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The Patient With Chronic Total Hip Arthroplasty Dislocations: A Case Series of Five Patients Who Underwent Revision THA Using Polypropylene Mesh for Capsular Reconstruction.

ABSTRACT: We report a case series of 5 patients who underwent revision total hip arthroplasty (THA) using a polypropylene mesh for capsular reconstruction for chronic THA instability. The average follow-up is 16.6 months (range, 9-20 months). There were no postoperative dislocations in our series. Three patients had previous infections with two-stage revisions before final revision surgery and were infection free at their most recent follow-up. One patient developed a prosthetic joint infection 2 months postoperatively. The use of a polypropylene mesh appears to be another tool that surgeons can use when dealing with the difficult dilemma on how to treat the patient with chronic THA instability and severe abductor and capsular tissue loss.

SUBMITTER: Nessler JM

PROVIDER: S-EPMC7451887 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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The Patient With Chronic Total Hip Arthroplasty Dislocations: A Case Series of Five Patients Who Underwent Revision THA Using Polypropylene Mesh for Capsular Reconstruction.

Nessler Joseph M JM Nessler Joseph P JP

Arthroplasty today 20200822 4

We report a case series of 5 patients who underwent revision total hip arthroplasty (THA) using a polypropylene mesh for capsular reconstruction for chronic THA instability. The average follow-up is 16.6 months (range, 9-20 months). There were no postoperative dislocations in our series. Three patients had previous infections with two-stage revisions before final revision surgery and were infection free at their most recent follow-up. One patient developed a prosthetic joint infection 2 months p ...[more]

PMID: 32875015

Similar Datasets

A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach.

Project description:BackgroundDislocation is a challenging problem after total hip arthroplasty (THA). We sought to evaluate the incidence of early dislocation with 2 different posterior repair techniques after THA using a posterior approach.MethodsFrom September of 2008 to August of 2019, we evaluated 841 THAs performed by a single surgeon using a posterior approach. Before November of 2015, the capsule was repaired to the greater trochanter (group 1, 605 patients). Starting November 2015, the posterior capsule was repaired in a side-to-side fashion (direct soft-tissue repair) (group 2, 236 patients). There was a mean follow-up of 31.1 months (range, 2.5-122.5 months). A multivariable logistic regression model was constructed to assess the impact of baseline patient and operative factors on the dislocation rate.ResultsThere were 22 dislocations, all of which occurred in group 1. There were no dislocations in group 2. After adjusting for patient and operative factors, the direct soft-tissue repair had a large impact on the overall multivariable model as indicated by its effect likelihood ratio of 10.33 (P = .001); however, the odds ratio was not calculable for this factor, given that there were no dislocations in hips with direct soft-tissue repair. Increasing age was associated with an increased odds of dislocation (odds ratio, 1.04, P = .017), with an effect likelihood ratio of 6.25 (P = .012).ConclusionsSwitching from a capsular repair to the greater trochanter to a side-to-side capsular repair was associated with a decreased rate of dislocation in primary THA through a posterior approach.

| S-EPMC7509067 | biostudies-literature

Revision of a Tronzo Total Hip Arthroplasty.

Project description:Revision total hip arthroplasty presents many challenges in regards to reconstructing or managing large amounts of bone loss and soft-tissue damage. Modern revision components, as well as techniques, have helped to address these challenges; however, the goal of any surgery is to provide the least amount of surgery with the most successful outcome. This case highlights a 74-year-old man with a Tronzo total hip arthroplasty placed over 50 years prior. He presented with subjective hip instability and radiographs demonstrating disassociation of the modular component. In an attempt to avoid more extensive and costly surgery, a custom-made all-polyethylene femoral head was used. This case illustrates the revision of likely one of the few Tronzo total hips remaining and the utility of obtaining a compassionate-use clearance from the Food and Drug Administration to create a custom piece, to minimize potential morbidity and mortality from extensive hip revision surgery.

| S-EPMC7225601 | biostudies-literature

MAASH Technique for Total Hip Arthroplasty: A Capsular Work.

