Retrospective multi-centre study on head adapters in partial revision hip arthroplasty

Abstract

Background: Instability and dislocation after total hip arthroplasty (THA) is a common reason for revision surgery. THA head-neck adapters promise the reconstruction of optimal femoral offset and leg length in revision THA (rTHA) while retaining stable implants. The aim of this retrospective multi-centre study is to report on the results achieved with the use of head adapters in partial rTHA, to avoid the instability of the implant. Methods: 55 cases of partial rTHA performed between February 2015 and April 2017 in 3 different hospitals using the Bioball Head Adapter (BHA) (Bioball Merete, Medical GmbH, Berlin, Germany) were retrospectively recorded. All patients were evaluated from a radiological point of view at an average follow-up of 3.5 years. Failure was defined as re-revision surgery for any cause as well as a subjective feeling of instability of the joint. Results: One failure was registered in an extreme case and radiological findings show no suggestive signs of radiolucencies or loosening and therefore all implants have been considered stable. Conclusions: Despite some limitations of this retrospective study and according to the relevant literature, our data confirms that BHA is a safe system that allows the flexibility to restore femoral offset and version, to adjust leg length, to minimise instability, to avoid unnecessary removal of otherwise well-fixed components thus improving tribology and reducing the risk of taper junction issues without major complications in partial rTHA.

Revision Hip Arthroplasty Using a Modular Head–Neck Adapter System and a Ceramic Head: 5-Year Clinical and Radiographic Outcomes

“…Patients were clinically and radiographically evaluated at one month, three months and then annually. Clinical assessment was conducted using Harris Hip Score (HHS) [1]. The radiographic evaluation was conducted by the first author: osteointegration, radiolucency, osteolysis or migration were assessed.…”

“…In revisions, the use of a modular head-neck adapter could restore the correct hip biomechanics through the intraoperative fine tuning of length, version or offset, aiming to avoid the risks of instability and unnecessary morbidity due to the removal of fully integrated components [1,2]. However, modularity carries adjunctive risks of failure, like breakage, dissociation, fretting, corrosion and consequent generation of adverse local tissue reactions.…”

Usefulness of modular neck adapter in partial hip revision

“…Another possible issue may be the disassembly of the system, especially when using the longest adapters in addition to the offset configuration ( 29 ). To date, there are not any known cases of this phenomenon reported in literature: other reviews such as the one by Novoa et al ( 1 ) and the one by Hoberg et al ( 2 ) confirm this thesis.…”

Preliminary Results of Total Hip Arthroplasty in Subjects at Risk for Dislocation Using a Novel Modular Cementless Dual-Mobility Cup. A Single-Center Prospective Study

“…Instability following THA is a multi-factorial event, with different etiologies, and eventually several categories of risk factors are recognized, related to the patients and/or to the surgeons' choice: primary diagnosis such as femoral neck fracture and post-traumatic arthritis, secondary diagnosis at the neighbor joints such as spino-pelvic imbalance, neurological and psychiatric disorders such as Parkinson's disease, epilepsy, and schizophrenia, implant orientation and design, and laxity of the surrounding soft tissues [2][3][4].…”