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Ruckenstuhl P, Wassilew G, Theobald K, Hipfl C, Pumberger M, Perka C, Hardt S. Recovery of muscular tissue and functional results of patients treated with a gluteus maximus flap transfer due to chronic abductor deficiency after total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:3063-3071. [PMID: 38960932 PMCID: PMC11319562 DOI: 10.1007/s00402-024-05417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/22/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND To evaluate the function of the abductor mechanism after a gluteus maximus flap transfer due to a degeneration of the muscles after hip arthroplasty, we analyzed the post-operative functional outcome as well as radiographic effects in muscle tissue. METHODS This present study included six consecutive patients operatively treated with a gluteus maximus flap due to chronic gluteal deficiency after total hip arthroplasty. All patients presented a preoperative severe limp, hip abductor deficiency and a history of conservative treatment without the relief of symptoms. MRI scans were performed pre- and postoperatively to evaluate the muscle volume and grade of degeneration of the abductor mechanism. For clinical evaluation, the Harris hip score (HHS) was applied pre- and postoperatively. Moreover, the intensity of pain, the Trendelenburg sign, the internal rotation lag sign and the abductor muscle force were measured before and after surgery. RESULTS Overall, the evaluation of the Magnetic Resonance Imaging (MRI) showed no significant changes in total muscle volume during the follow-up period. Separate measurements presented a significant growth of muscle volume for the gluteus minimus and tensor fascia lata compared to preoperative imaging during the follow-up period. The amount of fat volume decreased for all the measured muscles with statistical significance for the gluteus minimus, the gluteus medius and the tensor fascia lata. No further muscle degeneration and no flap necrosis were measured. The postoperative HHS results were not statistically significant compared to the preoperative results. CONCLUSIONS Besides fair clinical results, the radiological measurements indicate that the flap transfer enables functional muscular tissue recovery and prevents further degeneration. Given these conditions, the gluteus maximus muscle flap transfer represents a viable treatment option for patients with chronic gluteal deficiency in selected patients.
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Affiliation(s)
- Paul Ruckenstuhl
- Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Luisenstraße 64, 10117, Berlin, Germany.
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria.
| | - Georgi Wassilew
- Department of Orhtopaedics, University Hospital Greifswald Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Katrin Theobald
- Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Luisenstraße 64, 10117, Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Luisenstraße 64, 10117, Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Luisenstraße 64, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Luisenstraße 64, 10117, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité University Hospital Berlin, Luisenstraße 64, 10117, Berlin, Germany
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Scholz J, Perka C, Hipfl C. Dual-mobility bearings reduce instability but may not be the only answer in revision total hip arthroplasty for recurrent dislocation. Bone Joint J 2024; 106-B:89-97. [PMID: 38688508 DOI: 10.1302/0301-620x.106b5.bjj-2023-0828.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims There is little information in the literature about the use of dual-mobility (DM) bearings in preventing re-dislocation in revision total hip arthroplasty (THA). The aim of this study was to compare the use of DM bearings, standard bearings, and constrained liners in revision THA for recurrent dislocation, and to identify risk factors for re-dislocation. Methods We reviewed 86 consecutive revision THAs performed for dislocation between August 2012 and July 2019. A total of 38 revisions (44.2%) involved a DM bearing, while 39 (45.3%) and nine (10.5%) involved a standard bearing and a constrained liner, respectively. Rates of re-dislocation, re-revision for dislocation, and overall re-revision were compared. Radiographs were assessed for the positioning of the acetabular component, the restoration of the centre of rotation, leg length, and offset. Risk factors for re-dislocation were determined by Cox regression analysis. The modified Harris Hip Scores (mHHSs) were recorded. The mean age of the patients at the time of revision was 70 years (43 to 88); 54 were female (62.8%). The mean follow-up was 5.0 years (2.0 to 8.75). Results DM bearings were used significantly more frequently in elderly patients (p = 0.003) and in hips with abductor deficiency (p < 0.001). The re-dislocation rate was 13.2% for DM bearings compared with 17.9% for standard bearings, and 22.2% for constrained liners (p = 0.432). Re-revision-free survival for DM bearings was 84% (95% confidence interval (CI) 0.77 to 0.91) compared with 74% (95% CI 0.67 to 0.81) for standard articulations, and 67% (95% CI 0.51 to 0.82) for constrained liners (p = 0.361). Younger age (hazard ratio (HR) 0.92 (95% CI 0.85 to 0.99); p = 0.031), lower comorbidity (HR 0.44 (95% CI 0.20 to 0.95); p = 0.037), smaller heads (HR 0.80 (95% CI 0.64 to 0.99); p = 0.046), and retention of the acetabular component (HR 8.26 (95% CI 1.37 to 49.96); p = 0.022) were significantly associated with re-dislocation. All DM bearings which re-dislocated were in patients with abductor muscle deficiency (HR 48.34 (95% CI 0.03 to 7,737.98); p = 0.303). The radiological analysis did not reveal a significant relationship between restoration of the geometry of the hip and re-dislocation. The mean mHHSs significantly improved from 43 points (0 to 88) to 67 points (20 to 91; p < 0.001) at the final follow-up, with no differences between the types of bearing. Conclusion We found that the use of DM bearings reduced the rates of re-dislocation and re-revision in revision THA for recurrent dislocation, but did not guarantee stability. Abductor deficiency is an important predictor of persistent instability.
