Dislocation Of Hip Prosthesis Research Articles

Closed reduction of dislocated hip prosthesis using a traction table.

This article describes three cases in which a dislocated hip prosthesis was reduced by a new reduction technique - that we previously described - using traction table. The dissociation of a prosthesis is a rare but serious complication of closed reduction manoeuvre. The new reduction manoeuvre using a traction table may be a good option to avoid dissociation of the prosthesis during closed reduction for treatment of dislocation after total hip arthroplasty.

More complications and higher transfusion rate in patients with rheumatoid arthritis than osteoarthritis undergoing total hip arthroplasty.

Total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) has been associated with an increased risk of periprosthetic joint infection, periprosthetic fractures, dislocations, and post-operative blood transfusion. However, higher post-operative blood transfusion is unclear whether it reflects peri-operative blood loss or is characteristic of RA. This study aimed to compare the complications, allogenic blood transfusion, albumin use, and peri-operative blood loss between patients who underwent THA because of RA or osteoarthritis (OA). Patients undergoing cementless THA for hip RA (n = 220) or hip OA (n = 261) at our hospital between 2011 and 2021 were retrospectively enrolled. Deep vein thrombosis, pulmonary embolism, myocardial infarction, calf muscular venous thrombosis, wound complications, deep prosthetic infection, hip prosthesis dislocation, periprosthetic fractures, 30-day mortality, 90-day readmission, allogeneic blood transfusion, and albumin infusions were considered as primary outcomes, while secondary outcomes included the number of perioperative anaemia patients as well as total, intra-operative, and hidden blood loss. Compared to the OA group, patients with hip RA showed significantly higher rates of wound aseptic complications, hip prosthesis dislocation, homologous transfusion, and albumin use. RA patients also showed a significantly higher prevalence of pre-operative anemia. However, no significant differences were observed between the two groups in total, intra-operative, or hidden blood loss. Our study suggests that RA patients undergoing THA are at a higher risk of wound aseptic complications and hip prosthesis dislocation than patients with hip OA. Pre-operative anaemia and hypoalbuminaemia in patients with hip RA place them at a significantly higher risk of post-operative blood transfusion and use of albumin.

Reduction of posterior dislocated hip prosthesis using a modified lateral position maneuver: a retrospective, clinical comparative, and follow-up study

BackgroundPosterior dislocation (PD) is a common complication after total hip arthroplasty (THA), and the Allis maneuver is the most widely used method for reduction. However, this classic maneuver has some disadvantages. The aim of the present study was to investigate whether a modified lateral position (MLP) reduction maneuver provides an easier and safer method for PD reduction than the Allis maneuver.MethodsBetween August 2019 and September 2021, a series of 88 consecutive PD patients who underwent THA were retrospectively evaluated. The patients were divided into the MLP reduction group and Allis reduction group according to the electronic health medical record. The success rate of closed reduction, Harris hip score (HHS), and radiographic outcomes were determined. Satisfaction scores, doctor safety events and complications were also determined and compared between the groups. The mean follow-up period was 1.66 ± 0.88 years.ResultsThe success rate of reduction in the MLP group was significantly 12.5% higher than that in the Allis group (P = 0.024). Periprosthetic fracture and implant loosening were retrospectively identified in 2 hips and 1 hip, which all occurred in the Allis group. The mean doctor and patient SAPS scores in the MLP group were 84.00 points and 76.97 points, respectively, which were significantly higher than those in the Allis group (72.12, P = 0.008 and 63.28 points, P = 0.001). Four adverse events were reported in the Allis group, compared with 0 in the MLP group.ConclusionsFor PD after THA, the MLP reduction maneuver can effectively increase the reduction success rate, satisfaction, and doctor safety without increasing the risk of complications compared with the traditional Allis supine reduction maneuver.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (ChiCTR2100054562) in December 19th 2021.

