Abstract
Patients with chronic instability or late dislocation following total hip arthroplasty often require operative management. Unfortunately, there is an increased risk of recurrent dislocation following revision in these patients. Over the past decade the use of constrained devices for patients with chronic instability has gained increased interest; however, there is a paucity of studies available in the literature regarding the use of these devices. The purpose of this study was to analyze the available literature over the past 15 years, focusing on larger, long-term studies, to obtain recommendations from the respective articles for indications and contraindications for the use of constrained devices. Our review of eight reports included 1,199 hips in 1,148 patients with a total mean follow-up of 51 months (range, 24 to 124 months). The mean rate of dislocation following revision with a constrained liner was 10% and the mean re-operation rate for reasons other than dislocation was 4%. We concluded that constrained liners are an option for patients who have failed management of instability with other implants, those with instability of unclear etiology, those with cognitive problems who are unable to follow dislocation precautions, those with deficient abductors, and elderly or low-demand individuals with well-positioned implants requiring revision.
Résumé
Les patients présentant une instabilité ou des luxations tardives de prothèse totale de hanche, nécessitent un traitement particulier. Malheureusement, il existe un risque important de luxations résiduelles après révision de prothèse totale chez ces patients. Nous avons utilisé, dans les dix dernières années, un implant contraint pour ces patients présentant une instabilité chronique. Peu d’études font part dans la littérature de l’utilisation de tels implants. Le propos de ce travail a été d’analyser la littérature des dernières quinze années sur ce sujet, afin de mettre en place des recommandations. Après cette revue de la littérature, sur 8 articles, nous avons pu analyser 1199 hanches sur 1148 patients avec un suivi minimum de 51 mois (24 à 124 mois). Le taux de luxation après révision de prothèses totales de hanche avec un insert contraint a été de 10% et le taux moyen de réintervention pour une raison autre qu’une luxation a été de 4%. Nous pouvons conclure que les inserts contraints sont une possibilité thérapeutique chez ces patients présentant une instabilité, chez les patients présentant une instabilité dont l’origine n’est pas clairement définie, chez ceux présentant des troubles cognitifs, chez ceux qui sont incapables de suivre le moindre conseil, la moindre précaution, chez ceux présentant des troubles des muscles abducteurs et chez les sujets très âgés, dont la demande fonctionnelle est peu importante et qui nécessitent la révision d’un implant.
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Williams, J.T., Ragland, P.S. & Clarke, S. Constrained components for the unstable hip following total hip arthroplasty: a literature review. International Orthopaedics (SICOT) 31, 273–277 (2007). https://doi.org/10.1007/s00264-006-0191-y
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DOI: https://doi.org/10.1007/s00264-006-0191-y