Clinical Orthopaedics and Related Research®

, Volume 471, Issue 12, pp 3883–3890 | Cite as

Acetabular Liner With Focal Constraint to Prevent Dislocation After THA

  • Jacob T. Munro
  • Mihai H. Vioreanu
  • Bassam A. Masri
  • Clive P. Duncan
Symposium: 2012 International Hip Society Proceedings

Abstract

Background

Dislocation continues to commonly cause failure after primary and revision total hip arthroplasty (THA). Fully constrained liners intended to prevent dislocation are nonetheless associated with a substantial incidence of failure by redislocation, mechanical failure, aseptic loosening, or a combination. Constrained liners with cutouts of the elevated rims can theoretically increase range of movement and therefore decrease the risk dislocation, but it is unclear if they do so in practice and whether they are associated with early wear or loosening.

Questions/purposes

We therefore determined (1) occurrence or recurrence of dislocation and (2) rate of complications associated with constrained implants with cutouts; and (3) assessed for early cup loosening.

Methods

We retrospectively reviewed the records of 81 patients at high risk for dislocation who had 82 constrained liners inserted for primary (n = 10) or revision (n = 72) THA between 2008 and 2010. From the records we extracted demographic and implant data and instances of recurrent dislocation, implant failure, osteolysis, loosening, or construct failure. The minimum followup was 24 months (mean, 34 months; range, 24–49 months).

Results

Three liners failed as a result of further dislocation (3%). Three deep infections occurred. One patient had progressive loosening at the shell-bone interface.

