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Deutsches Arzteblatt International Dec 2014Hip replacement ranks among the more successful operations on the musculoskeletal system, but it can have serious complications. A common one is dislocation of the total... (Review)
Review
BACKGROUND
Hip replacement ranks among the more successful operations on the musculoskeletal system, but it can have serious complications. A common one is dislocation of the total hip endoprosthesis, an event that arises in about 2% of patients within 1 year of the operation. Physicians should be aware of how this problem can be prevented and, if necessary, treated, so that the degree of trauma due to hip dislocation after hip replacement surgery can be kept to a minimum.
METHODS
The authors searched Medline selectively for pertinent publications and analyzed the annual reports of international endoprosthesis registries.
RESULTS
The rate of dislocation of primary hip replacements ranges from 0.2% to 10% per year, while that of artificial hip joints that have already been surgically revised can be as high as 28%, depending on the patient population, the follow-up interval, and the type of prosthesis. Patient-specific risk factors for displacement of a hip endoprosthesis include advanced age, accompanying neurologic disease, and impaired compliance. Patients should scrupulously avoid hip movements such as bending far forward from a standing position, or internal rotation of the flexed hip. Operation-specific risk factors include suboptimal implant position, insufficient soft-tissue tension, and inadequate experience of the surgeon. Conservative treatment is justified the first time dislocation occurs without any identifiable cause. If a mechanical cause of instability is found, then operative revision should be performed as recommended in a standardized treatment algorithm, because, otherwise, dislocation is likely to recur.
CONCLUSION
The dislocation of a total hip endoprosthesis is an emotionally traumatizing event that should be prevented if possible. Preoperative risk assessment should be performed and the operation should be performed with optimal technique, including the best possible physical configuration of implant components, soft-tissue balance, and an adequately experienced orthopedic surgeon.
Topics: Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Prosthesis; Humans; Immobilization; Physical Therapy Modalities; Reoperation
PubMed: 25597367
DOI: 10.3238/arztebl.2014.0884 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Femoral stem modularity in hip replacement was first developed to connect a ceramic head to the stem, then extended to metal heads using the Morse taper principle. Is it... (Review)
Review
Femoral stem modularity in hip replacement was first developed to connect a ceramic head to the stem, then extended to metal heads using the Morse taper principle. Is it a good thing, or a necessary evil? It contributes to improving lower limb length and lateralization setting, at the cost of fairly rare complications such as dissociation and fretting corrosion, which can exceptionally lead to ARMD (Adverse Reaction to Metal Debris). Modular necks were later recommended, with a double Morse taper: cylindrical for the head junction, and more or less flattened for the stem. Is this one modularity too far? Dual modularity in theory perfectly reproduces the biomechanical parameters of the hip, but is unfortunately associated with fractures and severe corrosion, leading to ARMD and pseudotumor, especially in Cr-Co necks. Moreover, it provides no functional advantage, and no longer has a role outside dysplasia and other femoral deformities. Metaphyseal-diaphyseal modularity is not widespread in primary implants, and is it really necessary? Only one model has been widely studied: S-Rom™ (Depuy®). It features a metaphyseal sleeve adapting to the anatomy of the proximal femur, with a stem fitted via an inverse Morse taper. Its only interest is in case of congenital dislocation; like all metal connections, it incurs a risk of fracture and corrosion. On the other hand, modularity is widely employed in revision implants. Does it really help these procedures? The connection between a proximal femoral component of variable geometry and a diaphyseal stem with press-fit distal fixation provides a real solution to problems of length, lateralization and anteversion. Early models encountered high rates of fracture, but current implants and rigorous surgical technique have reduced this risk. Corrosion is a less serious problem, as the Morse taper undergoes only axial stress, without the friction undergone by other models subject to varus stress.
Topics: Arthroplasty, Replacement, Hip; Ceramics; Corrosion; Femur; Hip Prosthesis; Humans; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 31624033
DOI: 10.1016/j.otsr.2019.05.019 -
Medical Science Monitor : International... Jun 2022Total hip arthroplasty (THA) is one of the most effective surgical procedures. It improves quality of life, increases range of motion, and reduces pain in patients with... (Review)
Review
Total hip arthroplasty (THA) is one of the most effective surgical procedures. It improves quality of life, increases range of motion, and reduces pain in patients with hip joint degeneration. THA allows patients to return to everyday social and professional activities. Therefore, today it is the best approach to treatment of several chronic conditions affecting the hip joint, including advanced degenerative diseases, avascular necrosis, and some traumatic events. The aim of this study was to present the mechanism of hip prosthesis dislocation, associated risk factors, and the factors reducing the risk of dislocation, as well as its consequences and methods of risk minimization. Hip dislocation is a common complication following THA. It is responsible for up to 2% to 3% failures of primary replacements, increasing even to 10% in extreme cases of patients highly predisposed to this condition. In most cases, technical errors during implant placement are responsible for the incidence. The measures taken to prevent complications include activities aimed at correct implant insertion and the selection of the most appropriate type of implant for the patient, depending on individual needs. We summarized the current knowledge of implant dislocation to help surgeons understand the changes in biomechanics of the hip after its replacement and the impact of each particular element that participates in it. This knowledge can enable a surgeon choose the most favorable surgical method and the most appropriate implant to reduce the risk of implant dislocation.