Artículo traducido] Efecto de la luxación de la prótesis parcial de cadera en la mortalidad tras la cirugía de fractura de cadera

IntroductionHip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methodsWe conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. ResultsThe women population represented 78.7%, and the mean age of the population was 85.2 ± 6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (P = .016) and one-year follow-up (P < .001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p < .001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (P = .035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DiscussionOur study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Effect of hip hemiarthroplasty dislocation on mortality after hip fracture surgery

IntroductionHip arthroplasty is the treatment of choice for displaced femoral neck fractures among the older population. The hip prosthesis dislocation is one of the most pointed potential complications after hip arthroplasty, but there is a lack of updated information on the effect of dislocation on the survival of older hip fracture patients so treated by hip hemiarthroplasty. We aim to evaluate the standalone effect of hip prosthesis dislocation after hip fracture hemiarthroplasty on patients’ survival outcomes. Materials and methodsWe conducted a retrospective multicenter study, including 6631 femoral neck fracture patients over 65 surgically treated by hemiarthroplasty. We made follow-up cut-offs 30-days, 6 weeks, 90-days, and one year after hospital discharge determining hip dislocation rate and patients’ survival. ResultsThe women population represented 78.7%, and the mean age of the population was 85.2±6.7 years. Hip prosthesis dislocation incidence was 1.9% in the first 90-days after discharge, representing 91.54% of primary dislocations yearly noted. We reported statistically significant increased mortality rates of patients presenting at least one hip prosthesis dislocation event (from 16.0% to 24.6% at 90-day after discharge, and 29.5% to 44.7% at one year), and also significantly decreasing patient survival function at 90-day (p=0.016) and one-year follow-up (p<0.001). The recurrent dislocation events (26.15%) showed even higher mortality rates (up to 60.6%, p<0.001). The multivariate Cox regression model determined that prosthesis dislocation was the only significant variable (p=0.035) affecting patient survival, increasing the risk of dying before one year of follow-up by 2.7 times. DiscussionOur study stands for the standalone hip prosthesis dislocation entailing a higher risk of death after hip fracture hemiarthroplasty in the older population.

Narrative Review of the Mechanism of Hip Prosthesis Dislocation and Methods to Reduce the Risk of Dislocation.

Total hip arthroplasty (THA) is one of the most effective surgical procedures. It improves quality of life, increases range of motion, and reduces pain in patients with hip joint degeneration. THA allows patients to return to everyday social and professional activities. Therefore, today it is the best approach to treatment of several chronic conditions affecting the hip joint, including advanced degenerative diseases, avascular necrosis, and some traumatic events. The aim of this study was to present the mechanism of hip prosthesis dislocation, associated risk factors, and the factors reducing the risk of dislocation, as well as its consequences and methods of risk minimization.Hip dislocation is a common complication following THA. It is responsible for up to 2% to 3% failures of primary replacements, increasing even to 10% in extreme cases of patients highly predisposed to this condition. In most cases, technical errors during implant placement are responsible for the incidence. The measures taken to prevent complications include activities aimed at correct implant insertion and the selection of the most appropriate type of implant for the patient, depending on individual needs.We summarized the current knowledge of implant dislocation to help surgeons understand the changes in biomechanics of the hip after its replacement and the impact of each particular element that participates in it. This knowledge can enable a surgeon choose the most favorable surgical method and the most appropriate implant to reduce the risk of implant dislocation.

Can we trust combined anteversion and Lewinnek safe zone to avoid hip prosthesis dislocation?

IntroductionDislocation is one of the most common complications after primary total hip arthroplasty (THA). Combined anteversion (CA) is currently considered one of the most important measures of stability for THA. Thus, the aim of this study is to determine the association between a correct CA after THA and hip prosthesis dislocation, and to analyze the reliability of the Lewinnek safe zone parameters. Material and methodsThis is a non-interventional retrospective study, carried out at a tertiary hospital in Spain. 2489 primary THA in 2147 patients between January 2008 and December 2014 were identified. Clinical, biological and radiographic data, including cup inclination and cup and femoral anteversion, were analyzed of all patients who developed a hip prosthesis dislocation. ResultsThirty-four patients met the eligibility criteria to be analyzed. In 73.5% (25/34) of cases, acetabular anteversion (AV) was correct, with a mean AV of 15.1° ± 9.4°. Femoral anteversion (FA) was considered correct only in 38.2% (13/34) of the dislocated THA, with a mean FA of 8.4° ± 17.2°. Sixteen of these 34 patients (47.0%) presented a correct CA, with a mean CA of 24.2° ± 21.0°. Nineteen hips (55.8%) were within the Lewinnek safe zone. Moreover, eleven patients (32.3%) developed a dislocation even though components were within the Lewinnek safe zone and presented a correct CA. ConclusionOur findings suggest that even when the THA components are positioned within a correct CA and in the Lewinnek safe zone, hip prosthesis dislocations can occur in a not inconsiderable percentage of the cases. Thus, further radiological and clinical analysis should be done to identify potential reasons for hip prosthesis dislocation.

