The Lawrence D. Dorr Surgical Techniques & Technologies Award: Conversion Total Hip Arthroplasty: Is it a Primary or Revision Hip Arthroplasty

2016 ◽  
Vol 31 (9) ◽  
pp. 16-21 ◽  
Author(s):  
Mahta Baghoolizadeh ◽  
Ran Schwarzkopf
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Techniques ◽  
Revision Hip Arthroplasty ◽  
Total Hip

scholarly journals Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 15 ◽  
Author(s):  
Constant Foissey ◽  
Mathieu Fauvernier ◽  
Cam Fary ◽  
Elvire Servien ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operating Time ◽  
Surgical Techniques ◽  
Direct Anterior Approach ◽  
Clinical Results ◽  
Total Hip ◽  
Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

Long-term results of tripolar constrained total hip arthroplasty in revision hip arthroplasty

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 123-126 ◽  
Author(s):  
M. El-Husseiny ◽  
B. Masri ◽  
C. Duncan ◽  
D. S. Garbuz
Keyword(s):  
At Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Hip Arthroplasty ◽  
Long Term Results ◽  
Total Hip ◽  
Patients At Risk ◽  
Patient At Risk

AimsWe investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores.Patients and MethodsWe retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications.ResultsAt ten years, the Kaplan–Meier survivorship for dislocation was 95.6% (95% confidence interval (CI) 90 to 98), with 101 patients at risk. At 20 years, the survivorship for dislocation was 90.6% (95% CI 81.0 to 95.5), with one patient at risk. Eight patients (7.2%) had a dislocation of their constrained liners. At ten years, the survival to any event was 89.4% (95% CI 82 to 93.8), with 96 patients at risk. At 20 years, the survival to any event was 82.5% (95% CI 71.9 to 89.3), with one patient at risk. Five hips (4.4%) had deep infection. Two patients (1.8%) developed dissociated constraining rings with pain but without dislocation, which required re-operation. Two patients (1.8%) had periprosthetic femoral fractures, without dislocation, that were treated by revision stems along with exchange of the well-functioning constrained liners.ConclusionConstrained tripolar liners used at revision hip arthroplasty provided favourable results in the long term for treatment of recurrent dislocation and for patients at high risk of dislocation. Cite this article: Bone Joint J 2019;101-B(6 Supple B):123–126.

scholarly journals Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications

2019 ◽  
Vol 11 (6) ◽  
pp. 966-973 ◽  
Author(s):  
Xiao‐tong Shi ◽  
Chao‐feng Li ◽  
Yu Han ◽  
Ya Song ◽  
Shu‐xuan Li ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Dysplasia ◽  
Surgical Techniques ◽  
Total Hip ◽  
Type Iv

scholarly journals Postero-posterolateral approach in total hip arthroplasty

2020 ◽  
Vol 44 (12) ◽  
pp. 2577-2585
Author(s):  
Mokrane Ait Mokhtar
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Average Length ◽  
Surgical Techniques ◽  
Posterolateral Approach ◽  
Anatomical Landmarks ◽  
Rehabilitation Centre ◽  
Dual Mobility ◽  
Total Hip ◽  
The Stability

Abstract Introduction Evolving surgical techniques in total hip arthroplasty (THA) have sought to make the surgical procedures safer. This requires having highly reproducible incision landmarks and simplifying the procedures. The postero-posterolateral approach, a very posterior incision in the hip, meets those requirements. However, this has not helped to reduce the post-operative dislocation rate. The aim of this study was to assess the relevance of combining the postero-posterolateral approach and next-generation dual mobility cups (DMC) in terms of dislocation risk. Materials and methods One hundred and fifty-eight THA were performed consecutively using the postero-posterolateral approach on 150 patients, by a single surgeon, over a 49-month period (November 2010 to December 2014). All acetabular implants were impacted. Results Average length of the incision was 7 cm (6 to 9 cm). Mean duration of the surgical procedure was 75 minutes (40 to 100). Mean blood loss was estimated at 210 cc (25 to 410 cc). All patients could walk with assistance the day before transferring to a rehabilitation centre. There was one posterior dislocation (0.63%), without recurrence. Conclusion The straightforwardness and reproducibility of the anatomical landmarks used for the postero-posterolateral approach, added to the stability of the dual mobility cup, result in a safe combination in the therapeutic THA arsenal.

