Bipolar Hip Arthroplasty as a Salvage Treatment for Instability of the Hip*

Background: Recurrent instability of the hip in the absence of an identifiable cause is a challenging problem. It has been proposed that bipolar hip arthroplasty may have a role in the treatment of these complex cases. The purpose of our study was to evaluate the results of bipolar hip arthroplasty for the treatment of recurrent instability of the hip in a series of patients at our institution. Methods: We reviewed the records of twenty-seven patients who had undergone bipolar hip arthroplasty as a salvage procedure for the treatment of recurrent instability of the hip after total hip replacement. All patients had undergone at least two, and a mean of three, stabilizing operative procedures on the hip prior to the bipolar arthroplasty. The mean duration of follow-up was five years (range, two to twelve years), with no patient lost to follow-up. There were six deaths, of unrelated causes. Results: Bipolar arthroplasty prevented redislocation in twenty-two hips (81 percent). At the time of final follow-up, twenty-five patients (93 percent) had a stable hip. Five patients (19 percent) had had episodes of subluxation or dislocation following the bipolar arthroplasty. Two of these patients had only a single episode of dislocation that was treated successfully by immobilization. Two of the remaining three patients required a reoperation because of the instability. The hip was stabilized with the use of a constrained cup prosthesis in one of these patients, and the other patient eventually required resection arthroplasty. The third patient had continuing instability but improved function and pain relief, and a reoperation was not performed. There were a total of seven reoperations; these included revision because of disassembly of the cup in one hip, revision bipolar arthroplasty because of continuing instability in two, resection arthroplasty because of deep infection in two, revision arthroplasty because of recalcitrant groin pain in one, and revision arthroplasty because of deep infection and superior migration of the implant in one. The Harris hip score improved significantly, from a mean of 24 points (range, 5 to 45 points) preoperatively to a mean of 55 points (range, 35 to 80 points) postoperatively (p < 0.05). Conclusions: We believe that, despite some potential problems, bipolar hip arthroplasty can have a role in the salvage management of recurrent instability of the hip in patients in whom other stabilization procedures have failed.

[1]  D Resnick,et al.  Evaluation of acetabular anteversion following total hip arthroplasty: necessity of proper centring. , 1975, The British journal of radiology.

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

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

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

[5]  P. Pellicci,et al.  Bipolar hemiarthroplasty for fracture of the femoral neck. Clinical review with special emphasis on prosthetic motion. , 1988, The Journal of bone and joint surgery. American volume.

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

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

[8]  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.

[9]  D G Lewallen,et al.  Use of bipolar endoprosthesis and bone grafting for acetabular reconstruction. , 1991, Clinical orthopaedics and related research.

[10]  J R Roberson,et al.  Bipolar Components for Severe Periacetabular Bone Loss Around the Failed Total Hip Arthroplasty , 1990, Clinical orthopaedics and related research.

[11]  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.

[12]  P. D. Wilson,et al.  Revision total hip arthroplasty. , 1982, Clinical orthopaedics and related research.

[13]  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.

[14]  E. Y. Chao,et al.  Biomechanics of bipolar hip endoprostheses , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

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

[16]  G. Verberne.  A femoral head prosthesis with a built-in joint. A radiological study of the movements of the two components. , 1983, The Journal of bone and joint surgery. British volume.

[17]  R. Beckenbaugh,et al.  2,012 total hip arthroplasties. A study of postoperative course and early complications. , 1974, The Journal of bone and joint surgery. American volume.

[18]  H. Amstutz,et al.  Tripolar hip replacement for recurrent prosthetic dislocation. , 1994, Clinical orthopaedics and related research.

[19]  P. Langan.  Bipolar hemiarthroplasty for fracture of the femoral neck. , 1989, Clinical orthopaedics and related research.

[20]  M. B. Coventry.  Late dislocations in patients with Charnley total hip arthroplasty. , 1985, The Journal of bone and joint surgery. American volume.

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

[22]  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.

[23]  M. Ritter,et al.  Dislocation and subluxation of the total hip replacement. , 1976, Clinical orthopaedics and related research.

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

[25]  P. Langan.  The Giliberty bipolar prosthesis: a clinical and radiographical review. , 1979, Clinical orthopaedics and related research.

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

[27]  D J Schurman,et al.  Range of motion studies for total hip replacements. A comparative study with a new experimental apparatus. , 1975, Clinical orthopaedics and related research.

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

[29]  R. Poss,et al.  Dislocation in total hip arthroplasties. , 1980, Clinical orthopaedics and related research.

[30]  K. Mitchell,et al.  The movements of the components of the Hastings bipolar prosthesis. A radiographic study in 65 patients. , 1989, The Journal of bone and joint surgery. British volume.

[31]  B. Mogensen,et al.  Socket wall addition for dislocating total hip. Report of two cases. , 1986, Acta orthopaedica Scandinavica.

[32]  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.

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

[34]  W. Harris,et al.  Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. , 1969, The Journal of bone and joint surgery. American volume.