A comparison of peri-operative effects of modified Bikini minimally invasive approach versus direct lateral approach for total hip arthroplasty

Objective To compare the perio-perative effects of modified bikini minimally invasive approach versus direct lateral approach for total hip arthroplasty(THA). Methods A total of 60 patients(70 hips), including 45 males(49 hips)and 15 females(21 hips)aged(54.9±6.1)years(range from 38 to 63 years)who underwent THA for the first time at joint surgery department of our hospital were retrospectively analyzed from October 2015 to May 2017.Thirty patients(34 hips)underwent modified bikini approach THA(the modified bikini group), and 30 patients(36 hips)received direct lateral approach THA(the direct lateral group). The comparisons were performed between the two groups in the orthopaedic pelvic films, disease stages, Harris scores before and after operation, intra-operative blood loss, postoperative drainage, blood transfusion rate, 24-h visual analog scale(VAS)scores for pain after operation, operation time and incision length.The straight leg elevation time, recovery time of hip abduction muscle strength, average hospitalization days and subjective satisfaction of patients were evaluated.Relevant surgical complications were recorded. Results Postoperative X-ray examinations showed that the position of prosthesis was good in both groups.There were no statistically significant difference between the two groups in operation time, intraoperative blood loss, postoperative drainage, blood transfusion rate, straight leg elevation time and subjective satisfaction(P>0.05). There were statistically significant differences between the modified bikini group and the direct lateral group in the incision length[(9.2±1.9) cm vs.(18.5±3.3) cm], recovery time of hip abductor muscle strength[(1.6±0.8) d vs. (12.1±3.9) d], Harris scores[(87.1±5.9) vs.(86.8±7.1)], 24-hour VAS scores[(4.6±2.3) vs.(7.0±3.6)]and average hospitalization days[(7.4±1.8) vs.(10.8±2.4)]after operation between the modified bikini group and the direct lateral group(P<0.05). One case with lateral femoral cutaneous nerve injury and 1 case of posterior cortical perforation of proximal femur were found in the modified bikini group, and 1 case of dislocation of hip prosthesis was observed in the direct lateral group. Conclusions Both of the modified bikini minimally invasive approach and direct lateral approach for THA can achieve better postoperative effect, while the modified bikini approach achieves faster recovery. Key words: Arthroplasty; Replacement, hip; Surgical procedures, minimally invasive

Treatment of Bilateral Recurrent Dislocation of Hip Pros-thesis with Malpositioned Well-Fixed Shell: A Case Report

Dislocations of total hip prostheses cause pain and patient dissatisfaction. Recurrent dislocations are difficult to treat mainly when the acetabular metal shell is well-fixed. The purpose of this article was to describe the surgical technique used for the treatment of a bilateral recurrent posterior dislocation after a cementless total hip prosthesis, caused by excessive inclination of acetabular components, in a 72-year-old patient. On both sides, acetabular metal shell, porouscoated, was well-fixed. Revision of the entire acetabular component could be an appropriate therapeutic option because it was malpositioned. Nevertheless, a conservative operation was performed. The metal shell was left in situ and the preexisting polyethylene liner was removed and replaced by a new undersized cross-linked polyethylene liner, then, cemented into the shell and properly oriented. An acetabular cemented augmentation reinforced by 3 cortical screws was associated with the reconstruction. This report suggests that cementation of new liner into a malpositioned well- fixed metal shell associated with an acetabular cemented augmentation is a simple and safe technique for the management of recurrent hip dislocation, for elderly patients in which it is advisable to avoid a major revision hip surgery by medical comorbidities. Nonetheless, further studies with medium-and long-term follow-up are needed to validate this technique.