Project description:BackgroundDislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure.PurposesModified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the "weak area" of the capsule, in the so called "internervous safe zone" and introducing the "box concept" for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier.MethodsFrom November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique.ResultsMAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development.ConclusionMAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.

| S-EPMC3757492 | biostudies-literature

Hip Capsular Plication With Crossed Mattress Stitch Configuration for a Revision Hip Arthroscopy in the Setting of Capsular Insufficiency.

Project description:The hip capsule is an important static stabilizer of the hip joint. Perioperative capsular management during hip-preservation surgery is critical to maintain hip stability. Many biomechanical and clinical studies have demonstrated the importance of performing a comprehensive capsular closure to restore normal hip kinematics. For this reason, capsular closure or plication is now routine practice for many hip arthroscopists. The purpose of the technique is to describe a capsular plication technique using a mattress stitch configuration performed in the revision setting.

| S-EPMC8355413 | biostudies-literature

Revision total hip arthroplasty for metal-on-metal failure.

Project description:Metal-on-metal (MoM) arthroplasty systems became popular in the early-2000s due to presumed advantages of improved wear characteristics and superior stability. However, subsequent reports of abnormal soft-tissue reactions to MoM implants and national registry data reporting high failure rates raised concerns. Early outcomes of revision total hip arthroplasty (THA) for adverse reaction to metal debris (ARMD) were poor, leading to development of surveillance programs and a trend towards early revision surgery. Patients with MoM arthroplasties require surveillance, comprehensive history and physical examination, imaging with ultrasound or magnetic resonance imaging (MRI), and laboratory evaluation including metal ion levels. Operative strategies for revision THA vary from exchange of modular components to extensive debridement and reconstruction with revision components. Surgeons should be aware of the increased risks of dislocation and infection following revision THA for ARMD. However, there is growing evidence that early revision surgery prior to extensive soft tissue destruction results in improved outcomes and decreased re-operation rates. It is estimated that >1 million MoM articulations have been implanted, with a large proportion still in situ. It is imperative to understand the aetiology, presentation, and management strategies for these patients to optimise their clinical outcomes.

| S-EPMC6985013 | biostudies-literature

The Hidden Cost of Revision Hip and Knee Arthroplasty.

Project description: Not available

| S-EPMC9249566 | biostudies-literature

Fast-track revision hip arthroplasty: a multicenter cohort study on 1,345 elective aseptic major component revision hip arthroplasties.

Project description:Background and purposeData on application of fasttrack/enhanced recovery protocols in revision hip arthroplasty (R-THA) surgery is scarce. We report length of stay (LOS), risk of LOS > 5 days, and readmission ≤ 90 days after revision hip arthroplasty in centers with a well-established fast-track protocol in both primary and revision procedures.Patients and methodsThis is an observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Hip Arthroplasty Register. Consecutive elective aseptic major component revision hip arthroplasties from 6 dedicated fast-track centers from 2010 to 2018 were included.Results1,345 R-THAs were analyzed, including 23% total revisions, 52% acetabular component revisions, and 25% femoral component revisions. Mean age was 70 years (SD 12) and 61% were female. Median LOS was 3 days (interquartile range [IQR] 2-6), decreasing from median 6 (IQR 3-10) days in 2010 to 2 (IQR 1-4) days in 2018. The 90-day readmission rate was 20%, but showed a fluctuating and increasing trend from 13% in 2010 to 28% in 2018. Risk factors for LOS > 5 days and readmission were use of walking aid, preoperative hemoglobin ≤ 13 g/dL, pharmacological treated psychiatric disorder, age ≥ 80 years, age 70-79 years (only LOS > 5 days), cardiac disease (only LOS > 5 days), pulmonary disease (only readmission), BMI ≥ 35 (only LOS > 5 days) and ≥ 1 previous revision (only LOS > 5 days).InterpretationLOS decreased to median 2 days at the end of the study period, but the 90 days readmission risk remained high (> 20%). Several risk factors for postoperative complications were identified, suggesting that at-risk patients should be treated using an extended fast-track/enhanced recovery protocol focusing on preoperative optimization and postoperative monitoring as well as surgical techniques to reduce hip dislocations.

| S-EPMC8865005 | biostudies-literature

Hemiarthroplasty and total hip arthroplasty in 30,830 patients with hip fractures: data from the Dutch Arthroplasty Register on revision and risk factors for revision.

