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Ricard MA, Ardell J, Laboudie P, Wei R, Beaulé PE. Outcome of hip resurfacing revision through the Hueter-anterior approach. Hip Int 2024; 34:356-362. [PMID: 37795633 DOI: 10.1177/11207000231200416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND The Hueter-Anterior Approach (HAA) with its limited soft tissue and internervous dissection has been shown to be an effective approach for primary total hip and hip resurfacing arthroplasty (HRA). The purpose of this study is to evaluate the clinical outcome of patients requiring revision of HRA to total hip replacement using the HAA, assessing function and complications. METHODS We performed a retrospective review of a prospectively maintained research database. Between 2006 and 2015, 555 primary metal-on-metal (MoM) HRAs were performed via the HAA; we identified 33 hips in 30 patients that required revisions for aseptic causes to THA: aseptic loosening of acetabulum in 12 and femoral in 7, 10 for pseudotumour/ALTR, 4 for femoral neck fracture. All revision surgeries were performed through a HAA by a single surgeon who had also performed the index operation. PROMs were collected preoperatively and yearly at various timepoints postoperatively. RESULTS The mean age at time of revision was 48.9 years (±5.3 SD) for 22 males (67%) and 11 females (33%). The mean time to revision surgery/failure of hip resurfacing was 3.3 years (±2.4 SD). There were 5 major reoperations with 3 infections, 1 acetabular loosening and 1 trunnionosis. There were significant improvements in multiple PROMs. CONCLUSIONS The HAA is a viable surgical approach for revision of HRA with smaller initial HRA acetabular components generally requiring a relatively larger acetabular compoent at time of revision. Patients reported improvement in symptoms and function and a lower risk of subsequent reoperation than what has previously been reported for failed MoM bearings.
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Affiliation(s)
| | - James Ardell
- Division of Orthopaedic Surgery, Regina General Hospital, Regina, SK, Canada
| | - Pierre Laboudie
- Division of Orthopaedic Surgery, Hôpital Cochin, Paris, France
| | - Roger Wei
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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Revision Total Hip Arthroplasty for Aseptically Failed Metal-On-Metal Hip Resurfacing Arthroplasty. J Arthroplasty 2022; 37:2399-2405. [PMID: 35738361 DOI: 10.1016/j.arth.2022.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND While common, studies assessing outcomes of failed metal-on-metal (MoM) resurfacings converted to total hip arthroplasties (THAs) are limited. We determined the outcomes following revision THA of aseptic MoM hip resurfacings. METHODS Between 2000 and 2019, we identified 52 revision THAs for failed MoM hip resurfacings through our total joint registry. Mean age was 55 years, 42% were women, and mean body mass index was 28 kg/m2. Adverse local tissue response led to THA in 67% of the cases. The most common revision articulation was metal-on-cross-linked or ceramic-on-cross-linked polyethylene (71%). Median head size was 36 mm. The acetabular component was retained in 21% and 28% used dual-mobility constructs. The mean follow-up was 6 years (range, 2-12 years). RESULTS The 5-year survivorships free of any re-revision or reoperation were 89% and 85%, respectively. The primary cause of re-revision (6) was dislocation (4). The 5-year cumulative probability of dislocation was 19% and was 13% in those patients treated with dual-mobility constructs versus 22% in those treated with standard articulations (P = .58). No dislocations occurred in THAs with retained acetabular components and dual-mobility constructs versus a 5-year cumulative probability of dislocation of 25% in those with revised acetabular components and standard articulations (P = .24). CONCLUSION Revision THAs for aseptically failed MoM hip resurfacings yielded a 5-year survivorship free of re-revision of 89%. The main reason for failure was dislocation, which was reduced, but not statistically significantly, when a dual-mobility construct was used, especially if the acetabular component was retained. LEVEL OF EVIDENCE IV.
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Lancaster A, Boes E, Gililland J, Anderson L. Direct Anterior Cup-Half Cage for Revision and Complex Primary Total Hip Arthroplasty: Surgical Technique. Arthroplast Today 2022; 16:140-149. [PMID: 35694614 PMCID: PMC9184889 DOI: 10.1016/j.artd.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 10/30/2022] Open
Abstract
As surgeons' comfort with the direct anterior approach (DAA) for total hip arthroplasty continues to increase, there is a growing interest in performing complex surgeries through this approach. Acetabular bone loss and/or pelvic discontinuity in the primary or revision setting often requires specialized implants such as a cup-cage construct. We describe our surgical technique for implanting modified cup-half cages through the DAA and show 2 case examples of how this technique was utilized in the setting of complex acetabular bone loss. In our experience, this is an effective method for complex total hip arthroplasty, with the potential added benefits of the DAA of reduced soft-tissue dissection, direct measurement of leg length, and ease of fluoroscopic navigation for implant positioning.