The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

2018 ◽  
Vol 02 (04) ◽  
pp. 194-204
Author(s):  
Hari Parvataneni ◽  
Luis Pulido ◽  
Hernan Prieto ◽  
Arnold Silverberg
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Clinical Success ◽  
The United States ◽  
Revision Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Hip Stability

AbstractThe concept of dual mobility (DM) bearings in total hip arthroplasty was first introduced by Professors Gilles Bousquet and Andre Rambert in France in 1974 with the goal of enhancing hip stability. Although DM did not receive U.S. Food and Drug Administration approval for commercial use in the United States until 2009, there has been a surge in popularity of DM implants over the past several years, evidenced by the American Joint Replacement Registry data. The enthusiasm for DM stems from a growing body of literature that supports its use across a range of patient populations, most notably revision hip arthroplasty and high-risk primary scenarios. DM has been shown to effectively reduce the risk of dislocation while also exhibiting excellent survivorship. DM does incur some unique risks, namely, intraprosthetic dissociation, but many of the early concerns with DM have not been realized in the literature and do not seem to negatively impact its long-term survivorship. The exact indications for DM have yet to be defined and remain a matter of debate. It should be considered as an alternative for any primary or revision hip arthroplasty at high risk for postoperative instability. In this article, the authors review the current literature regarding the clinical success of DM implants for a variety of indications, all of which predispose to hip instability. The history, basic biomechanics, modern designs, and unique complications are also discussed.

Reporting Surgical Site Infections Following Primary and Revision Hip Arthroplasty— One Size Does Not Fit All

2011 ◽  
Vol 32 (3) ◽  
pp. 296-297 ◽  
Author(s):  
LJ Worth ◽  
AL Bull ◽  
MJ Richards
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Revision Hip Arthroplasty ◽  
Total Hip ◽  
Clinical Phenomenon ◽  
Using Data ◽  
Healthcare Associated ◽  
Current Risk

The risk of surgical site infection (SSI) is greater after revision hip arthroplasty than after primary procedures. While this is accepted as a clinical phenomenon, standardized surveillance strategies for healthcare-associated infections, including SSIs, do not currently take this into consideration. Most notably, the National Nosocomial Infections Surveillance (NNIS) risk index for stratification does not differentiate between primary and revision surgeries. Using data from a single US center, Leekha et al. recently demonstrated that the risk for SSI was almost twice as high after revision total hip arthroplasty when compared to primary total hip arthroplasty and that risk was even greater when deep incisional or organ/space infections were analyzed. The objective of this study was to compare SSI rates following primary and revision hip arthroplasty in a much larger Australian population to determine whether differences are accounted for by current risk indexing.

scholarly journals The short-term outcome of hip revision arthroplasty with Trabecular Metal™ components and augments

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
L Noconjo ◽  
MB Nortje
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Trabecular Metal ◽  
Short Term ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Hip Revision ◽  
Total Hip

ABSTRACT BACKGROUND: Highly porous Trabecular Metal™ acetabular components are increasingly being used in revision hip arthroplasty as they facilitate ingrowth, provide a useful mechanism to deal with bone loss and may decrease the risk of infection. The purpose of this audit was to describe: 1) the total number of hip arthroplasty surgeries over Ave years, the ratio of revision to primary hip arthroplasty and indications for revision; 2) the short-term outcomes of revision hip arthroplasty with Trabecular Metal™ components and augments METHODS: A retrospective folder and radiograph review of all patients who had revision total hip arthroplasty (THA) at a tertiary level hospital from February 2012 to February 2017 was done RESULTS: There were 979 THAs performed over the period - 863 (87%) primary THAs, and 116 (12%) hip revision cases performed in 107 patients. Of the 116 (107 patients) hip revisions, there were seven (6%) re-revisions in Ave patients. The indications for revision were aseptic loosening 67 (59%), septic loosening 11 (10%), liner wear 18 (16%), periprosthetic fracture Ave (4%), other 15 (13%). Trabecular Metal™ was used for revision in 16 hips (14 patients), which is 14% of the total 116 revisions. There were ten females and four males with an average age of 61 years. The average duration of follow-up in this group was 18.5 months (1.5-39.2). In these 16 Trabecular Metal™ hips, there were three (19%) early failures of fixation due to technical errors CONCLUSION: In our institution, 12% of the arthroplasty is revision surgery. The indications for revision are similar to published literature. Trabecular Metal™ revisions had a 19% early failure rate due to technical error Level of evidence: Level 4 Keywords: Trabecular Metal™, augments, total hip arthroplasty, revision hip arthroplasty

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