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Constrained Liner in Neurologic or Cognitively Impaired Patients Undergoing Primary THA

  • Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

THA performed in patients with cognitive deficits or neuromuscular diseases has been associated with a high postoperative dislocation rate. The constrained liner reportedly provides stability in patients with recurrent dislocation. However, achieving stability could be offset by early loosening when used in patients with neurologic diseases.

Questions/purposes

We therefore asked whether constrained liners had a higher risk of loosening when used in primary THA for patients with neurologic diseases.

Methods

We retrospectively reviewed a 144 patients (164 hips) with neuromuscular disease who had a constrained polyethylene insert from 1999 to 2004 and compared them to another 120 patients (132 hips) with neuromuscular disease operated on immediately before this period (from 1994 to 1998) who had a conventional polyethylene insert.

Results

Thirty-three (25%) of the 132 hips without a constrained liner were known to have had at least one dislocation and 21 had revision for recurrent dislocation. Ten other hips had revision for loosening of the cup. The survival rate was 82% at 5 years and 77% at 10 years with revision due to recurrent dislocation or loosening of the cup as the endpoint. With a constrained liner, at minimum 5-year followup (mean, 7 years; range, 5–10 years), the incidence of complications, particularly dislocation, was decreased (three dislocations among 164 hips; 2%), with one revision for recurrent dislocation and one revision for loosening.

Conclusions

This constrained acetabular component provides durable protection against dislocation without substantial increased loosening at midterm followup.

Level of Evidence

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

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Paris XII, Hôpital Henri Mondor, 94010, Creteil, France

    Philippe Hernigou MD, Paolo Filippini MD, Charles-Henri Flouzat-Lachaniette MD & Alexandre Poignard MD

  2. Department of Orthopaedic Surgery, University Federal of Bahia, Hospital Edgar Santos, Salvador, Brazil

    Sobrinho Uirassu Batista MD

Authors
  1. Philippe Hernigou MD
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  2. Paolo Filippini MD
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  3. Charles-Henri Flouzat-Lachaniette MD
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  4. Sobrinho Uirassu Batista MD
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  5. Alexandre Poignard MD
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Correspondence to Philippe Hernigou MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Hôpital Henri Mondor.

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Hernigou, P., Filippini, P., Flouzat-Lachaniette, CH. et al. Constrained Liner in Neurologic or Cognitively Impaired Patients Undergoing Primary THA. Clin Orthop Relat Res 468, 3255–3262 (2010). https://doi.org/10.1007/s11999-010-1340-6

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  • DOI: https://doi.org/10.1007/s11999-010-1340-6

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