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Holzapfel BM, Corten K, Goldberg T, Rudert M, Nogler M, Moskal J, Thaler M. Acetabular defect management and revision arthroplasty via the direct anterior approach. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:203-217. [PMID: 35680676 DOI: 10.1007/s00064-022-00767-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/06/2021] [Accepted: 03/13/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Acetabular revision arthroplasty and osseous defect management through the direct anterior approach (DAA) with or without proximal extension. INDICATIONS Aseptic or septic component loosening, periacetabular osseous defects, pelvic discontinuity, intrapelvic cup protrusion, anterior pseudotumors, iliopsoas tendonitis, polyethylene wear or iliopsoas abscess. CONTRAINDICATIONS Clinically relevant gluteal tendon lesions, active infection, morbid obesity, large abdominal pannus, ASA (American Society of Anesthesiologists) score > III, inguinal skin infection. SURGICAL TECHNIQUE Electrocautery dissection is recommended to dissect the Hueter interval and to debulk pericapsular scar tissue. At all times during capsular debulking, it should be made sure not to damage the iliopsoas tendon or the neurovascular bundle. A stepwise releasing sequence can facilitate dislocation of the prosthesis. Most cases can be revised via the standard DAA but certain circumstances require an intra- or extrapelvic extension. Access to the anterior gluteal surface of the ilium can be provided using a "tensor snip". More posterior access is provided by the extensile extrapelvic approach described by Smith-Petersen. The intrapelvic Levine extension offers access to the entire visceral surface of the ilium and large parts of the anterior column. POSTOPERATIVE MANAGEMENT Patient revised via the intra- or extrapelvic extension and patients suffering from extensive soft tissue or osseous defects should undergo postoperative weight-bearing restrictions with 20 kg for 6 weeks. RESULTS Based on our studies, there is no limitation on the type of acetabular implant that can be used in DAA revision arthroplasty. Moreover, virtually all types of periacetabular osseous defects can be managed through the approach and its extensions. Acetabular revision arthroplasty via the DAA and its extensions is safe and can result in good midterm results.
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Affiliation(s)
- Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Kristoff Corten
- Hip Unit, Orthopedic Department, Ziekenhuis Ooost-Limburg Genk, Schiepse Bos 6, 3600, Genk, Belgium
| | - Tyler Goldberg
- 4700 Seton Center Parkway, Texas Orthopedics, LLC, 78759, Austin, TX, USA
| | - Maximilian Rudert
- Department of Orthopedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany
| | - Michael Nogler
- Department of Experimental Orthopedics, Department of Orthopedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Joseph Moskal
- Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Institute for Orthopedics and Neuroscience, 2331 Franklin Rd, 24014, SW, Roanoke, VA, USA
| | - Martin Thaler
- Arthroplasty Center, Helios Klinikum Munich West, Steinerweg 5, 81241, Munich, Germany
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University of Greifswald, Greifswald, Germany
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Singh G, Khurana A, Gupta S. Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review. Hip Pelvis 2021; 33:109-119. [PMID: 34552888 PMCID: PMC8440135 DOI: 10.5371/hp.2021.33.3.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/21/2021] [Accepted: 04/03/2021] [Indexed: 12/03/2022] Open
Abstract
The direct anterior approach (DAA) is an established approach for total hip arthroplasty (THA) but has been sparingly tried for revisions. The purpose of this study was to examine the available literature in order to consolidate information available on revision THA using the DAA. A PubMed, Embase, and Scopus search was performed using relevant keywords. Studies reporting on patients undergoing revision THA using DAA were included for analysis. In a review of the literature, nine studies matched the pre-decided inclusion criteria with 319 hip joints undergoing revision THA. Mean follow-up of all included studies was 34 months. The indications of revision after primary THA in decreasing order were aseptic loosening (53%), prosthetic joint infection (20.7%), peri-prosthetic fracture (16.9%), dislocation (7.2%), psoas impingement (1.9%), polyethylene wear (1.2%), pain (0.6%), and instability (0.3%). Of the 319 revisions evaluated, 107 underwent a stem revision, 142 underwent cup revision, 49 underwent a combined revision, and 21 underwent isolated liner/head change. A statistically significant improvement in functional score (P<0.05) was observed for all studies reporting on functional outcomes. A low complication rate (51/319, 16.0%), which includes dislocation (12), infection (12), loosening of the acetabular shell (5), peri-prosthetic fractures (6), haematoma (4), and transient nerve palsy (6), was reported. Based on available level III-IV evidence, DAA appears to be a reliable alternative for revision of the failed hip arthroplasty with acceptable complication rates. Evidence of a higher quality is needed to further characterize its role in revision scenarios.
