The use of a constrained acetabular component for recurrent dislocation

Shapiro, Gary S.; Weiland, Daniel E.; Markel, David C.; Padgett, Douglas E.; Sculco, Thomas P.; Pellicci, Paul M.

doi:10.1054/arth.2003.50090

Cited by 113 publications

(64 citation statements)

References 15 publications

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“…We also do not know whether the high cumulative probability of dislocation reported here would have been the same for these patients if they had received implants with the larger femoral head sizes [3,9,22] now in common use; we can only remark the risk of dislocation was not reduced in our experience with hemiarthroplasties when they were used. Although it has become clear there is markedly decreased dislocation when constrained liners are used for the treatment of recurrent dislocation in THA [32][33][34] as compared with other solutions [13,28,29,36], no analysis has been conducted using constrained liners in the prevention of dislocation in patients with NMDs, except (to our knowledge) one case report [6]. Our findings (decrease of the risk of dislocation with a constrained liner in neurologically impaired patients) are supported by this case report in neurologic patients and by those of other large series for other indications.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings (decrease of the risk of dislocation with a constrained liner in neurologically impaired patients) are supported by this case report in neurologic patients and by those of other large series for other indications. From review of the literature [32], there is evidence that the constrained liner is successful in providing stability in patients with recurrent dislocation. Our rate of dislocation with the design of this implant was not higher than the rates of dislocation observed for different implants in the literature (Table 4).…”

Section: Discussionmentioning

confidence: 99%

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Constrained Liner in Neurologic or Cognitively Impaired Patients Undergoing Primary THA

Hernigou

Filippini

Flouzat-Lachaniette

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background THA performed in patients with cognitive deficits or neuromuscular diseases has been associated with a high postoperative dislocation rate. The constrained liner reportedly provides stability in patients with recurrent dislocation. However, achieving stability could be offset by early loosening when used in patients with neurologic diseases. Questions/purposes We therefore asked whether constrained liners had a higher risk of loosening when used in primary THA for patients with neurologic diseases. Methods We retrospectively reviewed a 144 patients (164 hips) with neuromuscular disease who had a constrained polyethylene insert from 1999 to 2004 and compared them to another 120 patients (132 hips) with neuromuscular disease operated on immediately before this period (from 1994 to 1998) who had a conventional polyethylene insert. Results Thirty-three (25%) of the 132 hips without a constrained liner were known to have had at least one dislocation and 21 had revision for recurrent dislocation. Ten other hips had revision for loosening of the cup. The survival rate was 82% at 5 years and 77% at 10 years with revision due to recurrent dislocation or loosening of the cup as the endpoint. With a constrained liner, at minimum 5-year followup (mean, 7 years; range, 5-10 years), the incidence of complications, particularly dislocation, was decreased (three dislocations among 164 hips; 2%), with one revision for recurrent dislocation and one revision for loosening. Conclusions This constrained acetabular component provides durable protection against dislocation without substantial increased loosening at midterm followup. Level of Evidence Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Constrained Liner in Neurologic or Cognitively Impaired Patients Undergoing Primary THA

Hernigou

Filippini

Flouzat-Lachaniette

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…This device is particularly useful for the surgical management of recurrent dislocation in the setting of abductor deficiency, recurrent dislocation of undetermined etiology and in patients with multiple dislocations due to neurological impairment [16] . The success of constrained liners for instability in these specific situations has been well-documented in the literature [4,5,12,[78][79][80][81] . Additionally, constrained liners offer the ability provide enhanced stability to a hip without the need to revise well-fixed, well-positioned acetabular components [16] .…”

Section: Constrained Linersmentioning

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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“…In these cases, use of an allograft to increase the static soft tissue constraints [34,42,54], conversion to bipolar arthroplasty [4,47], or use of constrained devices [3,38,50,51] have been reported. More recently, the use of constraining systems has become the most popular salvage option [45].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, the use of constraining systems has become the most popular salvage option [45]. However, success to achieve stability is highly variable [3,26,50] and depends on the constrained component design [24]. Additionally, such devices raise concerns regarding the potential for increased wear, osteolysis, loosening, and implant disassembly as reports of failure begin to emerge [15,29,52,56,60].…”

Section: Introductionmentioning

confidence: 99%

Use of a Dual Mobility Socket to Manage Total Hip Arthroplasty Instability

Guyen

Pibarot

Vaz

et al. 2009

Clinical Orthopaedics &Amp; Related Research

178

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Unconstrained tripolar hip implants provide an additional bearing using a mobile polyethylene component between the prosthetic head and the outer metal shell. Such a design increases the effective head diameter and therefore is an attractive option in challenging situations of unstable total hip arthroplasties. We report our experience with 54 patients treated using this dual mobility implant in such situations. We ascertained its ability to restore and maintain stability, and examined component loosening and component failure. At a minimum followup of 2.2 years (mean, 4 years; range, 2.2-6

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The use of a constrained acetabular component for recurrent dislocation

Cited by 113 publications

References 15 publications

Constrained Liner in Neurologic or Cognitively Impaired Patients Undergoing Primary THA

Constrained Liner in Neurologic or Cognitively Impaired Patients Undergoing Primary THA

Instability after total hip arthroplasty

Use of a Dual Mobility Socket to Manage Total Hip Arthroplasty Instability

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