scholarly journals Computer Navigation for Revision Total Hip Arthroplasty Reduces Dislocation Rates

10.29007/hftx ◽  
2019 ◽  
Author(s):  
Zlatan Cizmic ◽  
Kaitlin Carroll ◽  
Seth Jerabek ◽  
Wayne Paprosky ◽  
Peter Sculco ◽  
...  
Keyword(s):  
Computer Navigation ◽  
Computer Assisted Surgery ◽  
Final Analysis ◽  
Computer Assisted ◽  
Revision Total Hip Arthroplasty ◽  
Revision Tha ◽  
Edge Loading ◽  
Postoperative Dislocation ◽  
Causes Of Failure

INTRODUCTION: Computer-assisted hip navigation offers more accurate placement of hip components, potentially avoiding impingement, edge-loading, and dislocation; major causes of failure leading to revision THA. As such, the use of computer navigation may be particularly beneficial in the revision THA population. The purpose of this study was to determine if the use of computer-assisted hip navigation reduced the rate of dislocation in patients undergoing revision THA.METHODS: A retrospective review of 72 patients undergoing computer-navigated revision THA between February 2016 and May 2017 was performed. Demographics, indications for revision, type of procedure performed, and postoperative complications were collected for all patients. Clinical follow-up was recorded at 3-months, 1-year and 2-years.RESULTS: All 72 patients (48% female; 52% male) were included in the final analysis. Mean age of patients was 70.4 ± 11.2 years. Mean BMI was 26.4 ± 5.2 kg/m2. The most common indications for revision THA were instability (31%), aseptic loosening (29%), osteolysis/eccentric wear (18%), infection (11%), and miscellaneous (11%). At 3-months, 1-year, and 2-years there were no dislocations in any patients (0%). Compared to preoperative dislocation values, there was a significant reduction in the rate of dislocation with the use of computer-assisted hip navigation (31% vs. 0%; p<0.05).DISCUSSION: Our study demonstrates a significant reduction in the rate of dislocation following revision THA with the use of computer navigation. Although the cause of postoperative dislocation is often multifactorial, the use of computer-assisted surgery may help to curtail femoral and acetabular malalignment in revision THA.

Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

2019 ◽  
pp. 112070001987361 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Xabier Foruria ◽  
Ioar Urra ◽  
Urko Aguirre ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Total Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

scholarly journals Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mitsuyoshi Yamamura ◽  
Nobuo Nakamura ◽  
Hidenobu Miki ◽  
Takashi Nishii ◽  
Nobuhiko Sugano
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Cement ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Revision Tha ◽  
Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

scholarly journals Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hou-Tsung Chen ◽  
Cheng-Ta Wu ◽  
Tsan-Wen Huang ◽  
Hsin-Nung Shih ◽  
Jun-Wen Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Type Ii ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Press Fit ◽  
Cementless Cup ◽  
Revision Tha ◽  
Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

scholarly journals Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 7-11
Author(s):  
Massimo Franceschini ◽  
N Amir Sandiford ◽  
Vincenzo Cerbone ◽  
Lucio Cappelli Toledo de Araujo ◽  
Daniel Kendoff
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Short Term ◽  
Total Hip ◽  
Antibacterial Coating ◽  
Revision Tha ◽  
Detailed Function ◽  
New Strategies

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

Is there a problem with modular dual mobility acetabular components in revision total hip arthroplasty at mid-term follow-up?

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 66-72
Author(s):  
Nicholas M. Hernandez ◽  
Zoe W. Hinton ◽  
Christine J. Wu ◽  
Paul F. Lachiewicz ◽  
Sean P. Ryan ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Revision ◽  
Revision Total Hip Arthroplasty ◽  
Dual Mobility ◽  
Revision Thas ◽  
Revision Tha ◽  
Acetabular Components ◽  
Acetabular Loosening

Aims Modular dual mobility (MDM) acetabular components are often used with the aim of reducing the risk of dislocation in revision total hip arthroplasty (THA). There is, however, little information in the literature about its use in this context. The aim of this study, therefore, was to evaluate the outcomes in a cohort of patients in whom MDM components were used at revision THA, with a mean follow-up of more than five years. Methods Using the database of a single academic centre, 126 revision THAs in 117 patients using a single design of an MDM acetabular component were retrospectively reviewed. A total of 94 revision THAs in 88 patients with a mean follow-up of 5.5 years were included in the study. Survivorship was analyzed with the endpoints of dislocation, reoperation for dislocation, acetabular revision for aseptic loosening, and acetabular revision for any reason. The secondary endpoints were surgical complications and the radiological outcome. Results The overall rate of dislocation was 11%, with a six-year survival of 91%. Reoperation for dislocation was performed in seven patients (7%), with a six-year survival of 94%. The dislocations were early (at a mean of 33 days) in six patients, and late (at a mean of 4.3 years) in four patients. There were three intraprosthetic dissociations. An outer head diameter of ≥ 48 mm was associated with a lower risk of dislocation (p = 0.013). Lumbrosacral fusion was associated with increased dislocation (p = 0.004). Four revision THAs (4%) were further revised for aseptic acetabular loosening, and severe bone loss (Paprosky III) at the time of the initial revision was significantly associated with further revision for aseptic acetabular loosening (p = 0.008). Fourteen acetabular components (15%) were re-revised for infection, and a pre-revision diagnosis of reimplantation after periprosthetic joint infection (PJI) was associated with subsequent PJI (p < 0.001). Two THAs had visible metallic changes on the backside of the cobalt chromium liner. Conclusion When using this MDM component in revision THA, at a mean follow-up of 5.5 years, there was a higher rate of dislocation (11%) than previously reported. The size of the outer bearing was related to the risk of dislocation. There was a low rate of aseptic acetabular loosening. Longer follow-up of this MDM component and evaluation of other designs are warranted. Cite this article: Bone Joint J 2021;103-B(7 Supple B):66–72.

