nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

18.02.2021 | Orthopaedic Surgery

Outcome and risk factors of failures associated with revision total hip arthroplasty for recurrent dislocation

verfasst von: Christian Klemt, Wenhao Chen, Georges Bounajem, Venkatsaiakhil Tirumala, Liang Xiong, Young-Min Kwon

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 8/2022

Einloggen, um Zugang zu erhalten

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.

Khan RJK, Fick D, Alakeson R et al (2006) A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br 88:870–876. https://doi.org/10.1302/0301-620X.88B7.17644CrossRefPubMed

Carlson BC, Desy NM, Johnson JD et al (2018) Modern surgical treatment of recurrent posterior dislocation of the native hip. J Bone Joint Surg Am 100:1056–1063. https://doi.org/10.2106/JBJS.17.01170CrossRefPubMed

Bonner B, Arauz P, Klemt C, Kwon Y-M (2020) Outcome of re-revision surgery for adverse local tissue reaction in metal-on-polyethylene and metal-on-metal total hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.02.006CrossRefPubMed

Malik AT, Jain N, Scharschmidt TJ et al (2018) Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty 33:3329–3342. https://doi.org/10.1016/j.arth.2018.05.040CrossRefPubMed

Elbuluk AM, Coxe FR, Schimizzi GV et al (2020) Abductor deficiency-induced recurrent instability after total hip arthroplasty. JBJS Rev 8:e0164. https://doi.org/10.2106/JBJS.RVW.18.00164CrossRefPubMed

Dammerer D, Schneider F, Renkawitz T et al (2020) High risk of hip dislocation following polyethylene liner exchange in total hip arthroplasty-is cup revision necessary? Arch Orthop Trauma Surg 140:1837–1845. https://doi.org/10.1007/s00402-020-03603-3CrossRefPubMedPubMedCentral

Hamadouche M, Biau DJ, Huten D et al (2010) The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res 468:3248–3254. https://doi.org/10.1007/s11999-010-1404-7CrossRefPubMedPubMedCentral

Fricka KB, Marshall A, Paprosky WG (2006) Constrained liners in revision total hip arthroplasty: an overuse syndrome. In the affirmative. J Arthroplasty. https://doi.org/10.1016/j.arth.2006.02.100CrossRefPubMed

Kaplan SJ, Thomas WH, Poss R (1987) Trochanteric advancement for recurrent dislocation after total hip arthroplasty. J Arthroplasty 2:119–124. https://doi.org/10.1016/s0883-5403(87)80018-9CrossRefPubMed

10.

Klemt C, Smith EJ, Oganesyan R et al (2020) Outcome of dual mobility constructs for adverse local tissue reaction associated abductor deficiency in revision total hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.06.043CrossRefPubMed

11.

Hoskins W, Griffin X, Hatton A et al (2020) THA for a fractured femoral neck: comparing the revision and dislocation rates of standard-head, large-head, dual-mobility, and constrained liners. Clin Orthop Relat Res. https://doi.org/10.1097/CORR.0000000000001447CrossRefPubMedCentral

12.

Chalmers BP, Pallante GD, Taunton MJ et al (2018) Can dislocation of a constrained liner be salvaged with dualmobility constructs in revision THA? Clin Orthop Relat Res 476:305–312. https://doi.org/10.1007/s11999.0000000000000026CrossRefPubMedPubMedCentral

13.

Brown TS, Tibbo ME, Arsoy D et al (2019) Long-term outcomes of constrained liners cemented into retained, well-fixed acetabular components. J Bone Jt Surg Am 101:620–627. https://doi.org/10.2106/JBJS.18.00607CrossRef

14.

Plate JF, Seyler TM, Stroh DA et al (2012) Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty. BMC Res Notes 5:553. https://doi.org/10.1186/1756-0500-5-553CrossRefPubMedPubMedCentral

15.

Lewinnek GE, Lewis JL, Tarr R et al (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220CrossRef

16.

Karvonen M, Karvonen H, Seppänen M et al (2017) Freedom constrained liner for the treatment and prevention of dislocation in total hip arthroplasty. Scand J Surg SJS Off organ Finnish Surg Soc Scand Surg Soc 106:165–172. https://doi.org/10.1177/1457496916660035CrossRef

17.

Flecher X, Ollivier M, Argenson JN (2016) Lower limb length and offset in total hip arthroplasty. Orthop Traumatol Surg Res 102:S9-20. https://doi.org/10.1016/j.otsr.2015.11.001CrossRefPubMed

18.

Kusin DJ, Ungar JA, Samson KK, Teusink MJ (2019) Body mass index as a risk factor for dislocation of total shoulder arthroplasty in the first 30 days. JSES Open Access 3:179–182. https://doi.org/10.1016/j.jses.2019.07.001CrossRefPubMedPubMedCentral

19.

Mendez JH, Mehrani A, Randolph P, Stagg S (2019) Throughput and resolution with a next-generation direct electron detector. IUCrJ 6:1007–1013. https://doi.org/10.1107/S2052252519012661CrossRefPubMedPubMedCentral

20.

Kenney C, Dick S, Lea J et al (2019) A systematic review of the causes of failure of revision total hip arthroplasty. J Orthop 16:393–395. https://doi.org/10.1016/j.jor.2019.04.011CrossRefPubMedPubMedCentral

21.

