Clinical outcomes and dislocation rates after hip reconstruction using the Bioball system

Abstract

Introduction: Instability accounts for 1/3 of revision total hip arthroplasty (rTHA) performed in the UK. Removal of well-fixed femoral stems in rTHA is challenging with a risk of blood loss and iatrogenic damage to the femur. The Bioball universal adaptor (BUA), a modular head neck extension adaptor, provides a mechanism for optimisation of femoral offset, leg length and femoral anteversion. This can avoid the need for femoral stem revision in selected cases. The aim of this study is to present the clinical results and rate of instability following revision with this BUA at a minimum of 2 years follow-up. Patients and methods: A review of our prospectively collected database was performed. All patients treated with the Bioball device were included. Clinical and radiologic review were performed pre- and post-surgery. Specific enquiry for instability was made. The Oxford Hip Score (OHS), EuroQol (EQ-5D) score and WOMAC scores were calculated pre-and post-operatively. Complications were recorded. Results: 32 rTHA procedures were performed using the Bioball device between 2013 and 2016. 4 patients did not wish to complete post-operative questionnaires. 2 patients (2/28, 7%) complained of recurrent dislocations following their rTHA procedure. 1 patient complained of instability but no dislocation. The median pre-operative EQ-5D was 0.195 (range −0.07–0.85), OHS was 20 (range 5–43) and WOMAC was 29.8 (range 15.5–52.3). The median EQ-5D was 0.85 (range 0.59–1), OHS was 39 (range 21–48) and WOMAC was 91.1 (range 44.5–99.2) at final follow-up. There were significant improvements in the EQ-5D ( p = 0.0009), OHS ( p = 0.0004) and WOMAC ( p = 0.0001). Conclusion: The BUA is associated with significant functional improvement and relatively low dislocation rates in revision THA. It is a viable option for use in the revision setting.

Outcome of revision surgery in recurrent dislocation of primary total hip arthroplasty

“…Long-term outcomes on the use of the BioBall head neck adaptor for revision THA are limited. A recent study by Dabis et al 25 demonstrated good functional outcomes with a low dislocation rate in patients who had BioBall revision THA at 2-year follow-up. They included patients undergoing revision surgery for a variety of reasons and not just recurrent dislocation.…”

“…They included patients undergoing revision surgery for a variety of reasons and not just recurrent dislocation. Dabis et al 25 report a recurrent dislocation rate of 7% (2/28) with significant improvement in Euro-Quol (EQ-5D) Score ( p < 0.001), Oxford Hip Score ( p < 0.001) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores ( p < 0.001) following revision with Bioball. A recent meta-analysis on the Merete BioBall system by Novoa et al 24 demonstrated insufficient evidence to recommend or contradict the use of this system.…”

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

“…Some manufacturers also provide special ceramic heads for THA revision surgery, where the titanium sleeve is integrated into the ceramic head 62 and several studies have demonstrated good results when this technology is used. 63 – 68 …”

Retrospective multi-centre study on head adapters in partial revision hip arthroplasty

“…[9][10][11][12] In the event of inadequate femoral offset and/or length, rather than excessive anteversion or retroversion, the use of head adapters can allow length modularity to aid balancing soft-tissue tension with restoration of the proper geometry and biomechanics of the artificial hip. 13 The aim of this retrospective multi-centre study is to report on the results achieved with the use of head adapters in partial revision hip arthroplasty in avoiding instability of the implant.…”

“…In the event of inadequate femoral offset and/or length, rather than excessive anteversion or retroversion, the use of head adapters can allow length modularity to aid balancing soft-tissue tension with restoration of the proper geometry and biomechanics of the artificial hip. 13…”