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Affiliation(s)
- Johann Scholz
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Hipfl
- Centre for Musculoskeletal Surgery, Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Berlin, Germany
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A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants. J Arthroplasty 2022; 38:957-969.e1. [PMID: 36481281 DOI: 10.1016/j.arth.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence of dislocation after revision total hip arthroplasty (rTHA) is reported to be up to 25% and remains a common source of failure. Constrained acetabular components and dual mobility implants are two implant classes being utilized to alleviate this burden in patients who have recurrent instability or major intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with constrained acetabular components and dual mobility implants in rTHA. METHODS Longitudinal studies reporting dislocation after the use of constrained acetabular components or dual mobility implants in rTHA were sought from Medline and Embase to October 2022. Secondary outcomes included re-revision surgery for dislocation and all causes. A total of 75 relevant citations were identified comprising 36 datasets of 3,784 constrained acetabular components and 47 datasets of 10,216 dual mobility implants. RESULTS For constrained acetabular components, the pooled incidence of dislocation was 9% (95% confidence interval: 7.2, 11.7) (range 0.0%-35.3%) over a weighted mean follow-up of 6 years, in contrast to 3% (95% confidence interval: 2.2, 4.4) (range 0.0%-21.4%) over 5 years for dual mobility implants. Re-revision rates for dislocation after using constrained acetabular components were around 9%, in contrast to 2% for dual mobility implants. Re-revision rates for all causes after using constrained acetabular components were around 19%, in contrast to 8% for dual mobility implants. CONCLUSION Dual mobility implants in the context of rTHA demonstrate lower incidences of dislocation (3% versus 9%), re-revision for dislocation (2% versus 9%), and rer-evision for any cause (8% versus 19%) in contrast to constrained acetabular components. This must be considered by surgeons when implanting such devices, often selected to treat instability.