Project description:Background and purpose - In the Netherlands about 40% of hip fractures are treated with a hemiarthroplasty (HA) or a total hip arthroplasty (THA). Although these procedures are claimed to have fewer complications than osteosynthesis (i.e., reoperation), complications still occur. Analyses of data from national registries with adequate completeness of revision surgery are important to establish guidelines to diminish the risk for revision. We identified risk factors for revision. Patients and methods - All patients older than 50 years of age with a hip fracture treated with arthroplasty by orthopedic surgeons and registered in the (national) Dutch arthroplasty register (LROI) were included in the study. In this register, patient characteristics and surgical details were prospectively collected. Revision surgery and reasons for revision were evaluated. A proportional hazard ratio model for revision was created using competing risk analysis (with death as competing risk). Results - 1-year revision rate of HA was (cumulative incidence function [CIF] 1.6% (95% CI 1.4-1.8) and THA 2.4% (CI 2.0-2.7). Dislocation was the most common reason for revision in both groups (HA 29%, THA 41%). Male sex, age under 80 years, posterolateral approach, and uncemented stem fixation were risk factors for revision in both THA and HA. THA patients with ASA classification III/IV were revised more often, whereas revision in the HA cohort was performed more often in ASA I/II patients. Interpretation - After arthroplasty of hip fractures, both a posterolateral approach and an uncemented hip stem have higher risks for revision surgery compared with an anterolateral approach and an cemented stem.

| S-EPMC6202728 | biostudies-literature

The influence of bearing surfaces on revisions due to dislocations in total hip arthroplasty.

Project description:IntroductionRecurrent dislocations are still the most frequent reason for revision in total hip arthroplasty (THA). The impact of bearing surfaces on dislocations is still controversial. We hypothesized that: (1) bearing surfaces influence the revisions due to dislocations; (2) ceramic-on-ceramic reduced the revisions for dislocations in adjusted models; (3) Delta-on-Delta bearings reduced the revisions for dislocations in comparison to surfaces with cross-linked polyethylene.Materials and methodsThe regional arthroplasty registry was enquired about bearing surfaces and revisions for dislocations and instability. Unadjusted and adjusted rates were provided, including sex, age (<65 years or ≥65 years), head diameter (≤28 mm or >28 mm; <36 mm or ≥36 mm) as variables. 44,065 THAs were included.ResultsThe rate of revisions for dislocations was significantly lower in ceramic-on-ceramic and metal-on-metal bearings (unadjusted rates). After adjusting for age, sex, and head size (36 and 28 mm), hard-on-hard bearings were protective (p < 0.05): ceramic-on-ceramic had a lower risk of revisions due to dislocation than ceramic-on-polyethylene (HR 1.6, 95% CI 1.2-2.2 p = 0.0009). The rate of revisions for dislocation was similar in bearings with cross-linked polyethylene and Delta-on-Delta articulations, in unadjusted and adjusted models.ConclusionBearings with conventional polyethylene were more predisposed to dislocations. Currently adopted bearings exerted no significant influence on revisions due to dislocations. These findings could be primarily related to wear, but due to the time distribution, soft tissue envelopes and surface tension may also play a role. Pre-clinical biomechanical evaluations and prospective matched cohort studies are required to draw definitive conclusions.

| S-EPMC8443492 | biostudies-literature

Occlusion of an Aortobifemoral Graft after Revision Total Hip Arthroplasty.

Project description:With the aging population, the demand for total hip arthroplasty is rising. Improvements in arthroplasty techniques and design allow for total hip arthroplasty to be increasingly performed in older patients and those with multiple comorbidities. Complications are rare in young and healthy patients; however, there is greater risk in patients with multiple medical comorbidities and those who have had prior revision procedures. Large-vessel thrombosis is an especially rare, but potentially devastating, complication, particularly in patients with existing major-vessel bypass grafts. Only 3 case reports of major-vessel graft occlusion after total hip arthroplasty have been reported in the literature, and none after revision. In this article, we report a case of occlusion of an aortobifemoral graft after revision total hip arthroplasty for periprosthetic joint infection.

| S-EPMC7920877 | biostudies-literature

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