The use of a constrained acetabular component to treat instability after total hip arthroplasty.

BACKGROUND Recurrent dislocation after total hip arthroplasty is a disabling complication that can be difficult to treat and may not be amenable to nonoperative management. The purpose of the present study was to evaluate the clinical and radiographic outcome associated with the use of a constrained acetabular component as a salvage treatment for instability after hip arthroplasty. METHODS We retrospectively reviewed the clinical and radiographic outcome of 110 arthroplasties, in 109 patients, that had been performed with use of a single design of constrained acetabular component. In seventy-nine hips the constrained component was implanted for the treatment of recurrent instability, and in thirty-one hips it was implanted because of absent or grossly deficient soft-tissue attachments that were believed to be associated with a high risk for subsequent instability. RESULTS The constrained acetabular device eliminated or prevented hip instability in all patients except two, who continued to have sensations of subluxation. The mean Harris hip score improved significantly, from 62.7 points preoperatively to 76.4 points at the time of the latest follow-up (p < 0.0001). There were no instances of dislocation or disassembly of the hip components. Radiographic analysis revealed radiolucent lines around the cup in fifteen hips (14%). There was a total of nine revisions: six for deep infection, two for acetabular component loosening, and one for a periprosthetic fracture of the femur. CONCLUSIONS A constrained acetabular component reliably restores and maintains hip stability in patients with recalcitrant recurrent instability and can dependably prevent dislocation in those who are at high risk because of absent or deficient soft tissues about the hip. However, because of the early appearance of radiolucent lines around some components and concerns about long-term fixation, the use of these devices should be reserved for situations in which other methods are inadequate or have already failed.

[1]  B F Morrey,et al.  Bipolar Hip Arthroplasty as a Salvage Treatment for Instability of the Hip* , 2000, The Journal of bone and joint surgery. American volume.

[2]  T. Brown,et al.  Salvage of a Recurrently Dislocating Total Hip Prosthesis with Use of a Constrained Acetabular Component. A Retrospective Analysis of Fifty-six Cases* , 1998, The Journal of bone and joint surgery. American volume.

[3]  B F Morrey,et al.  The Elevated-Rim Acetabular Liner in Total Hip Arthroplasty: Relationship to Postoperative Dislocation* , 1996, The Journal of bone and joint surgery. American volume.

[4]  H. Skinner,et al.  Constrained acetabular components. , 1994, The Journal of arthroplasty.

[5]  B F Morrey,et al.  Operative correction of an unstable total hip arthroplasty. , 1992, The Journal of bone and joint surgery. American volume.

[6]  M. Ries,et al.  Bipolar hip arthroplasty for recurrent dislocation after total hip arthroplasty. A report of three cases. , 1992, Clinical orthopaedics and related research.

[7]  D. Murray.  Impingement and loosening of the long posterior wall acetabular implant. , 1992, The Journal of bone and joint surgery. British volume.

[8]  R. Brumback,et al.  Functional evaluation of the shoulder after transfer of the vascularized latissimus dorsi muscle. , 1992, The Journal of bone and joint surgery. American volume.

[9]  R. Mollan,et al.  A prosthesis augmentation device for the prevention of recurrent hip dislocation. A preliminary report. , 1991, Clinical orthopaedics and related research.

[10]  C. Engh,et al.  Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. , 1990, Clinical orthopaedics and related research.

[11]  B F Kavanagh,et al.  Multiple revisions for failed total hip arthroplasty not associated with infection. , 1987, The Journal of bone and joint surgery. American volume.

[12]  J P Conaty,et al.  Classification and treatment of dislocations of total hip arthroplasty. , 1983, Clinical orthopaedics and related research.

[13]  B F Morrey,et al.  Dislocations after total hip arthroplasty. , 1982, The Journal of bone and joint surgery. American volume.

[14]  W H Harris,et al.  Femoral component loosening using contemporary techniques of femoral cement fixation. , 1982, The Journal of bone and joint surgery. American volume.

[15]  J. Perry,et al.  The functional cost of dislocation following total hip arthroplasty. , 1982, Clinical orthopaedics and related research.

[16]  B. Wroblewski,et al.  Revision of the Charnley low-friction arthroplasty for recurrent or irreducible dislocation. , 1981, The Journal of bone and joint surgery. British volume.

[17]  H. Amstutz,et al.  "Modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. , 1979, Clinical orthopaedics and related research.

[18]  F. Stinchfield,et al.  THE CLASSIC: Dislocation and Instability Complicating Low Friction Arthroplasty of the Hip Joint , 1976, Clinical orthopaedics and related research.

[19]  J. Charnley,et al.  Radiological demarcation of cemented sockets in total hip replacement. , 1976, Clinical orthopaedics and related research.

[20]  M. B. Coventry,et al.  Complications of total hip arthroplasty treated by reoperation. , 1975, The Journal of bone and joint surgery. American volume.

[21]  D. Berry.  Unstable total hip arthroplasty: detailed overview. , 2001, Instructional course lectures.

[22]  R. Poss,et al.  Trochanteric advancement for recurrent dislocation after total hip arthroplasty. , 1987, The Journal of arthroplasty.

[23]  S. Haraldsson.  [Joint replacement (arthroplasty)]. , 1972, Timarit Hjukrunarfelags Islands.