Mehta N, Selvaratnam V, Alsousou J et al (2020) Outcome of revision surgery in recurrent dislocation of primary total hip arthroplasty. Hip Int J Clin Exp Res hip Pathol Ther. https://doi.org/10.1177/1120700020911146CrossRef

22.

Herman A, Masri BA, Duncan CP et al (2020) Multivariate analysis of risk factors for re-dislocation after revision for dislocation after total hip arthroplasty. Hip Int J Clin Exp Res hip Pathol Ther 30:93–100. https://doi.org/10.1177/1120700019831628CrossRef

23.

Biviji AA, Ezzet KA, Pulido P, Colwell CWJ (2009) Modular femoral head and liner exchange for the unstable total hip arthroplasty. J Arthroplasty 24:625–630. https://doi.org/10.1016/j.arth.2008.03.015CrossRefPubMed

24.

Hernigou P, Trousselier M, Roubineau F et al (2016) Dual-mobility or constrained liners are more effective than preoperative bariatric surgery in prevention of THA dislocation. Clin Orthop Relat Res 474:2202–2210. https://doi.org/10.1007/s11999-016-4859-3CrossRefPubMedPubMedCentral

25.

Huang C-C, Jiang C-C, Hsieh C-H et al (2016) Local bone quality affects the outcome of prosthetic total knee arthroplasty. J Orthop Res Off Publ Orthop Res Soc 34:240–248. https://doi.org/10.1002/jor.23003CrossRef

26.

Gill K, Whitehouse SL, Hubble MJW, Wilson MJ (2016) Short-term results with a constrained acetabular liner in patients at high risk of dislocation after primary total hip arthroplasty. Hip Int J Clin Exp Res hip Pathol Ther 26:580–584. https://doi.org/10.5301/hipint.5000396CrossRef

27.

Malkani AL, Himschoot KJ, Ong KL et al (2019) Does timing of primary total hip arthroplasty prior to or after lumbar spine fusion have an effect on dislocation and revision rates? J Arthroplasty 34:907–911. https://doi.org/10.1016/j.arth.2019.01.009CrossRefPubMed

28.

Esposito CI, Carroll KM, Sculco PK et al (2018) Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation. J Arthroplasty 33:1449–1454. https://doi.org/10.1016/j.arth.2017.12.005CrossRefPubMed

29.

Limmahakhun S, Box HN, Arauz P et al (2019) In vivo analysis of spinopelvic kinematics and peak head-cup contact in total hip arthroplasty patients with lumbar degenerative disc disease. J Orthop Res 37:674–680. https://doi.org/10.1002/jor.24234CrossRefPubMed

30.

Klemt C, Limmahakhun S, Bounajem G et al (2020) Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J. https://doi.org/10.1302/0301-620X.102B9.BJJ-2020-0777.R1CrossRefPubMed

31.

Waterson HB, Whitehouse MR, Greidanus NV et al (2018) Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications. Bone Joint J 100-B:720–724. https://doi.org/10.1302/0301-620X.100B6.BJJ-2017-1466.R1CrossRefPubMed

32.

Gaillard R, Kenney R, Delalande J-L et al (2019) Ten- to 16-year results of a modern cementless dual-mobility acetabular implant in primary total hip arthroplasty. J Arthroplasty 34:2704–2710. https://doi.org/10.1016/j.arth.2019.06.051CrossRefPubMed

33.

Hartzler MA, Abdel MP, Sculco PK, et al (2018) Otto Aufranc award: dual-mobility constructs in revision THA reduced dislocation, rerevision, and reoperation compared with large femoral heads. In: Clinical Orthopaedics and Related Research

34.

Abdel MP (2018) Dual-mobility constructs in revision total hip arthroplasties. J Arthroplasty 33:1328–1330. https://doi.org/10.1016/j.arth.2018.01.030CrossRefPubMed

35.

Chalmers BP, Ledford CK, Taunton MJ et al (2018) Cementation of a dual mobility construct in recurrently dislocating and high risk patients undergoing revision total arthroplasty. J Arthroplasty 33:1501–1506. https://doi.org/10.1016/j.arth.2017.11.055CrossRefPubMed

36.

Fessy M-H, Jacquot L, Rollier J-C et al (2019) Midterm clinical and radiographic outcomes of a contemporary monoblock dual-mobility cup in uncemented total hip arthroplasty. J Arthroplasty 34:2983–2991. https://doi.org/10.1016/j.arth.2019.07.026CrossRefPubMed

37.

Klemt C, Bounajem G, Tirumala V et al (2020) Three-dimensional kinematic analysis of dislocation mechanism in dual mobility total hip arthroplasty constructs. J Orthop Res Off Publ Orthop Res Soc. https://doi.org/10.1002/jor.24855CrossRef

Titel: Outcome and risk factors of failures associated with revision total hip arthroplasty for recurrent dislocation
verfasst von: Christian Klemt
Wenhao Chen
Georges Bounajem
Venkatsaiakhil Tirumala
Liang Xiong
Young-Min Kwon
Publikationsdatum: 18.02.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 8/2022
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03814-2

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Outcome and risk factors of failures associated with revision total hip arthroplasty for recurrent dislocation