Abstract
Background: Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty. One treatment method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, redislocation rate, and revisions of a focally constrained liner in a high-risk patient cohort. Methods: Fifty-eight hips between 2008 and 2011 underwent implantation of a focally constrained liner. Nineteen were placed concurrent with acetabular component revision and 39 were placed into a well-fixed acetabular shell. Mean age was 69 years and mean number of previous ipsilateral hip surgeries was 4.2. At mean follow-up of 3.5 years, we analyzed clinical outcomes, redislocation, and revisions. Results: Mean Harris Hip Scores was 74. Fourteen hips (24%) were revised and 3 hips (5%) required reoperation at final follow-up. Eleven hips (19%) redislocated at a mean time to dislocation of 12.2 months; 31% (11 of 36 patients) that underwent modular exchange specifically for instability redislocated. Risk factors for redislocation included number of previous surgeries (P = .013), implantation of a 28 mm femoral head (hazards ratio 12.8), revision indication of instability (P = .04), and modular exchange with constrained liner implantation without acetabular shell revision (P = .01). Conclusion: Implantation of a focally constrained liner in revision total hip arthroplasty for recurrent instability has a high failure rate, especially with a modular exchange. Although concurrent acetabular revision had a lower redislocation rate, the decision to revise a well-fixed cup should be weighed with potential complications associated with cup revision.
| Original language | English (US) |
|---|---|
| Journal | Journal of Arthroplasty |
| DOIs | |
| State | Accepted/In press - Dec 9 2015 |
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Keywords
- Cemented liner
- Constrained liner
- Dislocation
- Instability
- Modular exchange
- Revision total hip arthroplasty
ASJC Scopus subject areas
- Orthopedics and Sports Medicine
Cite this
High Failure Rate of Modular Exchange With a Specific Design of a Constrained Liner in High-Risk Patients Undergoing Revision Total Hip Arthroplasty. / Chalmers, Brian P.; Arsoy, Diren; Sierra, Rafael J.; Lewallen, David G.; Trousdale, Robert T.
In: Journal of Arthroplasty, 09.12.2015.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - High Failure Rate of Modular Exchange With a Specific Design of a Constrained Liner in High-Risk Patients Undergoing Revision Total Hip Arthroplasty
AU - Chalmers, Brian P.
AU - Arsoy, Diren
AU - Sierra, Rafael J.
AU - Lewallen, David G.
AU - Trousdale, Robert T.
PY - 2015/12/9
Y1 - 2015/12/9
N2 - Background: Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty. One treatment method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, redislocation rate, and revisions of a focally constrained liner in a high-risk patient cohort. Methods: Fifty-eight hips between 2008 and 2011 underwent implantation of a focally constrained liner. Nineteen were placed concurrent with acetabular component revision and 39 were placed into a well-fixed acetabular shell. Mean age was 69 years and mean number of previous ipsilateral hip surgeries was 4.2. At mean follow-up of 3.5 years, we analyzed clinical outcomes, redislocation, and revisions. Results: Mean Harris Hip Scores was 74. Fourteen hips (24%) were revised and 3 hips (5%) required reoperation at final follow-up. Eleven hips (19%) redislocated at a mean time to dislocation of 12.2 months; 31% (11 of 36 patients) that underwent modular exchange specifically for instability redislocated. Risk factors for redislocation included number of previous surgeries (P = .013), implantation of a 28 mm femoral head (hazards ratio 12.8), revision indication of instability (P = .04), and modular exchange with constrained liner implantation without acetabular shell revision (P = .01). Conclusion: Implantation of a focally constrained liner in revision total hip arthroplasty for recurrent instability has a high failure rate, especially with a modular exchange. Although concurrent acetabular revision had a lower redislocation rate, the decision to revise a well-fixed cup should be weighed with potential complications associated with cup revision.
AB - Background: Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty. One treatment method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, redislocation rate, and revisions of a focally constrained liner in a high-risk patient cohort. Methods: Fifty-eight hips between 2008 and 2011 underwent implantation of a focally constrained liner. Nineteen were placed concurrent with acetabular component revision and 39 were placed into a well-fixed acetabular shell. Mean age was 69 years and mean number of previous ipsilateral hip surgeries was 4.2. At mean follow-up of 3.5 years, we analyzed clinical outcomes, redislocation, and revisions. Results: Mean Harris Hip Scores was 74. Fourteen hips (24%) were revised and 3 hips (5%) required reoperation at final follow-up. Eleven hips (19%) redislocated at a mean time to dislocation of 12.2 months; 31% (11 of 36 patients) that underwent modular exchange specifically for instability redislocated. Risk factors for redislocation included number of previous surgeries (P = .013), implantation of a 28 mm femoral head (hazards ratio 12.8), revision indication of instability (P = .04), and modular exchange with constrained liner implantation without acetabular shell revision (P = .01). Conclusion: Implantation of a focally constrained liner in revision total hip arthroplasty for recurrent instability has a high failure rate, especially with a modular exchange. Although concurrent acetabular revision had a lower redislocation rate, the decision to revise a well-fixed cup should be weighed with potential complications associated with cup revision.
KW - Cemented liner
KW - Constrained liner
KW - Dislocation
KW - Instability
KW - Modular exchange
KW - Revision total hip arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=84960384877&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84960384877&partnerID=8YFLogxK
U2 - 10.1016/j.arth.2016.02.021
DO - 10.1016/j.arth.2016.02.021
M3 - Article
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
SN - 0883-5403
ER -