Instability (INS)/Dislocation (DISL)

Kenanidis, Eustathios; Tsiridis, Eleftherios; Heckmann, Nathanael; McKnight, Braden; Dorr, Lawrence D.; Gibon, Emmanuel; Goodman, Stuart B.

doi:10.1007/978-3-319-64177-5_25

Cited by 1 publication

(3 citation statements)

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“…1 Implant malposition, low offset, femoral neck impingement and small diameter femoral heads are among the most common iatrogenic causes of instability. 2,3 On the other hand, cognitive impairment and abductor insufficiency are frequent patient-related risk factors of hip dislocation. 4 The refined surgical technique, use of 36-mm heads and surgery from high-volume surgeons mitigate the risk of dislocation.…”

Section: Introductionmentioning

confidence: 99%

“…4 The refined surgical technique, use of 36-mm heads and surgery from high-volume surgeons mitigate the risk of dislocation. 3…”

Section: Introductionmentioning

confidence: 99%

“…The treatment depends on the cause and timing of instability. 3 Revision arthroplasty with 36-mm femoral heads and dual mobility, constrained, or lipped liners are effective treatment options. 5 Constrained polyethylene liners (CLs) have been used to manage hip instability in the primary or revision setting in high-risk patients with cognitive deficits, neuromuscular disorders or abductor insufficiency.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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