Constrained Liners in Revision Total Hip Arthroplasty: An Overuse Syndrome

Fricka, Kevin B.; Marshall, Amanda; Paprosky, Wayne G.

doi:10.1016/j.arth.2006.02.100

Cited by 49 publications

(28 citation statements)

References 16 publications

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“…This would appear to support the claim of some investigators that the wear rate of constrained cups is higher than unconstrained devices of the same head diameter [1,2,18,31]. However, wear rates of components retrieved at revision THA tend to be higher than those derived from primary cases, with average values of 94 and 99 mm 3 /year reported in previous series [20,48].…”

Section: Discussionsupporting

confidence: 58%

Constrained Cups Appear Incapable of Meeting the Demands of Revision THA

Noble

Durrani

Usrey

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Failure rates of constrained cups for treating recurrent dislocation in revision THA range from 40% to 100%. Although constrained liners are intended to stabilize the hip by mechanically preventing dislocation, the resulting loss of range of motion may lead to impingement and, ultimately, implant failure. Questions/purposes We therefore documented the mechanisms of failure of constrained acetabular cups in revision THA and determined the type and severity of damage (wear, fracture, and impingement) that occurs in situ.Methods We retrieved 57 constrained components of four different designs at revision THA and examined for the presence of rim impingement, oxidation, cracks within the liner, backside wear, pitting, scratching, abrasion, burnishing, and the presence of embedded particles. Articular wear was calculated from the volume of the concave articular bearing surface, which was measured using the fluid displacement method. Results Failure of the locking ring was responsible for 51% of failures, whereas 28% of revisions were the result of acetabular cup loosening, 6% backside wear, and 22% infection. Impingement damage of the rim of the polyethylene liner was seen in all retrievals with moderate or severe damage in 54%. The average volumetric wear rate of the articular surface was 95 mm 3 /year. Conclusions Failure of the locking liner ring and loosening of the acetabular cup are the primary causes of mechanical failure with constrained liners; polyethylene is an inadequate material for restricting motion of the hip to prevent instability. The durability of these devices is unlikely to improve unless the mechanical demands are modified through increased range of motion leading to less frequent rim impingement.

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Section: Discussionsupporting

confidence: 58%

Constrained Cups Appear Incapable of Meeting the Demands of Revision THA

Noble

Durrani

Usrey

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…10 The use of large femoral heads (> 32 mm) has been shown to improve stability in vitro. 19,[22][23][24]43,44 An increase in the size of the femoral head leads to a corresponding increase in the jump distance and hence a reduction in the risk of dislocation. 45 In addition, an increase in the head-toneck ratio results in a greater range of movement before impingement occurs with its consequent risk of dislocation.…”

Section: Discussionmentioning

confidence: 99%

The double-mobility acetabular component in revision total hip replacement

Vasukutty

Middleton

Matthews

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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We present our experience with a double-mobility acetabular component in 155 consecutive revision total hip replacements in 149 patients undertaken between 2005 and 2009, with particular emphasis on the incidence of further dislocation. The mean age of the patients was 77 years (42 to 89) with 59 males and 90 females. In all, five patients died and seven were lost to follow-up. Indications for revision were aseptic loosening in 113 hips, recurrent instability in 29, peri-prosthetic fracture in 11 and sepsis in two. The mean follow-up was 42 months (18 to 68). Three hips (2%) in three patients dislocated within six weeks of surgery; one of these dislocated again after one year. All three were managed successfully with closed reduction. Two of the three dislocations occurred in patients who had undergone revision for recurrent dislocation. All three were found at revision to have abductor deficiency. There were no dislocations in those revised for either aseptic loosening or sepsis.These results demonstrate a good mid-term outcome for this component. In the 29 patients revised for instability, only two had a further dislocation, both of which were managed by closed reduction.The most common indications for revision total hip replacement (THR) are aseptic loosening, dislocation and infection.

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“…ing surgery [1,8,9,[17][18][19] . Accordingly, the cumulative risk of dislocation does not remain constant following THA, increasing with time due to trauma, polyethylene wear, increased pseudocapsule laxity and deteriorating muscle strength [20][21][22] .…”

Section: Topic Highlightmentioning

confidence: 99%

“…A landmark review in 1982 by Woo and Morrey of over 10 000 primary THAs reported a dislocation rate of 3.2% [1] . Other studies have reported dislocation rates of 0.3% to 10% for primary THAs and up to 28% for revision THAs [2][3][4][5][6][7][8][9][10][11][12][13][14] . The risk of dislocation is influenced by patient factors such as age, sex, previous surgery, and cognitive or neurologic disorders as well as surgical factors, including surgical approach, choice of implant, soft tissue and surgeon experience [13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Instability after total hip arthroplasty

Werner

Brown

2012

WJO

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Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. Non-operative management is often successful if the components are well-fixed and correctly positioned in the absence of neurocognitive disorders. If conservative management fails, surgical options include revision of malpositioned components; exchange of modular components such as the femoral head and acetabular liner; bipolar arthroplasty; tripolar arthroplasty; use of a larger femoral head; use of a constrained liner; soft tissue reinforcement and advancement of the greater trochanter.

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Constrained Liners in Revision Total Hip Arthroplasty: An Overuse Syndrome

Cited by 49 publications

References 16 publications

Constrained Cups Appear Incapable of Meeting the Demands of Revision THA

Constrained Cups Appear Incapable of Meeting the Demands of Revision THA

The double-mobility acetabular component in revision total hip replacement

Instability after total hip arthroplasty

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