.
Modular
In primary total hip replacements there are numerous options available for providing hip stability in difficult situations (i.e. Down's syndrome, Parkinson's disease). However, in the revision situation in general and in revision for recurrent dislocation specifically, it is important to have all options available including
Constrained liners are a tantalizing solution to both prevent and treat instability, as they markedly increase the force needed for a dislocation to occur. They have, however, several important negatives that the surgeon must consider before entertaining their use including: Increased stresses at the implant bone interface which can increase the risk of loosening or cause catastrophic failure in the early post-operative period; Decreased range of motion with a greater risk of impingement; and Usually require an open reduction if they dislocate or otherwise fail. Given the limitations of constrained liners, we have looked to
Background:.
In primary total hip replacements there are numerous options available for providing hip stability in difficult situations i.e. Down's syndrome, Parkinson's disease. However, in the revision situation, in general, and in revision for recurrent dislocation situations specifically, it is important to have all options available including
Introduction. Reoperations to manage unstable total hip arthroplasty are reported with a high failure rate. The
National Institute of Clinical Excellence (NICE) recommended total hip replacement (THR) surgery for fit patients with fracture neck of femur (NOF) in 2011. Our hospital implemented hip fracture program to follow these recommendations the same year. However, the increased incidence of further procedures compared with those undergoing the THR for osteoarthritis alone has led to concern regarding dislocation and other complications when using THR treatment for fracture NOF particularly with the posterior approach. We introduced
Aims. Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with
Although the incidence of total hip dislocation has decreased, it still remains a major problem particularly if recurrent. The actual incidence is around 1–2% but it has been documented as the leading cause for hip revision in the United States. In patients with recurrent hip dislocation, technical issues of leg length inequality, incorrect offset, and poor implant position should be addressed surgically and the abnormality corrected. In patients with recurrent hip dislocation, the articulation is preferably converted to a more stable articulation, with constrained sockets and
Dislocation is a particular problem after total hip replacement in femoral neck fractures and elderly, especially female, patients. The increased rate of dislocation in this population is probably due to significant ligamentous laxity in these patients and poor coordination and proprioception. Another population of patients with increased propensity for dislocation is the revision hip replacement patient. Current dislocation rates in these patients can approach 10% with conventional implant systems. The
Aims. This combined clinical and in vitro study aimed to determine the incidence of liner malseating in modular
Instability continues to be a troublesome complication after THA and has been reported to be the main indication for revision in the United States, accounting for 22.5% of revisions. Risk factors associated with dislocation include: age of 75 years or older, body mass index (BMI) of 30 kg/m2 or greater, alcohol abuse, and neuro-degenerative diseases such as multiple sclerosis or Parkinson's disease. Dual-mobility articulations have become an increasingly popular option for these “at risk” primary THAs. Few studies have assessed their use in this complex patient population. The purpose of this study was to assess dislocation rate, radiographic outcomes and complications of the dual-mobility articulation in the setting of primary THA for patients at high risk for dislocation at a minimum follow up of 2 years. We retrospectively reviewed 151
Aims. Modular
Although the incidence of total hip dislocation has decreased, it still remains a major problem particularly if recurrent. The actual incidence is around 1–2% but it has been documented as the leading cause for hip revision in the United States. In patients with recurrent hip dislocation, technical issues of leg length inequality, incorrect offset, and poor implant position should be addressed surgically and the abnormality corrected. In patients with recurrent hip dislocation, the articulation is preferably converted to a more stable articulation, with constrained sockets and
Background. Instability and dislocation are some of the most important postoperative complications and potential causes of failure that dual mobility total hip arthroplasty (THA) systems continue to address. Studies have shown that increasing the relative head size provides patients implanted with smaller and larger cups increased stability, greater ROM and a lesser incidence of impingement, without compromising clinical results. The purpose of the current study was to review clinical outcomes in three groups of primary THA patients receiving a
Introduction. The rapidly expanding aging population in the UK are living longer than ever before, which is reflected by the rising number of relatively fit and healthy people that sustain fracture NOF (neck of femur). According to current NICE (National institute for health clinical excellence) guidelines a large proportion of fracture NOF patients meet the requirements to have a total hip arthroplasty (THA) for this injury. Dislocation rate of THA can be as high as 20% for patients with fracture NOF, which is a disastrous complication in these vulnerable patients. Numerous techniques have been adopted to minimise the risk of dislocation. The use of
Dislocation remains one of the most common complications after total hip arthroplasty. Precise cup position appears to be a main factor as significant variations occur for frontal and sagittal acetabular tilt and anteversion according to sitting or standing positions. An innovative
Studies have indicated that the shallow Ultra High Molecular Weight Polyethylene (UHMWPE) acetabular socket or the socket with no head center inset can significantly increase the risk of hip joint dislocation. A previous study suggested the rim loading model in UHMWPE socket and metal femoral head can generate an intrinsic dislocating force component pushing head out of socket. Recently there has been renewed interest in
Introduction. Cementless acetabular fixation in total hip replacement (THA) is reliable and has been the fixation method of choice in the United States for decades. While revision for failure of osseointegration or early loosening is relatively rare, recurrent dislocation remains a leading cause of early revision. Novel acetabular implants and those offered by smaller companies often lack constrained or
The main causes of total hip arthroplasty (THA) revisions are loosening and instability. Use of a
Introduction. The published results of the use of a
Background. Revision surgery for failed metal-on-metal (MOM) total hip arthroplasty (THA) or hip resurfacing (HR) has been a challenge. Previous studies have reported high failure and complication rates, including dislocation, infection, aseptic loosening and lower patient satisfaction. Options for revision depend on the integrity and stability of the femoral and acetabular components. When both components fail, full revision is required; however, when the acetabular component remains well fixed and oriented, only the isolated femoral component revision can be performed.
