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Acetabular Lip Augmentation Devices for the Unstable Total Hip Replacement—A Systematic Review

ABSTRACT:

Background

The optimal management strategy for instability afte total hip arthroplasty remains unclear. Acetabular lip augmentation devices may offer an operative solution for recurrent instability. This systematic review reports the clinical outcomes of acetabular lip augmentation devices in comparison to other treatment options.

Methods

A literature search strategy was performed of Medline, EMBASE, and CENTRAL on September 19, 2020, for all studies reporting outcomes of acetabular lip augmentation devices for recurrent dislocation after total hip arthroplasty. Non-English language articles were excluded. Clinical and survivorship data were collated and analyzed.

Results

Thirteen studies describing acetabular augmentation were included for analysis. A total of 644 hips in 636 patients were augmented with a mean age of 75 years (39 to 103). Five different augmentation devices were used. The posterior lip augmentation device (PLAD, DePuy) was the most used (406 hips). Overall, acetabular lip augmentation devices had a 10% postoperative dislocation rate at a mean follow-up of 49 months (0.2 to 132). The PLAD had a 3.9% subsequent dislocation rate with a mean follow-up of 51 months (0.2 to 132). Only one study compared the PLAD to a dual-mobility cup, which demonstrated shorter operative times with the PLAD but higher rates of dislocation and revision surgery.

Conclusion

The quality of literature on lip acetabular augmentation devices is poor. In these studies, the postoperative dislocation rate after lip acetabular augmentation was relatively high. The PLAD (DePuy) has the most evidence and may offer a therapeutic option for recurrent instability, in very specific clinical situations.

SUBMITTER: McCabe F

PROVIDER: S-EPMC8567156 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PURPOSE:Posttraumatic arthritis (PTA) may develop years after acetabular fracture, hindering joint function and causing significant chronic musculoskeletal pain. Given the delayed onset of PTA, few studies have assessed outcomes of delayed total hip arthroplasty (THA) in acetabular fracture patients. This study systematically reviewed the literature for outcomes of THA in patients with PTA and prior acetabular fracture. METHODS:Pubmed, EMBASE, SCOPUS, and Cochrane library were searched for articles containing the keywords "acetabular", "fracture", "arthroplasty", and "post traumatic arthritis" published between 1995 and August 2017. Studies with less than 10 patients, less than 2 years of follow-up, conference abstracts, and non-English language articles were excluded. Data on patient demographics, surgical characteristics, and outcomes of delayed THA, including implant survival, complications, need for revision, and functional scores, was collected from eligible studies. RESULTS:With 1830 studies were screened and data from 10 studies with 448 patients were included in this review. The median patient age on date of THA was 51.5 years, ranging from 19 to 90 years. The median time from fracture to THA was 37 months, with a range of 27-74 months. Mean follow-up times ranged from 4 to 20 years. The mean Harris hip scores (HHS) improved from 41.5 pre-operatively, to 87.6 post-operatively. The most prevalent postoperative complications were heterotopic ossification (28%-63%), implant loosening (1%-24%), and infection (0%-16%). The minimum 5-year survival of implants ranged from 70% to 100%. Revision rates ranged from 2% to 32%. CONCLUSION:Despite the difficulties associated with performing THA in patients with PTA from previous acetabular fracture (including soft tissue scarring, existing hardware, and acetabular bone loss) and the relatively high complication rates, THA in patients with PTA following prior acetabular fracture leads to significant improvement in pain and function at 10-year follow-up. Further high quality randomized controlled studies are needed to confirm the outcomes after delayed THA in these patients.

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