Treatment of the unstable total hip arthroplasty using modularity, soft tissue, and allograft reconstruction

McGann, William A.; Welch, Richard B.

doi:10.1054/arth.2001.29137

Cited by 30 publications

(14 citation statements)

References 3 publications

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“…At the time of revision, the surgeon may take advantage of numerous modular options, including increasing femoral head size, increasing neck length, or various liner options. Several studies have demonstrated reasonable success (69%-96%) with modular component exchange [61][62][63][64][65] .…”

Section: Modular Component Exchangementioning

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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Section: Modular Component Exchangementioning

confidence: 99%

Instability after total hip arthroplasty

Werner

Brown

2012

WJO

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“…Instability resulting from violation of the hip joint capsule, whether a result of the surgical approach or pre‐existing pathology, continues to be a significant concern following total hip arthroplasty (THA) and hip arthroscopy, in certain congenital hyperlaxity conditions and occasionally as a result of prior trauma (Bellabarba et al, ; Lavigne et al, ; McGann and Welch, ; Philippon, ; Stein et al, ; Fujishiro et al, ; Schweitzer et al, ; Guanche and Sikka, ; Torry et al, ; Benali and Katthagen, ; Jones et al, ; Matsuda, ; Ranawat et al, ; Blakey et al, ; Cuellar et al, ; Van Warmerdam et al, ). Recently, there has been greater emphasis on restoration of the integrity and function of the capsule, especially as it relates to recurrent dislocation and soft tissue reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…There have been many reports of augmentation and reinforcement of both the anterior and posterior capsule to restore stability in hips subject to instability and dislocation following THA (Lavigne et al, 2001;McGann and Welch, 2001;Fujishiro et al, 2003;Cuellar et al, 2010;Van Warmerdam et al, 2011). A meticulous posterior capsule repair during THA utilizing the posterior approach is known to significantly decrease dislocation rates (Pellicci et al, 1998;Goldstein et al, 2001;White et al, 2001), suggesting an important stabilizing function for the ischiofemoral ligament (ISFL).…”

Section: Introductionmentioning

confidence: 99%

A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction

et al. 2013

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Quantitative descriptions of the hip joint capsular ligament insertional footprints have been reported. Using a three-dimensional digitizing system, and computer modeling, the area, and dimensions of the three main hip capsular ligaments and their insertional footprints were quantified in eight cadaveric hips. The iliofemoral ligament (ILFL) attaches proximally to the anterolateral supra-acetabular region (mean area = 4.2 cm(2)). The mean areas of the ILFL lateral and medial arm insertional footprints are 4.8 and 3.1 cm(2), respectively. The pubofemoral ligament (proximal footprint mean area = 1.4 cm(2)) blends with the medial ILFL anteriorly and the proximal ischiofemoral ligament (ISFL) distally without a distal bony insertion. The proximal and distal ISFL footprint mean areas are 6.4 and 1.2 cm(2), respectively. The hip joint capsular ligaments have consistent anatomic and insertional patterns. Quantification of the ligaments and their attachment sites may aid in improving anatomic repairs and reconstructions of the hip joint capsule using open and/or arthroscopic techniques.

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“…Revision strategies typically are directed by the identified causes for instability [9,19] and numerous methods have been described, including reorientation of the implants [17], the use of modular implants [21,42,55], elevated rim liners or socket wall addition [10,13,14,41,43,46,57], trochanteric advancement [22,32], removal of sources of impingement [17], and abductor repair [58]. However, even when the etiology could be clearly identified, limited success rates for stability ranging from 60% to 80% have been reported [2,3,17,22,37,44,45,49,53,55,59].…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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Treatment of the unstable total hip arthroplasty using modularity, soft tissue, and allograft reconstruction

Cited by 30 publications

References 3 publications

Instability after total hip arthroplasty

Instability after total hip arthroplasty

A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction

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

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