Introduction. Postoperative dislocation remains a vexing problem for patients and surgeons following total hip arthroplasty (THA). It is the commonest reason for revision THA in the US.
Aims. Dislocation remains a significant complication after total hip arthroplasty (THA), being the third leading indication for revision. We present a series of acetabular revision using a
Introduction. The
Dislocation is a particular problem after total hip replacement in femoral neck fractures and elderly especially female patients. The increased rate of dislocation in this population is probably due to significant ligamentous laxity in these patients and poor coordination and proprioception. Another population of patients with increased propensity for dislocation is the revision hip replacement patient. Current dislocation rates in these patients can approach 10% with conventional implant systems. The
INTRODUCTION. Femoral head diameter has a major influence on stability and dislocation resistance of the hip joint after Total Hip Arthroplasty (THA).
Hip dislocation and recurrent instability continue to be a major cause of failure despite advances in materials to optimise offset and head size. The most common cause of revision after total hip arthroplasty (THA) remains recurrent dislocation (22.5%). Dislocation rates following revision THA are even higher than primary THA, and can be as high as 27%.
Abstract. Objectives.
Introduction. Total hip arthroplasty (THA) instability is well documented to be more common in specific demographic groups. We report a retrospective analysis of the use of a
Introduction. Dislocation as a primary cause of revision has been on the increase in Sweden (14% in 2014). The increasing use of
Introduction. The large diameter mobile polyethylene liner of the
Introduction. Revision procedures for unstable total hip arthroplasty have been reported with high failure rates. Many options have been proposed in such challenging cases, including
Introduction. The anatomic
Introduction. Revision surgery is generally recommended for recurrent dislocation following Total hip arthroplasty (THA). However, dislocation following revision THA continues to remain a problem with further dislocation rates upto 28% quoted in literature. We present early results of one of the largest series in U.K. using
In primary total hip replacements there are numerous options available for providing hip stability in difficult situations (i.e. Down's syndrome, Parkinson's disease). We have considered constrained liners in some of these cases. However, in the revision situation in general and in revision for recurrent dislocation situation specifically it is important to have all options available including tripolar constrained liners in order to optimise the potential for hip stability as well as function of the arthroplasty. Even with the newer options available dislocation rates of higher than 10–15% have been reported following revision surgery at institutions where high volumes of revision surgery are performed. Because of the deficient abductors, other soft tissue laxity and the requirement for large diameter cups revision cases will always have more potential for dislocation. In these situations in the lower demand patient, constraint has provided excellent success in terms of preventing dislocation and maintaining implant construct fixation to bone at intermediate- term follow-up. Hence in these situations tripolar constrained liners remains the option we utilise. We are also confident in using this device in cases with instability or laxity where there is a secure well- positioned acetabular shell. We cement a
Aims. The aim of this systematic review was to report the rate of dislocation
following the use of
To assess clinical outcomes, metal ion levels, and periprosthetic femoral bone mineral density (BMD) in young, active patients receiving a modular
Total Hip Replacement has become the most successful operation in the latter half of the 20th century for relief of pain and restoring function of the arthritic hip. Many improvements in surgical technique and implant technology have enhanced recovery, reduced complications, and increased implant survivorship. Minimising the complications of impingement, dislocation, bearing-wear, and implant loosening remain goals for surgeons and implant design. Patients at higher risk for post-operative dislocation including patients with high pre-op hip ROM, femoral neck fracture, posterior surgical approaches, smaller femoral head sizes, and most importantly folks undergoing revision THA may influence dislocation as much as component position. A tripolar type of articulation, where there is an additional bearing with a mobile polyethylene component between the prosthetic head and the acetabular shell, increase functional head diameter, reduce neck – component impingement, and reduce dislocation. These implants may greatly assist in the treatment of recurrent dislocation of the hip and in reducing the high rate of dislocation that follows revision THR as proven by many French authors connecting the world to this innovative technology. Aseptic loosening of monolithic cups (through inadequate initial fixation) and inner smaller femoral head dislocation from the larger polyethylene head remain risks with
The
Abstract. Introduction. Dislocation post THA confers a higher risk of re-dislocation (Kotwal et al, 2009). The
Background. Modular
Introduction. The
Aims. Modular
Introduction:.