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Shichman I, Kurapatti M, Roof M, Christensen TH, Rozell JC, Schwarzkopf R. Impact of Indication for Revision THA on Resource Utilization. J Arthroplasty 2022; 37:2333-2339. [PMID: 35738359 DOI: 10.1016/j.arth.2022.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Demographic variables play an important role in outcomes following revision total hip arthroplasty (rTHA). Surgical and in-patient variables as well as outcomes vary between indications for rTHA. The purpose of this study was to investigate the impact of the indication for the rTHA on costs and postoperative outcomes. METHODS This retrospective cohort analysis investigated all patients who underwent unilateral, aseptic rTHA at an academic orthopaedic specialty hospital who had at least 1-year postoperative follow-up. In total, 654 patients were evaluated and categorized based on their indication for aseptic rTHA. Demographics, direct and total procedure costs, surgical factors, postoperative outcomes, and re-revision rates were collected and compared between indications. RESULTS Younger patients had the greatest leg length discrepancy (LLD) and older patients had the highest incidence of periprosthetic fracture (PPF) (P = .001). The greatest proportion of full revisions were found for LLD (16.7%) and head/polyethylene liner-only revisions for metallosis/adverse tissue reaction (100%). Operative time was significantly longest for LLD revisions and shortest for metallosis/adverse tissue reaction revisions (P < .001). Length of stay was longest for periprosthetic fracture and shortest for LLD and stiffness/heterotopic ossification (P < .001). Re-revision rate was greatest for implant failure and lowest for LLD. Total cost was highest for PPF (148.9%) and lowest for polyethylene liner wear (87.7%). CONCLUSIONS Patients undergoing rTHA for indications such as PPF and aseptic loosening were associated with longer operative times, length of stay and higher total and direct costs. Therefore, they may need increased perioperative attention with respect to resource utilization, risk stratification, surgical planning, and cost-reducing measures. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Mark Kurapatti
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Mackenzie Roof
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | | | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Klemt C, Chen W, Bounajem G, Tirumala V, Xiong L, Kwon YM. Outcome and risk factors of failures associated with revision total hip arthroplasty for recurrent dislocation. Arch Orthop Trauma Surg 2022; 142:1801-1807. [PMID: 33599845 DOI: 10.1007/s00402-021-03814-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recurrent dislocation represents the third most common cause of revision surgery after total hip arthroplasty (THA). However, there is a paucity of information on the outcome of revision total hip arthroplasty for recurrent dislocation. In this study, we investigated (1) clinical outcomes of patients that underwent revision THA for recurrent dislocation, and (2) potential risk factors associated with treatment failure in patients who underwent revision total hip arthroplasty for recurrent dislocation. METHODS We retrospectively reviewed 211 consecutive cases of revision total hip arthroplasty for recurrent dislocation, 81 implanted with a constrained liner and 130 with a non-constrained liner with a large-diameter femoral head (> 32 mm). Patient- and implant-related risk factors were analyzed in multivariate regression analysis. RESULTS At 4.6-year follow-up, 32 of 211 patients (15.1%) underwent re-revision surgery. The most common causes for re-revision included infection (14 patients) and dislocation (10 patients). Kaplan-Meier analysis demonstrates a 5-year survival probability of 77% for patients that underwent revision THA for recurrent dislocation. Osteoporosis, obesity (BMI ≥ 40), spine disease and abductor deficiency are independent risk factors for failure of revision surgery for recurrent dislocation. Liner type (constrained vs. non-constrained) was found not to be associated with failure of revision THA for recurrent dislocation (p = 0.44). CONCLUSION This study suggests that THA revision for recurrent dislocation is associated with a high re-revision rate of 15% at mid-term follow-up. Osteoporosis, obesity (BMI ≥ 40) spine disease and abductor deficiency were demonstrated to be independent risk factors for failure of revision THA for recurrent dislocation. LEVEL OF EVIDENCE Level III, case-control retrospective analysis.
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Affiliation(s)
- Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Wenhao Chen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Georges Bounajem
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Venkatsaiakhil Tirumala
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Liang Xiong
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Can machine learning models predict failure of revision total hip arthroplasty? Arch Orthop Trauma Surg 2022; 143:2805-2812. [PMID: 35507088 DOI: 10.1007/s00402-022-04453-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/15/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Revision total hip arthroplasty (THA) represents a technically demanding surgical procedure which is associated with significant morbidity and mortality. Understanding risk factors for failure of revision THA is of clinical importance to identify at-risk patients. This study aimed to develop and validate novel machine learning algorithms for the prediction of re-revision surgery for patients following revision total hip arthroplasty. METHODS A total of 2588 consecutive patients that underwent revision THA was evaluated, including 408 patients (15.7%) with confirmed re-revision THA. Electronic patient records were manually reviewed to identify patient demographics, implant characteristics and surgical variables that may be associated with re-revision THA. Machine learning algorithms were developed to predict re-revision THA and these models were assessed by discrimination, calibration and decision curve analysis. RESULTS The strongest predictors for re-revision THA as predicted by the four validated machine learning models were the American Society of Anaesthesiology score, obesity (> 35 kg/m2) and indication for revision THA. The four machine learning models all achieved excellent performance across discrimination (AUC > 0.80), calibration and decision curve analysis. Higher net benefits for all machine learning models were demonstrated, when compared to the default strategies of changing management for all patients or no patients. CONCLUSION This study developed four machine learning models for the prediction of re-revision surgery for patients following revision total hip arthroplasty. The study findings show excellent model performance, highlighting the potential of these computational models to assist in preoperative patient optimization and counselling to improve revision THA patient outcomes. LEVEL OF EVIDENCE Level III, case-control retrospective analysis.