Surgical Technique: Methods for Removing a Compress® Compliant Prestress Implant

The Compress® device uses a unique design using compressive forces to achieve bone ingrowth on the prosthesis. Because of its design, removal of this device may require special techniques to preserve host bone. DESCRIPTION OF TECHNIQUES: Techniques needed include removal of a small amount of bone to relieve compressive forces, use of a pin extractor and/or Kirschner wires for removal of transfixation pins, and creation of a cortical window in the diaphysis to gain access to bone preventing removal of the anchor plug. We retrospectively reviewed the records of 63 patients receiving a Compress® device from 1996 to 2011 and identified 11 patients who underwent subsequent prosthesis removal. The minimum followup was 1 month (average, 20 months; range, 1-80 months). The most common reason for removal was infection (eight patients) and the most common underlying diagnosis was osteosarcoma (five patients). Three patients underwent above-knee amputation, whereas the others (eight patients) had further limb salvage procedures at the time of prosthesis removal. Five patients had additional unplanned surgeries after explantation. Irrigation and débridement of the surgical wound was the most common unplanned procedure followed by latissimus free flap and hip prosthesis dislocation. At the time of followup, all patients were ambulating on either salvaged extremities or prostheses. Although removal of the Compress® device presents unique challenges, we describe techniques to address those challenges.

BET 3 GENERAL ANAESTHESIA OR CONSCIOUS SEDATION FOR REDUCING A DISLOCATED HIP PROSTHESIS?

BET 3 GENERAL ANAESTHESIA OR CONSCIOUS SEDATION FOR REDUCING A DISLOCATED HIP PROSTHESIS?

Door to relocation time for dislocated hip prosthesis: multicentre comparison of emergency department procedural sedation versus theatre-based general anaesthesia

Background:Dislocation of a hip prosthesis is a painful event which has an incidence of 4% for primary total hip arthroplasty. Relocation is traditionally performed under general anaesthesia in the operating...

Lumbar plexus block via a femoral approach for total hip arthroplasty dislocation reduction: a report of 2 cases

The incidence of hip dislocation can vary based on factors including age and patient co-morbidities. Prosthetic hip dislocations present a particularly difficult challenge. Although many cases are treated in the emergency setting using procedural sedation for reduction, some may require general anesthesia. We report two cases in which lumbar plexus blockade was used as the primary means for successful hip prosthesis dislocation reduction.

Closed Reduction of Constrained Total Hip Arthroplasty in the ED

A dislocated hip prosthesis is a common occurrence in the Emergency Department. To combat this problem, orthopedists use constraint devices in an attempt to reduce the incidence of dislocation. However, when these devices fail, a more complicated case arises. We discuss a case report in which a patient presented with a dislocation of his hip after implantation of a constrained total hip arthroplasty. We describe a closed reduction procedure using deep sedation, fluoroscopy, and adequate assistance.

Disassembly and Dislocation of a Bipolar Hip Prosthesis

Dislocation of a hip prosthesis is a common complication. In usual cases of hip prosthesis dislocation, the prosthetic femoral head comes out from either the natural acetabular cavity in a bipolar hemiarthroplasty or the prosthetic acetabulum in a total hip arthroplasty. Only a few cases of bipolar hip prosthesis dislocation due to dissociation between the polyethylene and inner head of the prosthesis have been reported. We describe a rare case of disassembly of the inner head from the bipolar outer prosthesis in an osteoarthritic acetabulum. A 72-year-old woman had undergone bipolar hemiarthroplasty due to fracture of the left femoral neck about 10 years previously. Recently, she sustained an injury after falling from a chair, and examinations revealed an unusual disassembly-dislocation of the bipolar hip prosthesis. We classified this failure in our patient as a type II failure, representing extreme varus position of the outer head in the acetabulum, dislocation of the inner head from the outer head, and a detached locking ring around the stem neck. This mechanism of failure as shown in our patient rarely occurs in the bipolar prosthesis of the self-centering system. Osteoarthritic change of the acetabulum would place the outer head in the varus position, increasing wear on the beveled rim by impinging the femoral stem neck and causing dislodgment of the inner locking ring and consequent disassembly-dislocation of the inner head.

