Large Femoral Heads and Select Dual-Mobility Bearings Are Associated With Reduced Instability in Contemporary Posterior Approach Total Hip Arthroplasty

Pitz-Gonçalves, Lauren I.; Deckard, Evan R.; Meneghini, R. Michael

doi:10.1016/j.arth.2023.02.011

Cited by 4 publications

(3 citation statements)

References 71 publications

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“…In fact, as the use of 40-mm femoral heads increased from 4% to 51% from 2010 to 2021, the dislocation rate dropped from 1.4% to 0.7%. 39 Furthermore, no dislocations occurred in THAs where the effective femoral head size was at least 40 mm. Although surgeons are often hesitant to use larger femoral heads due to historical reports of increased volumetric wear in conventual polyethylene, recent reports with highly cross-linked polyethylene with and without vitamin E show low femoral head penetration and wear rates out to a mean of 11 years.…”

Section: Discussionmentioning

confidence: 96%

“…38 With the advancements in highly cross-linked polyethylene liners allowing for thinner liners and therefore larger femoral heads, use of larger heads has demonstrated a significant decrease in dislocation rates compared with smaller femoral heads. 39 Pitz-Gonçalves et al demonstrated in a consecutive cohort of 1,511 posterior approach THAs that maximizing the femoral head diameter per a given acetabular cup size (ie, higher head-cup ratio) resulted in lower dislocation rates. In fact, as the use of 40-mm femoral heads increased from 4% to 51% from 2010 to 2021, the dislocation rate dropped from 1.4% to 0.7%.…”

Section: Discussionmentioning

confidence: 99%

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Instability in Patients With Lumbar Spine Disease Undergoing Posterior Approach and Lateral Approach Primary Total Hip Arthroplasty

Parihar,

Deckard,

Buller

et al. 2024

J Am Acad Orthop Surg

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Introduction: Dislocation rates in patients who have fixed spinopelvic motion have been reported up to 20%. Few studies have directly compared dislocation rates in patients who have spine pathology undergoing total hip arthroplasty (THA) through different surgical approaches. This study compared postoperative dislocation rates in patients who had lumbar spine disease and underwent primary THA using a posterior or direct lateral approach. Methods: Between 2011 and 2017, consecutive cohorts of primary THAs were retrospectively reviewed. One surgeon routinely used a posterior approach, while the other used a direct lateral approach. Chart and radiographic review were conducted to identify patients who had lumbar spine disease. Dislocations among cohorts with and without lumbar spine disease were compared by posterior and direct lateral approaches. Results: The overall dislocation rate was 1.3% (15/1,198). The top four predictors of dislocation were presence of lumbar spine disease (odds ratio [OR] 5.0; P = 0.014), posterior surgical approach (OR, 6.5; P = 0.074), cases performed for fracture (OR, 4.4; P = 0.035), and women (OR, 4.6; P = 0.050). Dislocation rates among direct lateral approach patients who had lumbar spine pathology were significantly lower than posterior approach patients who had lumbar spine pathology (0.0% versus 3.6%; P = 0.011). Discussion: Although dislocation rates were low in both groups, study results suggest that a direct lateral approach for primary THA may reduce postoperative dislocations for patients who have limited spinopelvic motion due to lumbar spine pathology. Furthermore, surgeons using the posterior approach might consider optimizing the femoral head to acetabular cup ratio in patients who have lumbar spine disease.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Instability in Patients With Lumbar Spine Disease Undergoing Posterior Approach and Lateral Approach Primary Total Hip Arthroplasty

Parihar,

Deckard,

Buller

et al. 2024

J Am Acad Orthop Surg

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“…This represents an initial experience with a specific DM system. As a result of this initial experience, the senior author has decreased his use of DM and increased his use of larger diameter (40 mm) ceramic heads when clinically indicated [ 19 ]. However, DM remains a useful technique that needs to be in the armamentarium of every revision hip surgeon, as there may not be another satisfactory solution for certain difficult cases.…”

Section: Discussionmentioning

confidence: 99%

Malseated Liner in Modular Dual Mobility Total Hip Replacement: A Report of Three Cases

Gerber,

Lee,

De Silva

et al. 2024

Cureus

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Modular dual mobility total hip arthroplasty (THA) can be associated with complications if the liner is malseated, which can be unappreciated intraoperatively. A meticulous surgical technique is needed to ensure that the liner is perfectly seated. In addition, a malseated liner can be missed if the postoperative films are not carefully reviewed by the surgeon. We present three cases of THA associated with a malseated modular dual mobility liner. In one case, the malpositioned liner was appreciated intraoperatively, but it was wedged in place and could not be removed. The entire shell needed to be revised. In two other cases, malseating was not detected intra-operatively. Both were appreciated postoperatively, and early revision surgery was needed.

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Dislocation Following Anterior and Posterior Total Hip Arthroplasty in the Setting of Spinal Deformity and Stiffness: Evolving Trends Using a High-Risk Protocol at a Single Tertiary Center

Sarpong,

Rodriguez,

Kuyl

et al. 2024

The Journal of Arthroplasty

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Large Femoral Heads and Select Dual-Mobility Bearings Are Associated With Reduced Instability in Contemporary Posterior Approach Total Hip Arthroplasty

Cited by 4 publications

References 71 publications

Instability in Patients With Lumbar Spine Disease Undergoing Posterior Approach and Lateral Approach Primary Total Hip Arthroplasty

Instability in Patients With Lumbar Spine Disease Undergoing Posterior Approach and Lateral Approach Primary Total Hip Arthroplasty

Malseated Liner in Modular Dual Mobility Total Hip Replacement: A Report of Three Cases

Dislocation Following Anterior and Posterior Total Hip Arthroplasty in the Setting of Spinal Deformity and Stiffness: Evolving Trends Using a High-Risk Protocol at a Single Tertiary Center

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