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Schopper C, Luger M, Hipmair G, Schauer B, Gotterbarm T, Klasan A. The race for the classification of proximal periprosthetic femoral fractures : Vancouver vs Unified Classification System (UCS) - a systematic review. BMC Musculoskelet Disord 2022; 23:280. [PMID: 35321671 PMCID: PMC8944079 DOI: 10.1186/s12891-022-05240-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Periprosthetic femoral fractures (PFFs) represent a major cause for surgical revision after hip arthroplasty with detrimental consequences for patients. The Vancouver classification has been traditionally used since its introduction in 1995. The Unified Classification System (UCS) was described in 2014, to widen the spectrum by aiming for a more comprehensive approach. The UCS also aimed to replace the Vancouver classification by expanding the idea of the Vancouver classification to the whole musculoskeletal apparatus. After introduction of the UCS, the question was raised, whether the UCS found its place in the field of analysing PFFs. Therefore, this systematic review was performed to investigate, the use of the UCS compared to the established Vancouver classification. Methods Medline was searched for reports published between 1 January 2016 and 31 November 2020, without language restriction. Included were original articles, irrespective of the level of evidence and case reports reporting on a PFF and using either the Vancouver or the UCS to classify the fractures. Excluded were reviews and systematic reviews. Results One hundred forty-six studies were included in the analysis. UCS has not been used in a single registry study, giving a pooled cohort size of 3299 patients, compared to 59,178 patients in studies using the Vancouver classification. Since 2016, one study using UCS was published in a top journal, compared to 37 studies using the Vancouver classification (p=0.29). During the study period, the number of yearly publications remained stagnant (p=0.899). Conclusions Despite valuable improvement and expansion of the latter UCS, to date, the Vancouver system clearly leads the field of classifying PFFs in the sense of the common use. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05240-w.
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Affiliation(s)
- Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria.
| | - Günter Hipmair
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz and Altenberger Strasse 69, 4040, Linz, Austria
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Chisari E, Ashley B, Sutton R, Largoza G, Di Spagna M, Goyal N, Courtney PM, Parvizi J. Dual-Mobility Implants and Constrained Liners in Revision Total Hip Arthroplasty. Arthroplast Today 2022; 13:8-12. [PMID: 34934792 PMCID: PMC8661104 DOI: 10.1016/j.artd.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 09/15/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Instability remains the most common complication after revision total hip arthroplasty (THA). The purpose of this study was to determine whether there was a difference in aseptic revision rates and survivorship between dual-mobility (DM) and constrained liners (CL) in revision THA. METHODS We reviewed a consecutive series of 2432 revision THA patients from 2008 to 2019 at our institution and identified all patients who received either a CL or DM bearing. We compared demographics, comorbidities, indications, dislocations, and aseptic failure rates between the two groups. Bivariate and multivariate regression analyses were used to determine risk factors for failure, and a Kaplan-Meier survivorship analysis was performed with an aseptic re-revision as the endpoint. RESULTS Of the 191 patients, 139 (72%) received a DM bearing, and 52 (28%) had a CL. At a mean follow-up of 14.3 months, there was no statistically significant difference in rates of dislocation (10.4% vs 14.0%, P = .667), aseptic revision (30.9% vs 46.2%, P = .073), or time to revision (3.78 vs 6 months, P = .565) between the two groups. The multivariate analysis revealed CL had no difference in aseptic re-revision rates when compared with DM (odds ratio 1.47, 95% confidence interval 0.84-2.52, P = .177). The survivorship analysis found no difference in aseptic failure between the groups at 12 months (P = .059). CONCLUSION Both CL and DM bearings have high aseptic failure rates at intermediate term follow-up after revision THA. CL did show a higher risk of failure than DM bearings, but it was not statistically significant with the numbers available for this study. Further prospective studies are needed to determine the optimal treatment for recurrent instability.