Socket wall addition device in the treatment of recurrent hip prosthesis dislocation: Good outcome in 12 patients followed 4.5 (1–9) years

Socket wall addition device in the treatment of recurrent hip prosthesis dislocation: Good outcome in 12 patients followed 4.5 (1–9) years

Socket wall addition device in the treatment of recurrent hip prosthesis dislocation : Good outcome in 12 patients followed for 4.5 (1–9) years

Background Recurrent dislocation in total hip replacement is difficult to treat and causes severe morbidity.Patients and methods 12 patients suffering dislocations were reoperated with a socket wall addition device (anti-luxation ring) for the Lubinus SPII prosthesis, and were followed up after a mean of 4.5 (1–9) years with regard to redislocation, function and radiographic loos-ening.Results 1 of the patients suffered a redislocation after almost 7 years of use. There was no loosening during the follow-up time. A Harris hip score of 87 (60–100), a health-related quality of life (EQ-5D) index of 0.8 (0.6–1.0) and total range of motion of 145° (125–165) indicate that the patients had a level of function comparable to that of age-matched hip surgery patients with no com-plications.Interpretation The anti-luxation ring shows promising mid-term results and seems to provide an alternative to more extensive revision surgery for selected patients. ▪

Hand‐Modelled Composite Prostheses after Resection of Peri‐Acetabular Bone Malignancies

Purpose: To improve function after pelvic resection involving the acetabulum, using an anatomic composite implant built with screws and cement. Material and method: Since 1990, 66 patients with peri-acetabular bone malignancies have been treated by extensive resection followed by hand-modelled innominate prosthesis with partially constrained total hip prosthesis. The hand-modelled innominate prosthesis was made of a titanium cup, a set of long titanium screws and two or three packs of gentamycine-loaded cement. Results: Many postoperative complications were observed: deep infection (14%), hip prosthesis dislocation (25%) and local recurrence (15%). Sixteen patients (25%) had to be reoperated. Nevertheless, at last follow-up, 62 patients still had composite prosthesis. The mean functional result, rated according to a modified Enneking's staging system, was 80% with unlimited walking without support, average hip flexion 100°, length discrepancy less than 1 cm. Discussion: These results were similar to those described in the literature for custom-made innominate prostheses and much better than those of alternative reconstructive procedures. Hand-modelled composite prostheses are cheaper, easier, more adaptable and enables better anchorage than custom-made prostheses. Such a procedure can be used even after total iliac wing resection. Conclusion: The advantages of such a procedure plead for its extensive use after acetabular resection. But long-term follow-up is necessary to validate indications.

Cost-effectiveness of screening x-rays at admission to acute rehabilitation after joint replacement surgery: a retrospective chart review.

To investigate the cost-effectiveness of performing routine screening x-rays for patients on admission to an acute rehabilitation facility, after hip or knee replacement surgery, by reviewing the overall incidence of abnormal radiographic findings and determining their impact on patient care and outcome. A retrospective chart review study, in which 592 patients were admitted, after hip or knee replacement surgery, to three acute inpatient rehabilitation facilities under one system. Eight of 592 admissions revealed abnormal screening x-rays, for an overall incidence of 1.35%. All of the eight abnormal radiologic cases remained medically stable throughout their acute rehabilitation stay. The abnormalities did not alter the patients' medical management or length of stay. One case, which had demonstrated normal admission films, revealed a dislocated hip prosthesis on a follow-up x-ray, which was obtained as a result of new onset hip pain. The patient was subsequently transferred back to the acute care hospital for surgical correction. The authors found a relatively low incidence of abnormal admission x-ray findings; furthermore, the detection of abnormal admission films did not alter patient care or outcome. The results suggested that performing routine admission radiologic studies on all patients after joint replacement surgery or hemiarthroplasty may not be a cost-effective screening tool in rehabilitation.

A Prosthesis Augmentation Device for the Prevention of Recurrent Hip Dislocation

At present, revision is the only standard option for cases of recurrent hip prosthesis dislocation. A device is described that contains the head of the femoral component, preventing dislocation, while only slightly restricting external rotation of the affected leg. The device can be inserted through a small incision, minimizing operation time. This device differs from others, e.g., the reversed acetabular cup, by being predrilled (with drill guide supplied), modular in design, and tailored to the dimensions of the cup site.