Introduction. Modular
Introduction. Polyethylene (PE) wear is clearly linked to total hip arthroplasty (THA) failure, leading to osteolysis and decreasing survivorship rates.
Introduction.
Introduction.
BACKGROUND PURPOSES. dislocation is a classical complication in total hip arthroplasty (THA) revision. Cup fixation is the second concern. Since 1998 we routinely use cementless
Introduction. Pelvic posterior tilt change (PPTC) after THA is caused by release of joint contracture and degenerative lumbar kyphosis. PPTC increases cup anteversion and inclination and results in a risk of prosthesis impingement (PI) and edge loading (EL). There was reportedly no component orientation of fixed bearing which can avoid PI and EL against 20°PPTC. However,
Fractured neck of femur is a significant health concern within the UK. NICE guidance on the management of displaced intracapsular fractures states that total hip arthroplasty should be offered when patients can; walk independently out of doors with no more than a stick, not cognitively impaired, medically fit for anaesthesia and the procedure. We previously managed this subgroup using THA with standard sockets. Following an audit of this practice a dislocation rate of 9% was identified and practice was changed to using
Introduction.
Purpose of the study: The concept introduced by Gilles Bousquet is an effective arm against dislocation of total hip arthroplasty (THA), as has been demonstrated in clinical series with a long follow-up. There remain certain questions concerning wear of
The benefit of
Introduction. Dual-mobility (DM) liners provide increased range of motion and stability. However, large head diameters have been associated with anterior hip pain due to impingement with surrounding soft-tissues, particularly the iliopsoas. Further, during hip extension the liner can get trapped due to anterior soft-tissue impingement that resists rotation being imparted to the liner from posterior stem-liner contact. Over time this can cause liner rim damage, leading to intra-prosthetic dislocation of the small diameter inner head. To address this, an anatomically contoured
Hip instability is one of the early complications following total hip arthroplasty. The aetiology of hip instability is often multi-factorial. The aim of this study was to assess the efficacy of prosthesis with
A conceptually new, to the North American market, acetabular design is currently available when performing a total hip arthroplasty – the
The
Aims. The optimal treatment for independent patients with a displaced
intracapsular fracture of the hip remains controversial. The recognised
alternatives are hemiarthroplasty and total hip arthroplasty. At
present there is no established standard of care, with both types
of arthroplasty being used in many centres. Patients and Methods. We conducted a feasibility study comparing the clinical effectiveness
of a
Aims. The rate of dislocation when traditional single bearing implants are used in revision total hip arthroplasty (THA) has been reported to be between 8% and 10%. The use of
A conceptually new acetabular design is currently available when performing a total hip arthroplasty – the
Summary Statment. The dual-mobility cup seems to bring more stability without changing the gait pattern. Introduction. Dislocations and instability are among the worst complications after THA in elderly patient.
Objectives. The annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS?. Methods. We performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two – a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients. Results. We have shown that patients are willing to participate in this type of research and that surgeons value being part of a team that has a strong research ethos. However, surgical practice does not currently reflect NICE guidance. Current models of service delivery for hip fractures are unlikely to be able to provide timely total hip arthroplasty for suitable patients. Conclusions. Further observational research should be conducted to define the population of interest before future interventional studies are performed. Cite this article: C. Huxley, J. Achten, M. L. Costa, F. Griffiths, X. L. Griffin. A process evaluation of the WHiTE Two trial comparing total hip arthroplasty with and without
Introduction. Frictional torque is generated at the hip joint during normal gait loading and motion [1]. This study investigated the effect of shell deformation due to press-fit on frictional torque generated at the articulating surfaces of cementless acetabular shells that incorporated fixed and
Introduction.
Introduction. Upper femoral fractures include intra and extra-capsular fracture (ECF). For intra-capsular fracture (ICF), hemi-arthroplasty (HA) is the most commonly used treatment. Interest in total hip arthroplasty (THA) is growing because THA yields less revision (4% versus 7%) associated to better functional results despite higher dislocation rate (9% versus 3%). Regarding ECF, internal fixation is the reference treatment. THA could represent a relevant alternative. This study evaluates the efficiency of THA using
INTRODUCTION. Dislocation is one of the most important complications in THA.
Introduction. Several devices based upon the