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Affiliation(s)
- Gurvinder Singh
- Department of Orthopaedics, Dr. Baba Saheb Ambedkar Medical College and Hospital (BSAMCH), Rohini, Delhi, India
| | - Ankit Khurana
- Department of Orthopaedics, ESI Hospital, Rohini, Delhi, India
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Liu W, Lin H, Zeng X, Chen M, Tang W, Zhou T, Yu W, Liu Q, Xu G. Uncemented versus cemented arthroplasty after metal-on-metal total hip replacement in patients with femoral neck fractures: a retrospective study. J Int Med Res 2021; 49:3000605211012210. [PMID: 33969721 PMCID: PMC8113965 DOI: 10.1177/03000605211012210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes of primary metal-on-metal total hip replacement (MoM-TR) converted to uncemented total hip replacement (UTR) or cemented total hip replacement (CTR) in patients with femoral neck fractures (AO/OTA: 31B/C). METHODS Patient data of 234 UTR or CTR revisions after primary MoM-TR failure from March 2007 to January 2018 were retrospectively identified. Clinical outcomes, including the Harris hip score (HHS) and key orthopaedic complications, were collected at 3, 6, and 12 months following conversion and every 12 months thereafter. RESULTS The mean follow-up was 84.12 (67-100) months for UTR and 84.23 (66-101) months for CTR. At the last follow-up, the HHS was better in the CTR- than UTR-treated patients. Noteworthy dissimilarities were correspondingly detected in the key orthopaedic complication rates (16.1% for CTR vs. 47.4% for UTR). Statistically significant differences in specific orthopaedic complications were also detected in the re-revision rate (10.3% for UTR vs. 2.5% for CTR), prosthesis loosening rate (16.3% for UTR vs. 5.9% for CTR), and periprosthetic fracture rate (12.0% for UTR vs. 4.2% for CTR). CONCLUSION In the setting of revision of failed primary MoM-TR, CTR may demonstrate advantages over UTR in improving functional outcomes and reducing key orthopaedic complications.
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Affiliation(s)
- Wenlu Liu
- Department of Rehabilitation Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Jiang'an District, Wuhan, China
| | - Huanyi Lin
- Department of Urinary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Weiwei Tang
- Department of Ultrasound Medicine, The Affiliated Hospital of Xiangnan University, No. 25, Renmin West Road, Beihu District, Chenzhou, China
| | - Ting Zhou
- Department of Rehabilitation Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Jiang'an District, Wuhan, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Qilong Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
| | - Guixing Xu
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, China
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Lin J, Huang C, Yu W, Han G, Liu X, Zeng X. Revision of failed metal-on-metal total hip arthroplasty using cemented arthroplasty: a mean 10-year follow-up of 157 consecutive patients. J Int Med Res 2021; 49:300060520969478. [PMID: 33435780 PMCID: PMC7809321 DOI: 10.1177/0300060520969478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study was performed to assess the outcomes of Asian patients who underwent conversion from metal-on-metal total hip arthroplasty (MoM-THA) to cemented THA (CTHA). METHODS One hundred and fifty-seven consecutive patients (157 hips) who underwent CTHA following primary MoM-THA from January 2005 to February 2015 were retrospectively analysed. The primary endpoints were the clinical outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every 2 years following revision of MoM-THA. RESULTS The mean follow-up after conversion was 10 years (range, 5-14 years). Statistically significant improvements in the mean Harris hip score were observed between the preoperative and final follow-up evaluations (62.71 ± 13.85 vs. 84.03 ± 16.21, respectively). The major orthopaedic complication rate was 16.5% (26/157). Six (3.8%) patients underwent revision at a mean of 3.5 ± 1.3 years after conversion, predominantly because of prosthesis loosening or recurrent dislocation. Nine (5.7%) patients developed prosthesis loosening at a mean of 2.6 ± 1.1 years following conversion, two of whom requested revision surgery. Eleven (7.0%) patients developed prosthesis dislocation, four of whom requested revision surgery. CONCLUSION CTHA may yield favourable functional outcomes and a reduced rate of major orthopaedic complications.
