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Complication of intraprosthetic dislocation of dual-mobility hip implant following closed reduction.

ABSTRACT: Total hip replacement is a successful operation for the management of hip pain but there are potential complications, of which dislocation is one of the most common. The management of recurrent dislocation is a challenging problem that requires a multimodal approach and the use of dual-mobility implants is one option. We present a patient who was previously revised with a dual-mobility implant for recurrent dislocation, who had a complication after closed reduction of a subsequent intraprosthetic dislocation. Following a missed radiographical diagnosis, the patient experienced mechanical symptoms on hip flexion caused by a disassociated dual-mobility implant. Subsequent surgical removal of the failed implant and revision was required. Careful study of radiographs revealed an eccentric femoral head and evidence of the disassociated implant within the surrounding soft tissues. Radiographs following closed reduction of intraprosthetic dislocations should be scrutinised closely to detect implant failure to prevent further complications.

SUBMITTER: Mukundu Nagesh N

PROVIDER: S-EPMC5878339 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Complication of intraprosthetic dislocation of dual-mobility hip implant following closed reduction.

Mukundu Nagesh Navin N Patel Nimesh N Howell Jonathan J

BMJ case reports 20180322

Total hip replacement is a successful operation for the management of hip pain but there are potential complications, of which dislocation is one of the most common. The management of recurrent dislocation is a challenging problem that requires a multimodal approach and the use of dual-mobility implants is one option. We present a patient who was previously revised with a dual-mobility implant for recurrent dislocation, who had a complication after closed reduction of a subsequent intraprostheti ...[more]

PMID: 29572368

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Project description:The concept of a dual mobility (DM) cup has been in existence for more than 40 years and was initially popularized in Europe. Only recently has it started to garner attention in the United States. Its design, consisting of a small femoral head articulating within a larger polyethylene (PE) insert, which articulates with an outer shell, has found increasing use in patients that are at risk for post-operative dislocations. This case report describes a case of recurrent total hip arthroplasty (THA) dislocation managed with the implantation of a DM cup with an acute intraprosthetic dislocation of the DM construct.A 52-year-old woman underwent an uneventful left THA through a posterior approach. Within 6 weeks of her surgery, she had four dislocations, managed with closed reductions. She then underwent an open revision of her acetabular component with conversion to a DM construct. 5 weeks after her revision, she had another dislocation treated with closed reduction in the operating room, with the resultant eccentric location of the femoral head in the acetabular component. Computed tomography (CT) confirmed intraprosthetic dislocation with the PE liner lodged in the gluteal tissue. She was taken to the operating room with a plan to revise her acetabular component to another DM construct, but with an increase in the anteversion despite initial anteversion being "appropriate" on CT imaging. Intraoperatively, the PE liner was embedded in gluteal tissue as depicted on the CT. The abductors were intact. There was no impingement in extension and maximal external rotation when trialed with a conventional head/liner construct. A new DM construct was then implanted.Intraprosthetic dislocation is a rare occurrence and unique complication to DM constructs. It is not common in the short-term setting postoperatively to our knowledge, and this case report represents an early report of intraprosthetic dislocation in the literature. Care should be taken during reduction of dislocated DM constructs to avoid intraprosthetic dislocations. Open revisions can be managed with revisions to another DM construct or to a constrained liner construct to maximize stability.

Dataset Information

Complication of intraprosthetic dislocation of dual-mobility hip implant following closed reduction.

Publications

Complication of intraprosthetic dislocation of dual-mobility hip implant following closed reduction.

Similar Datasets

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