Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA

Guyen, Olivier

doi:10.1302/2058-5241.1.000054

Cited by 48 publications

(56 citation statements)

References 69 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A larger head size implies a wider joint range of motion (Figure 4a versus Figure 4c) as stated by many authors; 23,24 however, according to Levinnek et al, there is no more benefit beyond 28 mm size 20 and this statement is here confirmed by the results concerning the internal rotation (compare the upper curves in Figure 4b and 4c).…”

Section: Discussionsupporting

confidence: 83%

A multibody model for the optimization of hip arthroplasty in relation to range of movement

Zanetti¹,

Bignardi²,

Terzini³

et al. 2018

AMJ

View full text Add to dashboard Cite

BackgroundThe dislocation of the prosthesized hip is a relevant postoperative complication; this adverse outcome is dependent on the specific patient anatomy and on the artificial joint design. The geometry of the reconstructed hip is one of the key factors and it is usually designed at the time of the preoperative planning when the stem model and size, the head diameter and its offset, and the acetabular cup orientation are selected. AimsIn this work, the authors have developed a numerical model to support the pre-operative planning, allowing assessing the hip range of motion, once the geometry of the implant has been defined. MethodsA multi-body model of a prosthesized hip has been developed, and a dislocating movement has been applied; the software is able to assess the entity of displacements and of applied forces which can produce hip dislocation. ResultsAs a proof of concept, multiple combinations of geometric factors have been examined that are the head diameter, the acetabular cup anteversion and its inclination, reaching a total number of 675 configurations. This software is able to analyse and compare all configurations in few minutes. ConclusionThe developed numerical model can be a support to quickly compare a great number of solutions from the point of view of hip stability, reaching a comprehensive view of all possibilities, and giving a contribute to the final aim that is surgery optimization, in relation to each specific patient. What this study adds: What is known about this subject?Hip dislocation is a relevant complication in hip arthroplasty; this adverse outcome is dependent on the specific patient anatomy and on the artificial joint design. What new information is offered in this study?This study introduced a methodology, based on multibody model, which allows optimising the choice of prosthetic components and their positioning in relation to dislocation risk. What are the implications for research, policy, or practice?The pre-operative planning of hip arthroplasty can take benefit from numerical methods able to foresee the final hip range of motion.

show abstract

Section: Discussionsupporting

confidence: 83%

A multibody model for the optimization of hip arthroplasty in relation to range of movement

Zanetti¹,

Bignardi²,

Terzini³

et al. 2018

AMJ

View full text Add to dashboard Cite

show abstract

“…There was no difference in the 8-year survivorship between the two groups after excluding infections as the cause of revision. It has been stated previously that constrained implants may have an increased prevalence of impingement of the femoral neck on the cup, leading to liner damage, locking mechanism failure, dislocation, and loosening [10]. We did not find any evidence to support this assumption.…”

Section: Discussioncontrasting

confidence: 67%

“…Despite their advantages in terms of stability, constrained devices may result in a restricted range of motion and have a greater prevalence of impingement of the femoral neck on the cup. Impingement is responsible for high stress transmission to multiple interfaces, leading to liner damage, locking mechanism failure, dislocation, and loosening [10]. Therefore, the constrained acetabular device system is intended only for special situations where the patient has a high risk of dislocation because of a previous history of dislocation, severe joint laxity, palsy of the surrounding musculature, or abductor muscle deficiency.…”

mentioning

confidence: 99%

Implant Survival of Constrained Acetabular Device in Primary Total Hip Arthroplasty Based on Data From the Finnish Arthroplasty Register

Karvonen

Laaksonen

Pulkkinen

et al. 2020

The Journal of Arthroplasty

View full text Add to dashboard Cite

Background: Constrained acetabular devices were developed to prevent dislocations after total hip arthroplasty (THA). However, the data on their success have been contradictory. In this study, we aimed to assess implant survival of the constrained acetabular device in primary THA based on the Finnish Arthroplasty Register data. Methods: A total of 373 primary THAs with constrained acetabular devices inserted from 2006 to 2017 were included. A reference group was formed on a 1:3 basis and matched for age, sex, and diagnosis, consisting of 1118 conventional THAs. Implant survival estimates using death as a competing risk were assessed with revision for any reason and for any aseptic reason as the endpoints. The Cox multiple regression models were adjusted for age, sex, and diagnosis. The mean follow-up time was 3.3 (0-12.4) years for the constrained device group and 3.8 (0-12.0) years for the reference group. Results: Overall, there were 21 revisions in the constrained device group and 49 in the reference group. The 8-year survivorship for any reason was 94% (confidence interval [CI]: 91-96) for the constrained device group and 93% (CI: 89-97) for the reference group. With revision for any aseptic reason as the endpoint, the 8-year survivorships were 97% (CI: 95-99) and 94% (CI: 90-98), respectively. During the first 1.5 years, the constrained acetabular device group had a similar revision risk (hazard ratio: 1.09 [CI: 0.57-2.07], P ¼ .8) to that of the reference group. Conclusion: The constrained acetabular device had good survival in primary THA, and our results support its continued use even in high-risk patients.

show abstract

“… 12 The rationale for this is to reduce instability by increasing the jump distance without resorting to larger femoral heads. 13 A recent systematic review of revision THA using modern dual mobility bearings reported a dislocation rate of 2.2% at short-term follow-up, but only 1.2% needed re-revision, with the other 1% being stable after relocation. 14 …”

Section: Introductionmentioning

confidence: 99%

A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty

Khoshbin

Haddad

Ward

et al. 2020

The Bone & Joint Journal

View full text Add to dashboard Cite

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 dual mobility bearings can reduce this risk to between 0.5% and 2%. Dual mobility bearings are more expensive, and it is not clear if the additional clinical benefits constitute value for money for the payers. We aimed to estimate the cost-effectiveness of dual mobility compared with single bearings for patients undergoing revision THA. Methods We developed a Markov model to estimate the expected cost and benefits of dual mobility compared with single bearing implants in patients undergoing revision THA. The rates of revision and further revision were calculated from the National Joint Registry of England and Wales, while rates of transition from one health state to another were estimated from the literature, and the data were stratified by sex and age. Implant and healthcare costs were estimated from local procurement prices and national tariffs. Quality-adjusted life-years (QALYs) were calculated using published utility estimates for patients undergoing THA. Results At a minimum five-year follow-up, the use of dual mobility was cost-effective with an estimated incremental cost-effectiveness ratio (ICER) of between £3,006 and £18,745/QALY for patients aged < 55 years and between 64 and 75 years, respectively. For those aged > 75 years dual mobility was only cost-effective if the timeline was beyond seven years. The use of dual mobility bearings was cost-saving for patients aged < 75 years and cost-effective for those aged > 75 years if the time horizon was beyond ten years. Conclusion The use of dual mobility bearings is cost-effective compared with single bearings in patients undergoing revision THA. The younger the patient is, the more likely it is that a dual mobility bearing can be more cost-effective and even cost-saving. The results are affected by the time horizon and cost of bearings for those aged > 75 years. For patients aged > 75 years, the surgeon must decide whether the use of a dual mobility bearing is a viable economic and clinical option. Cite this article: Bone Joint J 2020;102-B(9):1128–1135.

show abstract

Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA

Cited by 48 publications

References 69 publications

A multibody model for the optimization of hip arthroplasty in relation to range of movement

A multibody model for the optimization of hip arthroplasty in relation to range of movement

Implant Survival of Constrained Acetabular Device in Primary Total Hip Arthroplasty Based on Data From the Finnish Arthroplasty Register

A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty

Contact Info

Product

Resources

About