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Affiliation(s)
- Jinluan Lin
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chunlong Huang
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guowei Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangzhen Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Siddiqi A, Alden KJ, Yerasimides JG, Kamath AF. Direct Anterior Approach for Revision Total Hip Arthroplasty: Anatomy and Surgical Technique. J Am Acad Orthop Surg 2021; 29:e217-e231. [PMID: 33351524 DOI: 10.5435/jaaos-d-20-00334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023] Open
Abstract
There has been increased interest and literature on the efficacy of direct anterior approach (DAA) for total hip arthroplasty (THA). Developments in surgical technique and instrumentation, along with exposure earlier in orthopaedic residency training, may augment the adoption of this approach among practicing orthopaedic surgeons. With the increasing number of primary THA performed through the DAA, understanding the indications and techniques associated with revision THA via the DAA has proved increasingly important. Patient positioning, understanding surgical anatomy and extensile maneuvers, and applying key reconstructive methods are essential for obtaining adequate exposure and fixation. Acetabular exposure can be facilitated through capsular and soft-tissue release, along with extensile approaches to the pelvis and acetabulum. Extensile distal extension can be performed for safe access to the femur, including extended femoral osteotomies. The purpose of this review is to describe indications, surgical anatomy, intraoperative tips, clinical outcomes, and complications after DAA for revision THA.
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Affiliation(s)
- Ahmed Siddiqi
- From the Department of Orthopedics, Cleveland Clinic Foundation, Cleveland, OH (Kamath and Siddiqi), the Hinsdale Orthopaedics, Hinsdale, IL (Alden), and the Norton Orthopedic Institute, Louisville, KY (Yerasimides)
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Yu W, Chen M, Zeng X, Zhao M, Zhang X, Ye J, Zhuang J, Han G. Favourable clinical outcomes following cemented arthroplasty after metal-on-metal total hip replacement: a retrospective study with a mean follow-up of 10 years. BMC Musculoskelet Disord 2020; 21:772. [PMID: 33220707 PMCID: PMC7680591 DOI: 10.1186/s12891-020-03797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the unexpected high rate of failure following metal-on-metal total hip replacement (MoM-THR), it is expected that more MoM-THR patients will experience revision. The long-term outcomes regarding the primary MoM-THR revised to cemented THR (CTHR) remain controversial. The purpose of this retrospective review was to evaluate the long-term outcomes of patients who underwent conversion from MoM-THR to CTHR. METHODS A total of 220 patients (220 hips) who underwent a conversion of primary MoM-THR to CTHR from March 2006 to October 2016 were retrospectively reviewed. The primary outcomes were the functional outcomes assessed using the Harris hip scores (HHS) and major radiographic outcomes. Follow-ups occurred at 3 months, 6 months, 1 year, 2 years, and then every two years after revision. RESULTS Mean follow-up was 10.1 years (5-13 years). Distinct improvements were detected in the mean HHS between the preoperative and last follow-up analysis (62.35[±8.49] vs. 84.70[±14.68], respectively, p < 0.001). The key orthopaedic complication rate was 18.2% (27/148). Seven (4.7%) cases experienced a CTHR failure at a mean of 3.4 (±1.2) years after revision MoM-THR, mostly attributed to recurrent dislocation. CONCLUSION CTHR might yield an acceptable functional score and a low rate of the key orthopaedic complications.
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Affiliation(s)
- Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Mingdong Zhao
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Xinchao Zhang
- Department of Orthopaedics, Jinshan Hospital, Fudan University, Longhang Road No. 1508, Jinshan District, Shanghai, 201508, China
| | - Junxing Ye
- Department of Orthopaedics, The Affiliated Hospital of Jiangnan University, No. 1000, Hefeng Road, Binhu District, Wuxi, 21400, Jiangsu, China. .,Department of Orthopaedics, The Third People's Hospital of Wuxi, No. 1000, Hefeng Road, Binhu District, Wuxi, 214000, Jiangsu, China.
| | - Jintao Zhuang
- Department of Urinary surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
| | - Guowei Han
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China.