scholarly journals A Cadaveric Comparative Study on the Surgical Accuracy of Freehand, Computer Navigation, and Patient-Specific Instruments in Joint-Preserving Bone Tumor Resections

Sarcoma ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Sarah E. Bosma ◽  
Kwok Chuen Wong ◽  
Laurent Paul ◽  
Jasper G. Gerbers ◽  
Paul C. Jutte
Keyword(s):  
Computer Navigation ◽  
Computer Assisted Surgery ◽  
Patient Specific ◽  
Computer Assisted ◽  
Oncologic Surgery ◽  
Engineering Software ◽  
Patient Specific Instrumentation ◽  
Quality Control Tool ◽  
Patient Specific Instruments ◽  
Intraoperative Quality Control

Orthopedic oncologic surgery requires preservation of a functioning limb at the essence of achieving safe margins. With most bone sarcomas arising from the metaphyseal region, in close proximity to joints, joint-salvage surgery can be challenging. Intraoperative guidance techniques like computer-assisted surgery (CAS) and patient-specific instrumentation (PSI) could assist in achieving higher surgical accuracy. This study investigates the surgical accuracy of freehand, CAS- and PSI-assisted joint-preserving tumor resections and tests whether integration of CAS with PSI (CAS + PSI) can further improve accuracy. CT scans of 16 simulated tumors around the knee in four human cadavers were performed and imported into engineering software (MIMICS) for 3D planning of multiplanar joint-preserving resections. The planned resections were transferred to the navigation system and/or used for PSI design. Location accuracy (LA), entry and exit points of all 56 planes, and resection time were measured by postprocedural CT. Both CAS + PSI- and PSI-assisted techniques could reproduce planned resections with a mean LA of less than 2 mm. There was no statistical difference in LA between CAS + PSI and PSI resections (p=0.92), but both CAS + PSI and PSI showed a significantly higher LA compared to CAS (p=0.042 and p=0.034, respectively). PSI-assisted resections were faster compared to CAS + PSI (p<0.001) and CAS (p<0.001). Adding CAS to PSI did improve the exit points, however not significantly. In conclusion, PSI showed the best overall surgical accuracy and is fastest and easy to use. CAS could be used as an intraoperative quality control tool for PSI, and integration of CAS with PSI is possible but did not improve surgical accuracy. Both CAS and PSI seem complementary in improving surgical accuracy and are not mutually exclusive. Image-based techniques like CAS and PSI are superior over freehand resection. Surgeons should choose the technique most suitable based on the patient and tumor specifics.

Papilla Formation in Response to Computer-Assisted Implant Surgery and Immediate Restoration

2015 ◽  
Vol 41 (4) ◽  
pp. 459-466 ◽  
Author(s):  
Paul A. Schnitman ◽  
Chie Hayashi
Keyword(s):  
Contact Point ◽  
Computer Assisted Surgery ◽  
Computer Assisted ◽  
Outer Diameter ◽  
Papilla Formation ◽  
Bone Level ◽  
Immediate Implant ◽  
Edentulous Patients ◽  
Implant Restoration

This retrospective analysis was undertaken to evaluate the effect of immediate implant restoration using a computer-assisted technique in partially edentulous sites on interimplant and intertooth bone level stability and papilla formation. Nine partially edentulous patients received a total of 23 implants that supported immediately placed implant restorations. Planning was accomplished using a radiographic guide, which allowed visualization of the emergence profile from the platform of the implant to the cervical of the planned restoration. Guided implants were placed according to the manufacturer's instructions, and restorations were screw retained directly to the implant. Multiple implants were splinted at surgery with autopolymerizing resin. Measurements were made at a mean of 545 days (range 288–958) postoperatively on the basis of radiographs and photographs. Measures were: (1) distance from bone crest to platform, (2) bone crest to contact point, (3) interimplant distance at the outer diameter of the platform, and (4) papilla from highest point to a reference line. At follow-up time, the bone ridge was located higher than the implant platform (mean 0.57 mm) compared to implants whose interimplant distance was less than 3 mm (mean 0.27 mm). Mean increase of the bone level between insertion and approximate 1-year follow-up was 0.047 mm. The mean distance from the contact point to bone was 2.39/3.93 mm postoperatively, resulting in 91/71% papilla fill between implants and between implant and adjacent tooth, respectively. Computer-assisted surgery with the preplanned immediate restoration seems to be an effective method to minimize bone loss at the implant platform resulting in support for papilla.

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