Topics: Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Prosthesis; Humans; Joint Dislocations; Prosthesis Failure; Quality of Life; Reoperation; Retrospective Studies; Risk Factors
PubMed: 35715941
DOI: 10.12659/MSM.935665 -
Acta Orthopaedica Jun 2020
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis
PubMed: 32406288
DOI: 10.1080/17453674.2020.1763566 -
The Journal of Bone and Joint Surgery.... Nov 2012The differential diagnosis of the painful total hip arthroplasty (resurfacing or total hip) includes infection, failure of fixation (loosening), tendinitis, bursitis,... (Review)
Review
The differential diagnosis of the painful total hip arthroplasty (resurfacing or total hip) includes infection, failure of fixation (loosening), tendinitis, bursitis, synovitis, adverse local tissue reaction (ALTR) to cobalt-chromium alloys, and non-hip issues, such as spinal disorders, hernia, gynecologic, and other pelvic pain. Assuming that the hip is the source of pain, the first level question is prosthetic or non-prosthetic pain generator? The second level prosthetic question is septic or aseptic? The third level question (aseptic hips) is well-fixed or loose? ALTR is best diagnosed by cross-sectional imaging. Successful treatment is dependent on correct identification and elimination of the pain generator. Treatment recommendations for ALTR and taper corrosion are evolving.
Topics: Arthroplasty, Replacement, Hip; Diagnosis, Differential; Hip Prosthesis; Humans; Pain, Postoperative; Postoperative Complications; Prosthesis Failure; Prosthesis-Related Infections
PubMed: 23118382
DOI: 10.1302/0301-620X.94B11.30825 -
The Journal of Arthroplasty Sep 2018Adverse local tissue reactions to corrosion products can lead to total hip arthroplasty failure. Although this problem has been well known for more than 25 years, it has... (Review)
Review
Adverse local tissue reactions to corrosion products can lead to total hip arthroplasty failure. Although this problem has been well known for more than 25 years, it has seemingly increased in frequency over the recent years. The occurrence of corrosion is multifactorial-depending on implant, patient, and surgeon factors. As of now, there is no "one-size-fits-all" solution to prevent corrosion in total hip arthroplasty devices. Thus, it is imperative to fully understand the exact mechanisms of modular junction corrosion to prevent premature implant failure. This review highlights a few key concepts that need to be explored to minimize the impact of corrosion. The key concepts include (1) the prevention of micromotion, (2) the role of implant alloy metallurgy in the corrosion process, (3) the in vivo generation of a corrosive environment, and (4) potential unanticipated problems.
Topics: Alloys; Arthroplasty, Replacement, Hip; Corrosion; Hip Prosthesis; Humans; Materials Testing; Movement; Prosthesis Design; Prosthesis Failure
PubMed: 29705684
DOI: 10.1016/j.arth.2018.03.055 -
Acta Orthopaedica Oct 2005
Topics: Arthroplasty, Replacement, Hip; Biomechanical Phenomena; Hip Prosthesis; Humans; Orthopedics; Research
PubMed: 16263605
DOI: 10.1080/17453670510041664 -
Acta Orthopaedica 2016
Topics: Alloys; Arthroplasty, Replacement, Hip; Female; Hip Joint; Hip Prosthesis; Humans; Male; Prosthesis Failure; Radiography; Titanium
PubMed: 26854321
DOI: 10.3109/17453674.2016.1146511 -
BMJ (Clinical Research Ed.) Feb 2005
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Practice Guidelines as Topic; Prosthesis Design; Technology Assessment, Biomedical
PubMed: 15705668
DOI: 10.1136/bmj.330.7487.318 -
The Bone & Joint Journal May 2017
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Joint Instability; Prosthesis-Related Infections; Reoperation; Salvage Therapy
PubMed: 28455462
DOI: 10.1302/0301-620X.99B5.38087