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Thompson Z, Khoshbin A, Ward S, Waddell JP, Atrey A. The early- to medium-term results of a hemispherical, porous coated acetabular shell with multiple different bearing combinations are excellent with the exception of metal-on-metal. INTERNATIONAL ORTHOPAEDICS 2020; 44:2537-2543. [PMID: 33068147 DOI: 10.1007/s00264-020-04817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE This study prospectively reports survivorship and radiographic and clinical outcomes following primary elective total hip arthroplasty (THA) using a novel single hemispherical, porous-coated acetabular cup with five different bearing combinations and a minimum of five year follow-up. METHODS Continuing post-market release monitoring of this cup, we prospectively enrolled 108 patients (121 THA) between 2009 and 2015. We followed this cohort by examining survivorship, in addition to clinical and radiological outcomes for metal-on-metal (MoM) compared with non-MoM bearing combinations (ceramic-on-ceramic, oxinium-on-polyethylene, ceramic-on-metal, and metal-on-polyethylene). RESULTS All 108 (121 hips) patients were followed up. Average age at time of surgery was 45.1 years (range 19 to 71 years) of which 42.1% were males. A total of seven (5.8%) cups were revised, all of which were MoM. No osteolysis was observed in any of the patients at the latest visit with a mean follow-up of 9.1 ± 1.7 years (range 4.4-10.7 years). With MoM excluded, survivorship of the cup at five years is 97.8%. Survivorship for MoM implants was 90.0%. Validated hip scores showed significant improvements for all bearing types and no significant difference between groups at latest follow-up (p = 0.614). There was no cup migration with any bearing surface. CONCLUSION This cup showed excellent survivorship at five year follow-up, except for patients receiving a MoM articulation. While there were concerns over the early survivorship of this cup, our cohort and joint registry data confirm excellent outcomes.
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Affiliation(s)
- Zoe Thompson
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada
| | - Amir Khoshbin
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Sarah Ward
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - James P Waddell
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Amit Atrey
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada.
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Abstract
Aims Hip resurfacing arthroplasty (HRA) is typically indicated for young and active patients. Due to the longevity of arthroplasty, these patients are likely to undergo revision surgery during their lifetime. There is a paucity of information on the long-term outcome of revision surgeries performed after failed HRA. The aim of our study was to provide survivorship data as well as clinical scores after HRA revisions. Methods A total of 42 patients (43 hips) were revised after HRA at our centre to a variety of devices, including four HRA and 39 total hip arthroplasties (THAs). In addition to perioperative complications, University of California, Los Angeles (UCLA) hip scores and 12-Item Short-Form Health Survey questionnaire (SF-12) quality of life scores were collected at follow-up visits after the primary HRA and after revision surgery. Results The mean follow-up time after revision surgery was 8.3 years (0.3 to 19.1). The mean UCLA pain and function scores post-revision were comparable with the best scores achieved by the patients after the index HRA, but UCLA activity scores were lower after revision. SF-12 physical component scores were comparable between timepoints, but the mental component score decreased after revision. Six patients underwent unilateral re-revision surgery at a mean follow-up time of 7.8 years (0.3 to 13.7). Using the time to any re-revision as endpoint, the Kaplan-Meier survivorship was 85.3% at 13 years. Conclusion Patients undergoing revision after HRA can expect to achieve function and quality of life similar to their best after their primary surgery, while the risk of re-revision is low. Cite this article: Bone Joint J 2020;102-B(10):1289–1296.
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Affiliation(s)
- Harlan C. Amstutz
- The Joint Replacement Institute at St Vincent Medical Center, Los Angeles, California, USA
| | - Michel Le Duff
- The Joint Replacement Institute at St Vincent Medical Center, Los Angeles, California, USA
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12
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Triflange acetabular reconstruction for pelvic discontinuity through a direct anterior approach. Arthroplast Today 2019; 5:407-412. [PMID: 31886380 PMCID: PMC6920714 DOI: 10.1016/j.artd.2019.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/07/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023] Open
Abstract
A 74-year-old female patient presented to our clinic with pelvic discontinuity after multiple revision total hip surgeries requiring custom triflange acetabular reconstruction, which we accomplished through a direct anterior approach to the hip. The direct anterior approach to the hip has grown in popularity but still has the reputation of being a minimally invasive approach without the capacity for extensile exposure in the revision setting. We describe the extensile technique and demonstrate through our case the ability to perform the most challenging cases through this approach and discuss the potential benefits of its utilization.