Conclusions

Our observations suggest this liner is associated with a relatively low risk of dislocation in patients at high risk for dislocation and those with recurrent dislocation.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Alberton GM, High WA, Morrey BF. Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am. 2002;84:1788–1792.PubMedGoogle Scholar
  2. 2.
    Amstutz HC, Le Duff MJ, Beaulé PE. Prevention and treatment of dislocation after total hip replacement using large diameter balls. Clin Orthop Relat Res. 2004;429:108–116.PubMedCrossRefGoogle Scholar
  3. 3.
    Anderson MJ, Murray WR, Skinner HB. Constrained acetabular components. J Arthroplasty. 1994;9:17–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide: AOA; 2010.Google Scholar
  5. 5.
    Berend KR, Lombardi AV, Mallory TH, Adams JB, Russell JH, Groseth KL. The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures. J Arthroplasty. 2005;20:93–102.PubMedCrossRefGoogle Scholar
  6. 6.
    Berend KR, Lombardi AV, Welch M, Adams JB. A constrained device with increased range of motion prevents early dislocation. Clin Orthop Relat Res. 2006;447:70–75.PubMedCrossRefGoogle Scholar
  7. 7.
    Bigsby E, Whitehouse MR, Bannister GC, Blom AW. The medium term outcome of the Omnifit constrained acetabular cup. Hip Int. 2012;22:505–510.PubMedCrossRefGoogle Scholar
  8. 8.
    Bremner BRB, Goetz DD, Callaghan JJ, Capello WN, Johnston RC. Use of constrained acetabular components for hip instability: an average 10-year follow-up study. J Arthroplasty. 2003;18:131–137.PubMedCrossRefGoogle Scholar
  9. 9.
    Callaghan JJ, Heithoff BE, Goetz DD, Sullivan PM, Pedersen DR, Johnston RC. Prevention of dislocation after hip arthroplasty: lessons from long-term followup. Clin Orthop Relat Res. 2001;393:157–162.PubMedCrossRefGoogle Scholar
  10. 10.
    Carter AH, Sheehan EC, Mortazavi SM, Purtill JJ, Sharkey PF, Parvizi J. Revision for recurrent instability: what are the predictors of failure? J Arthroplasty. 2011;26(Suppl):46–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Cogan A, Klouche S, Mamoudy P, Sariali E. Total hip arthroplasty dislocation rate following isolated cup revision using Hueter’s direct anterior approach on a fracture table. Orthop Traumatol Surg Res. 2011;97:501–505.PubMedCrossRefGoogle Scholar
  12. 12.
    Cooke CC, Hozack W, Lavernia C, Sharkey P, Shastri S, Rothman RH. Early failure mechanisms of constrained tripolar acetabular sockets used in revision total hip arthroplasty. J Arthroplasty. 2003;18:827–833.PubMedCrossRefGoogle Scholar
  13. 13.
    DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMedGoogle Scholar
  14. 14.
    Della Valle CJ, Chang D, Sporer S, Berger RA, Rosenberg AG, Paprosky WG. High failure rate of a constrained acetabular liner in revision total hip arthroplasty. J Arthroplasty. 2005;20(Suppl 3):103–107.Google Scholar
  15. 15.
    Engh CA Jr, Sychterz CJ, Young AM, Pollock DC, Toomey SD, Engh CA Sr. Interobserver and intraobserver variability in radiographic assessment of osteolysis. J Arthroplasty. 2002;17:752–759.PubMedCrossRefGoogle Scholar
  16. 16.
    Garbuz DS, Masri BA, Duncan CP, Greidanus NV, Bohm ER, Petrak MJ, Valle Della CJ, Gross AE. The Frank Stinchfield Award: dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial? Clin Orthop Relat Res. 2012;470:351–356.PubMedCrossRefGoogle Scholar
  17. 17.
    Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component. A retrospective analysis of fifty-six cases. J Bone Joint Surg Am. 1998;80:502–509.PubMedGoogle Scholar
  18. 18.
    Guyen O, Lewallen DG, Cabanela ME. Modes of failure of Osteonics constrained tripolar implants: a retrospective analysis of forty-three failed implants. J Bone Joint Surg Am. 2008;90:1553–1560.PubMedCrossRefGoogle Scholar
  19. 19.
    Hamadouche M, Biau DJ, Huten D, Musset T, Gaucher F. The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res. 2010;468:3248–3254.PubMedCrossRefGoogle Scholar
  20. 20.
    Havelin LI, Robertsson O, Fenstad AM, Overgaard S, Garellick G, Furnes O. A Scandinavian experience of register collaboration: the Nordic Arthroplasty Register Association (NARA). J Bone Joint Surg Am. 2011;93(Suppl 3):13–19.PubMedCrossRefGoogle Scholar
  21. 21.
    Hernigou P, Filippini P, Flouzat-Lachaniette C-H, Batista SU, Poignard A. Constrained liner in neurologic or cognitively impaired patients undergoing primary THA. Clin Orthop Relat Res. 2010;468:3255–3262.PubMedCrossRefGoogle Scholar
  22. 22.
    Khatod M, Barber T, Paxton E, Namba R, Fithian D. An analysis of the risk of hip dislocation with a contemporary total joint registry. Clin Orthop Relat Res. 2006;447:19–23.PubMedCrossRefGoogle Scholar
  23. 23.
    Knudsen R, Ovesen O, Kjaersgaard-Andersen P, Overgaard S. Constrained liners for recurrent dislocations in total hip arthroplasty. Hip Int. 2007;17:78–81.PubMedGoogle Scholar
  24. 24.
    Lachiewicz PF, Soileau ES. Low early and late dislocation rates with 36- and 40-mm heads in patients at high risk for dislocation. Clin Orthop Relat Res. 2012 May 11 [Epub ahead of print].Google Scholar
  25. 25.
    Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res. 2008;466:389–395.PubMedCrossRefGoogle Scholar
  26. 26.
    Lautridou C, Lebel B, Burdin G, Vielpeau C. [Survival of the cementless Bousquet dual mobility cup: minimum 15-year follow-up of 437 total hip arthroplasties] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:731–739.PubMedCrossRefGoogle Scholar
  27. 27.
    Meek RMD, Allan DB, McPhillips G, Kerr L, Howie CR. Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res. 2006;447:9–18.PubMedCrossRefGoogle Scholar
  28. 28.
    New Zealand Joint Registry. Eleven Year Report. Christchurch, New Zealand: NZOA; October 2010.Google Scholar
  29. 29.
    Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res. 2012;470:1907–1916.PubMedCrossRefGoogle Scholar
  30. 30.
    Shah SN, Kaye RJ, Kelly NH, Su EP, Padgett DE, Wright TM. Retrieval analysis of failed constrained acetabular liners. J Arthroplasty. 2009;24:54–57.PubMedCrossRefGoogle Scholar
  31. 31.
    Shapiro GS, Weiland DE, Markel DC, Padgett DE, Sculco TP, Pellicci PM. The use of a constrained acetabular component for recurrent dislocation. J Arthroplasty. 2003;18:250–258.PubMedCrossRefGoogle Scholar
  32. 32.
    Shrader MW, Parvizi J, Lewallen DG. The use of a constrained acetabular component to treat instability after total hip arthroplasty. J Bone Joint Surg Am. 2003;85:2179–2183.PubMedGoogle Scholar
  33. 33.
    Turner RS. Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management. Clin Orthop Relat Res. 1994;301:196–204.PubMedGoogle Scholar
  34. 34.
    Vasukutty NL, Middleton RG, Matthews EC, Young PS, Uzoigwe CE, Minhas THA. The double-mobility acetabular component in revision total hip replacement: the United Kingdom experience. J Bone Joint Surg Br. 2012;94:603–608.PubMedGoogle Scholar
  35. 35.
    Weiss RJ, Beckman MO, Enocson A, Schmalholz A, Stark A. Minimum 5-year follow-up of a cementless, modular, tapered stem in hip revision arthroplasty. J Arthroplasty. 2011;26:16–23.PubMedCrossRefGoogle Scholar
  36. 36.
    Williams JT Jr, Ragland PS, Clarke S. Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop. 2007;31:273–277.PubMedCrossRefGoogle Scholar
  37. 37.
    Yang C, Goodman SB. Outcome and complications of constrained acetabular components. Orthopedics. 2009;32:115.PubMedGoogle Scholar
  38. 38.
    Yun AG, Padgett D, Pellicci P, Dorr LD. Constrained acetabular liners: mechanisms of failure. J Arthroplasty. 2005;20:536–541.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Jacob T. Munro
    • 1
  • Mihai H. Vioreanu
    • 1
  • Bassam A. Masri
    • 1
  • Clive P. Duncan
    • 1
  1. 1.Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada

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