Größere Köpfe kompensieren erhöhte Hüft-TEP-Luxationsgefahr bei Hochrisikopatienten

Zajonz, Dirk; Philipp, H.; Schleifenbaum, Stefan; Möbius, Robert; Hammer, Niels; Grunert, Ronny; Prietzel, Torsten

doi:10.1007/s00132-015-3093-0

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…Third, the use of larger (≥ 36 mm) or functionally larger head (bi- or tripolar hip endoprostheses) considerably decreases the dislocation rate after primary THA [15, 16, 33, 34] and R-THA [33, 34]. …”

Section: Discussionmentioning

confidence: 99%

The impact of capsular repair on the risk for dislocation after revision total hip arthroplasty – a retrospective cohort-study of 259 cases

Jurkutat

Zajonz

Sommer

et al. 2018

BMC Musculoskelet Disord

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BackgroundDislocation following total hip arthroplasty has to date not been resolved satisfactorily. Previous work has shown that using a less-invasive adaption of Bauer’s lateral transgluteal approach with capsular repair significantly reduces dislocation rates in primary total hip arthroplasty. The aim of this retrospective cohort study was to assess whether this approach also helps to reduce the dislocation rate in revision total hip arthroplasty.MethodsWe analyzed revision total hip arthroplasty cases performed between 10/2005 and 12/2013 in our department, classifying capsular repair cases as study group and capsular resection cases as control group. The WOMAC score, the dislocations and the revisions were observed.ResultsA total of 259 cases were included, 100 in the study group and 159 in the control group. In the 12-month follow-up, dislocation rates were significantly lower in the study group (3%, n = 3) compared to the control group (21.4%, n = 34; p = 0.001). Overall follow-up periods were 49 and 79 months, revision frequencies were 10 and 29%, pain improvements were 5.5 compared to 4.4 and the WOMAC global scores averaged 2.0 ± 2.1 and 2.9 ± 2.6 for the study group and the control group, respectively.ConclusionThe modified, less-invasive, lateral transgluteal approach with capsular repair was accompanied by an 86% reduction in dislocation rates when compared to the conventional technique with capsular resection via the anterolateral Watson-Jones-approach. Capsular repair is possible in about 60% of the revision total hip arthroplasty cases, may be considered as beneficial to avoid dislocation and can therefore be recommended.

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Section: Discussionmentioning

confidence: 99%

The impact of capsular repair on the risk for dislocation after revision total hip arthroplasty – a retrospective cohort-study of 259 cases

Jurkutat

Zajonz

Sommer

et al. 2018

BMC Musculoskelet Disord

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Sind höhere Preise für größere Kopfdurchmesser in der Hüftendoprothetik medizinökonomisch vertretbar? Eine Analyse der Kosten und Effekte in Deutschland

et al. 2016

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In total hip arthroplasty (THA), femoral head diameter has not been regarded as a key parameter which should be restored when reconstructing joint biomechanics and geometry. Apart from the controversial discussion on the advantages and disadvantages of using larger diameter heads, their higher cost is another important reason that they have only been used to a limited extent. The goal of this study was to analyse the price structure of prosthetic heads in comparison to other components used in THA. A large group of patients with hip endoprostheses were evaluated with respect to the implanted socket diameter and thus the theoretically attainable head diameter. The relative prices of various THA components (cups, inserts, stems and ball heads) distributed by two leading German manufacturers were determined and analysed. Special attention was paid to different sizes and varieties in a series of components. A large patient population treated with THA was evaluated with respect to the implanted cup diameter and therefore the theoretically attainable head diameter. The pricing analysis of the THA components of two manufacturers showed identical prices for cups, inserts and stems in a series. In contrast to this, the prices for prosthetic heads with a diameter of 36-44 mm were 11-50 % higher than for 28 mm heads. Identical prices for larger heads were the exception. The distribution of the head diameter in 2719 THA cases showed significant differences between the actually implanted and the theoretically attainable heads. There are proven advantages in using larger diameter ball heads in THA and the remaining problems can be solved. It is therefore desirable to correct the current pricing practice of charging higher prices for larger components. Instead, identical prices should be charged for all head diameters in a series, as is currently established practice for all other THA components. Thus when reconstructing biomechanics and joint geometry in THA, it should be possible to recover not only leg length, femoral offset and antetorsion of the femoral neck, but also to approximately restore the diameter of the femoral head and thereby optimise the functional outcome.

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Größere Köpfe kompensieren erhöhte Hüft-TEP-Luxationsgefahr bei Hochrisikopatienten

Abstract: Our results with 40 and 44 mm heads and the existing literature confirm much higher joint stability and, thus, significantly reduced dislocation risk with larger prosthetic heads in THA. Their use is, therefore, justified in high-risk patients and should be considered in future THA.

Cited by 2 publications

References 31 publications

The impact of capsular repair on the risk for dislocation after revision total hip arthroplasty – a retrospective cohort-study of 259 cases

The impact of capsular repair on the risk for dislocation after revision total hip arthroplasty – a retrospective cohort-study of 259 cases

Sind höhere Preise für größere Kopfdurchmesser in der Hüftendoprothetik medizinökonomisch vertretbar? Eine Analyse der Kosten und Effekte in Deutschland

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