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The minimalinvasive direct anterior approach in aseptic cup revision hip arthroplasty: a mid-term follow-up. Arch Orthop Trauma Surg 2019; 139:121-126. [PMID: 30415415 DOI: 10.1007/s00402-018-3062-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The minimally invasive direct anterior approach (DAA) is an established approach for primary total hip arthroplasty (THA). The complication rates in hip revision arthroplasty are much higher in comparison with primary THA. A right positioning of the implants and a soft tissue, especially the abductors spearing approach, is important to get good functional results and low complication rates. The aim of this study was to show the clinical and radiological outcome of isolated revision hip arthroplasty of the cup by using the DAA. MATERIALS AND METHODS Aseptic cup revisions were carried out in 48 patients using the DAA. A decision to exchange the stem was made intraoperatively in seven cases. Complications, radiological and functional outcome were assessed. All of the data were collected retrospectively. The mean follow-up period was 65 months. RESULTS In most of the cases the standard DAA was used. A proximal extension was nescessary in 15 patients (31%). The mean cup inclination angle after revision was 44° (min. 25°, max. 62°). Six implants (12.5%) were located outside of the Lewinnek safe zone. The centers of rotation of the revision implants were a mean of 0.6 cm superior (min. 0, max. 2.2 cm) and 0.5 cm lateral (min. 0.2 cm, max 1.2 cm) in comparison with the center of rotation in the healthy hip on the contralateral side. Harris Hip Score improved significantly from 50 to 91 (P = 0.03). Complications noted consisted of two periprosthetic infections (4.2%), one aseptic cup loosening (2.1%), two hematomas requiring revision (4.2%), and one case each of femoral nerve injury, lower-leg venous thrombosis, and pneumonia. No dislocations were observed and there were no cases of heterotopic ossification based on the Brooker classification. No persistent damage of the nervus cutaneus femoris lateralis was found at the follow-up examinations. CONCLUSIONS The DAA represents a feasible option in hip revision arthroplasty. Anatomic reconstruction of the cup is reproducibly possible. Good medium-term results can also be achieved. Particularly in relation to dislocation, the complication rates are low. Due to the learning curve, the DAA should only be used in hip revision arthroplasty by those with sufficient experience in primary THA. Adequate data regarding stem revisions through the DAA are not available at the moment.
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Pisanu F, Doria C, Andreozzi M, Bartoli M, Saderi L, Sotgiu G, Tranquilli Leali P. Pleomorphic clinical spectrum of metallosis in total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 43:85-96. [PMID: 30269183 DOI: 10.1007/s00264-018-4176-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/18/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To summarize the biological effects of metal debris from hip arthroplasties which characterize a polymorphic clinical spectrum of local and remote manifestation. METHODS Retrospective study. Patient, implant, and surgical characteristics were collected, including implant survival, clinical manifestations, cause of arthroplasty revision or implant failure, and peri- and intra-operative complications. The primary endpoint was implant survivorship. Hip revision arthroplasty was decided considering clinical signs and symptoms, abnormal imaging (XR, MR, TC, echotomography, scintigraphy), and blood metal ion level. An ad hoc electronic form was used to collect demographic, epidemiological, and clinical variables. In-between group comparisons of quantitative variables were performed with the Student t test and the Mann-Whitney for parametric and non-parametric variables, respectively. Logistic regression analyses were carried out to assess the relationship between clinical and radiographic characteristics and stem and cup revision. Radiographic measurements of implant positioning validity and reliability were assessed using Krippendorff's alpha reliability coefficient. The statistical software STATA version 15 (StatsCorp, TX) was used to perform statistical computations. RESULTS In this MoM THA series, the most incident cause of implant failure was ARMD in 11 out of 14 (78.6%) patients. All clinical failure manifestations, revision surgery highlights, and intra-operative findings are reported. CONCLUSIONS The local adverse reactions include lesions of different clinical relevance from small asymptomatic soft tissue lesions to dramatic osteolysis, necrosis, effusion, and growing masses which can cause secondary pathological effects. Symptoms of systemic toxicity are rarely described but may have been largely unreported in literature. Despite the extensive literature on the topic, the patient's management is still uncertain and challenging. Every metallic implant (e.g., screws, plates, spinal instrumentations) has a potential local or systemic adverse effect. Organizing a national registry of arthroplasty should be mandatory, in order to collect data about the patients, the surgery, the implanted device (with a careful post-marketing tracking), and the follow-up for all the procedures performed at a national level. The data collected in the registry will allow to analyze the implant survival and to better recognize the undesirable and sometimes unexpected effects of different biomaterials on the whole body.
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Affiliation(s)
| | - Carlo Doria
- Università degli Studi di Sassari, Sassari, Italy
| | | | | | - Laura Saderi
- Università degli Studi di Sassari, Sassari, Italy
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