Dislocation rate after hip arthroplasty due to metastatic bone disease: a retrospective cohort study evaluating the postoperative dislocation risk across different articulating solutions

Abstract

Background and purpose: Joint stability after hip replacement (HR) in patients with metastatic bone disease (MBD) is of special importance. Dislocation is the second leading cause of implant revision in HR, while survival after MBD surgery is poor with an expected 1-year survival of around 40%. As few studies have investigated the dislocation risk across different articulation solutions in MBD, we conducted a retrospective study on primary HR for patients with MBD treated in our department.Patients and methods: The primary outcome is the 1-year cumulative incidence of dislocation. We included patients with MBD who received HR at our department in 2003–2019. We excluded patients with partial pelvic reconstruction, total femoral replacement, and revision surgery. We assessed the incidence of dislocation with competing risk analysis with death and implant removal as competing risks.Results: We included 471 patients. Median follow-up was 6.5 months. The patients received 248 regular total hip arthroplasties (THAs), 117 hemiarthroplasties, 70 constrained liners, and 36 dual mobility liners. Major bone resection (MBR), defined as resection below the lesser trochanter, was performed in 63%. The overall 1-year cumulative incidence of dislocation was 6.2% (95% CI 4.0–8.3). Dislocation stratified by articulating surface was 6.9% (CI 3.7–10) for regular THA, 6.8% (CI 2.3–11) for hemiarthroplasty, 2.9% (CI 0.0–6.8) for constrained liner, and 5.6% (CI 0.0–13) for dual mobility liners. There was no significant difference between patients with and without MBR (p = 0.5).Conclusion: The 1-year cumulative incidence of dislocation is 6.2% in patients with MBD. Further studies are needed to determine any real benefits of specific articulations on the risk of postoperative dislocation in patients with MBD.

Custom three‐dimensional printed implants for reconstruction of oncologic pelvic defects

“…However, no randomized trials have been performed to address this issue, particularly in the context of oncologic reconstruction of the hip. A 2023 noninferiority trial to compare both modalities has begun 54 …”

Surgical treatments of metastatic bone disease of the hip joint：A scoping review protocol

“…However, if extensive acetabular bone damage occurs and the remaining part is di cult to prevent the displacement and loosening, ordinary total hip replacement is not suitable [18]. As bone cement can withstand pressure but not shear stress [19] [19], xation methods such as liners, Steinmann pins, hollow screws, and composite bone cement are used to bridge bone defects when necessary [20,21].Percutaneous acetabulum three-column hollow screw xation technology can restore acetabular strength and weightbearing function in some patients.…”