Comprehensive Review of Current Constraining Devices in Total Hip Arthroplasty

Merwe, Johannes Michiel van der

doi:10.5435/jaaos-d-16-00488

Cited by 16 publications

(14 citation statements)

References 39 publications

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“…Constrained liners are for patients with well-positioned implants and patient-related factor for instability or in cases with an incompetent abduction mechanism; these implants should only be used in salvage procedures in elderly and/or low-demand patients with hip instability (94–96). There have also been case reports of the mechanical failure of these devises (97).…”

Section: Treatment Options For Dislocation Following Thamentioning

confidence: 99%

Causes of and treatment options for dislocation following total hip arthroplasty (Review)

Xiao

Xue

2019

Exp Ther Med

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The second most common complication following total hip arthroplasty (THA) is dislocation. The majority of dislocations occur early in the post-operative period and are due to either patient-associated or surgical factors. The patient-associated factors that have been implicated as causes of post-operative dislocation include previous surgery, lumbar spine fusion surgery and/or neurological impairment. The surgical factors include surgical approach, component orientation and prosthetic and/or bony impingement. In order to delineate the cause of the hip instability a thorough history and physical and a radiographic assessment (possibly including advanced imaging) needs to be performed. Approximately two thirds of cases are successfully treated; one third of cases will require surgical treatment (e.g., revision arthroplasty (including constrained liners, the use of elevated rim liners and dual mobility implants or trochanteric advancement). In this review, we discuss the causes leading to dislocation following THA and evaluate the different treatment options available.

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Section: Treatment Options For Dislocation Following Thamentioning

confidence: 99%

Causes of and treatment options for dislocation following total hip arthroplasty (Review)

Xiao

Xue

2019

Exp Ther Med

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“…The difficulty in management lies in recurrence of instability post revision which can lead to a cascade of further surgery [ 8 ]. Incidence of instability and recurrent dislocation has been reported to be as high as 25% in revision THA [ 2 , 9 , 10 ]. As a result, research and development continues in search of suitable prostheses to combat this complication.…”

Section: Introductionmentioning

confidence: 99%

“…Deciding on the correct treatment for patients experiencing instability with appropriately positioned implants and no indication of component failure proves difficult [ 11 ]. Operative options include fitting of a constrained liner, revision THA with a larger femoral head in a standard prosthesis, or a dual mobility interface [ 9 , 11 ]. Each is aimed at increasing the physical parameters required to dislocate, with common focuses being jump distance and reducing levering due to impingement [ 12 – 14 ], achieved by increasing the head-neck ratio.…”

Section: Introductionmentioning

confidence: 99%

“…Conventional dual mobility (DM) implants utilise a tripolar design in which the femoral head is situated within a constrained, head-shaped polyethylene liner which in turn is seated in an unconstrained acetabular socket [ 9 ]. This design confers benefits of the stability of a large femoral head but the wear characteristics of a small head.…”

Section: Introductionmentioning

confidence: 99%

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Novel Constrained Dual Mobility Hip Prosthesis to Combat Instability in Revision Total Hip Arthroplasty whilst Preserving Normal Function

Jiang

Lambers

Richardson

2020

Case Reports in Orthopedics

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We present the case of a male patient with sepsis and a chronic discharging sinus in a multirevised total hip replacement. Following extensive debridement, the reimplanted hip became unstable. With the patient’s long-term desire to return to work and ride a bicycle with his children, the patient agreed to proceed with a novel, custom-designed, constrained dual mobility liner which allowed unrestricted movement. In 2017, the patient underwent revision surgery with this novel dual mobility constrained prosthesis. The patient was very quickly able to regain independence. After 16 years of unemployment, he managed to return to gainful employment as a cleaner rapidly regaining function as well as finally being able to ride a bike with his children for the first time.

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“…The constrained liners, constrained tripolar components, and nonconstrained tripolar components are surgical options to manage this problem. 6 However, a high rate of recurrent failure was found after revision THA for recurrent instability by placing a constrained liner without optimizing other aspects of the reconstruction. 7 In addition, removal of a well-fixed shell is associated with bone loss and increasing morbidity.…”

Section: Introductionmentioning

confidence: 99%

Cementation of the highly cross‐linked polyethylene liner into a well‐fixed acetabular shell to treat patients with recurrent dislocation after total hip arthroplasty

et al. 2020

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Cementation of a highly cross-linked polyethylene liner into a well-fixed acetabular shell provided a good durability for liner wear. However, its efficacy in treating recurrent instability due to malposition cup is less reported. The aim of this study is to evaluate the outcome of this surgical technique to treat hip instability. From 2009 to 2019, we have identified 38 patients who had been surgically treated for recurrent instability, including cementation liner (N = 20) and revision cup (N = 18) procedures.Patients were followed for a mean of 45.66 months. We have recorded and analyzed all causes of implant failure including recurrent instability. Clinical outcomes were assessed including complication and Harris Hip Score (HHS) preoperatively and at the latest follow-up. Revision-free survivorship for any cause was 95.0% at 1 year, and 84.4% at 5 years in cementation liner group and 88.9% at 1 year and 5 years in revision cup group. Mean Harris hip score improved from 48.3 points preoperatively to 79.5 points at the last follow-up in cementation liner group and mean HHS improved from 43.3 points preoperatively to 77.2 points in revision cup group. There were two implant failures in each group, including one is due to persistent hip instability and the other is due to periprosthetic joint infection in the cementation liner group and two implant failure are due to persistent hip instability in the revision cup group. Functional scores and implant survival were similar in both groups. We demonstrated that orientation correction via the cementation of the polyethylene liner into well-fixed acetabular shell is a promising option to treat and prevent instability.

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Comprehensive Review of Current Constraining Devices in Total Hip Arthroplasty

Cited by 16 publications

References 39 publications

Causes of and treatment options for dislocation following total hip arthroplasty (Review)

Causes of and treatment options for dislocation following total hip arthroplasty (Review)

Novel Constrained Dual Mobility Hip Prosthesis to Combat Instability in Revision Total Hip Arthroplasty whilst Preserving Normal Function

Cementation of the highly cross‐linked polyethylene liner into a well‐fixed acetabular shell to treat patients with recurrent dislocation after total hip arthroplasty

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