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Affiliation(s)
- Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Blair Ashley
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Garrett Largoza
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marco Di Spagna
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nitin Goyal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Graulich T, Graeff P, Jaiman A, Nicolaides S, Omar Pacha T, Örgel M, Macke C, Omar M, Krettek C, Liodakis E. Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case-control study of patients with CT data. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:627-633. [PMID: 33098004 PMCID: PMC8053145 DOI: 10.1007/s00590-020-02819-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/15/2020] [Indexed: 01/07/2023]
Abstract
Purpose Bipolar hemiarthroplasty has been shown to have a lower rate of dislocation than total hip arthroplasty. However, as the influencing risk factors for bipolar hemiarthroplasty dislocation remain unclear, we aimed to analyse patient and surgeon-specific influencing risk factors for bipolar hemiarthroplasty dislocation. Methods We retrospectively analysed patients who were operated between 2012 and 2018 and had dislocated bipolar hemiarthroplasty and matched them to patients without a dislocated bipolar hemiarthroplasty, operated between 2018 and 2019. The study was limited to patients who received either a pre- or postoperative pelvic computed tomography. Besides demographic, morphologic, and physiologic data, we analysed duration of surgery; ASA score; Charlson Comorbidity Index; Almelo Hip Fracture Score; Parker Score; and acetabular morphology angles including acetabular anteversion angle, posterior acetabular sector angle, posterior wall angle, and acetabular roofing. Results We included nine patients with a dislocated bipolar hemiarthroplasty and 30 with a non-dislocated bipolar hemiarthroplasty. Patient-specific factors prompting a higher risk for dislocated bipolar hemiarthroplasty were longer duration of surgery (min) (115 ± 50 vs. 80 ± 27, p = 0.01); dementia (56% vs. 13%, p < 0.01); smaller posterior acetabular sector angle (°) (96 ± 6 vs. 109 ± 10, p < 0.01); and smaller posterior wall angle (°) (67 ± 6 vs. 77 ± 10, p = 0.02). Conclusion Dementia and insufficient posterior wall angle were associated with higher risk of dislocation in bipolar hemiarthroplasty
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Affiliation(s)
- Tilman Graulich
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Pascal Graeff
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Ashish Jaiman
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Stine Nicolaides
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tarek Omar Pacha
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Di Martino A, Geraci G, Stefanini N, Perna F, Mazzotti A, Ruffilli A, Faldini C. Surgical repair for abductor lesion after revision total hip arthroplasty: a systematic review. Hip Int 2020; 30:380-390. [PMID: 31777283 DOI: 10.1177/1120700019888863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abductor mechanism lesions represent a severe complication after revision total hip arthroplasty (rTHA). The resulting abductor insufficiency can cause limping, pain, instability, and a higher rate of failure, thus requiring further revision surgery. In case of severe degeneration and retraction of the abductor mechanism, several different surgical treatments are needed. AIM To systematically review all studies reporting on surgical treatment of severe abductor lesion after rTHA, focusing on surgical techniques, and clinical and functional results. METHOD Scientific databases were accessed in December 2018 to identify studies addressing the surgical management of severe abductor disruption after rTHA. The PRISMA guidelines were followed. Data were extracted from the identified articles and summarised. Only data about patients with symptoms of abductor insufficiency after rTHA were included in the database. RESULTS 9 retrospective studies were included, all being retrospective case series reporting on a total of 92 patients. Several surgical strategies have been described and performed: a repair using a synthetic mesh was reported in 1 study; 2 studies reported on local muscle transfer (gluteus maximus transfer or advancement); vastus lateralis advancement was described in 4 studies while in 2 studies the injury was repaired with the use of an allograft. Overall positive results have been reported in terms of pain reduction, while poor to mild functional scores with persistent limping have often been observed in the postoperative period. CONCLUSIONS The short follow-up time of the reviewed studies is inadequate to uncover any late dislocation, implant failure or different complications related to abductor mechanism reconstruction.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy.,Sidney Kimmel Medical College of Thomas Jefferson University (SKMC), Philadelphia, PA, USA
| | - Giuseppe Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Niccolò Stefanini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Fabrizio Perna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Antonio Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli Orthopaedic Institute, Bologna, Italy
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