Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

Abstract

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

Global mapping of institutional and hospital-based (Level II–IV) arthroplasty registries: a scoping review

“…According to the study type, 485 (74.85%) were cohorts [ 2 , 3 , 8 – 12 , 14 – 316 ], 91 (14.04%) were case-series [ 13 , 317 – 406 ], 49 (7.56%) were case–control studies [ 407 – 455 ], nine (1.39%) cross-sectional studies [ 456 – 464 ], eight (1.23%) protocols for registry-based studies [ 465 – 472 ] and six (0.93%) randomised control trials (RCT) [ 473 – 478 ]. Three hundred twenty-seven cohort studies were retrospective [ 2 , 8 , 11 , 14 , 17 , 18 , 21 – 26 , 29 – 34 , 36 , 38 , 41 , 42 , 44 – 46 , 54 – 56 , 64 – 71 , 83 – 91 , 106 – 118 , 123 , 137 – 146 , 155 – 190 , 200 – 217 , 233 – 266 , 273 , 281 – 308 , 311 – 315 , 479 – 590 ], and 158 were prospective [ 9 , 10 , 12 , 15 , 16 , 19 , 20 , …”

“…ORTHOTEP University HS Carl Gustav Carus [ 109 , 619 ] 2. Dresden Hip Surgery Registry [ 52 , 196 ] Heidelberg University of Heidelberg [ 410 ] Regensburg Regensburg University [ 198 , 255 , 292 , 296 , 299 ] Greece Athens General HS KAT [ 155 , 384 , 646 ] Thessaloniki Arthroplasty RG Thessaloniki (ART) [ 2 , 12 , 406 , 455 , 647 ] Italy Emilia-Romanga Register of Orthopaedic Prosthetic Implant (RIPO) [ 24 , 26 , 39 , 43 , 57 , 145 , 164 , 189 , 231 , 288 , 297 , 468 , 476 , 482 , 491 , 502 , 506 , 508 , 527 , 540 , 562 , 563 , 569 , 585 , 592 , 597 , …”

“…Quality of patients’ life and medical complications other than implant failure as infections, deep vein thrombosis or pulmonary embolism, are also frequently recorded [ 63 , 518 , 655 , 656 ]. The Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) are used to report patients’ quality of life from most registries [ 2 , 647 ]. There are also implant survival studies from various institutional JARs simultaneously reporting clinical outcomes, complications, PROMs and radiological implants’ data as secondary study outcomes [ 64 , 321 , 511 , 524 , 647 ].…”

“…Most well-known national JARs collect type I data because further data collection is expensive. Fewer regional, institutional, or hospital-based JARs collect more detailed patients’ data (type II–IV) [ 1 , 2 ].…”

Fully constrained acetabular liner vs. dual mobility hip joint in the surgical treatment of metastatic bone disease of the hip: study protocol for a randomized, open-label, two-arm, non-inferiority trial evaluating the post-operative hip dislocation rate

“…This option has been used increasingly in our department in the past years in patients with MBD. However, constrained liners are prone to polyethylene wear and high revision rates in the long run [13,14], while the constrained design potentially impedes the patient with a restricted range of joint motion [15]. An alternative to the constrained liner is the dual mobility cup (DM), which has been shown to decrease the risk of dislocation in other high-risk populations such as revision THA patients and hip fracture patients [16][17][18].…”