Authors
Dzhodzhua A.V., Kuzmin P.D., Pimanchev O.V., Ryapolov Yu.V.
Pirogov National Medical and Surgical Center, Moscow
Abstract
The aim of the research was to develop a technique that improves the results of surgical treatment of dislocations of the femoral head component of the hip endoprosthesis.
Materials and methods: The study included 64 patients who suffered from head dislocation after hip arthroplasty. For the treatment of patients of the first group, a technique was used in which the installation and fixation of the anti-luxation ring (“visor”) was performed screws to the existing cup or polyethylene insert of the endoprosthesis, which leads to the closure of the spherical head of the endoprosthesis in the pelvic component, which makes it impossible to separate them, thereby preventing dislocation of the endoprosthesis head for a long time. Patients of the second group were treated with other surgical methods.
Results and conclusion: Patients of the two groups were followed up for 24 months after the revision surgery. In the first group (26 patients), 2 cases of complications occurred – relapse of dislocation (7.7%). In the second group(38 patients), repeated dislocation occurred in 6 (15.8%); in one case, fubular neuritis occurred.
The developed technology, in which the device is fixed to the already installed parts of the endoprosthesis, will avoid a larger volume of surgery associated with the removal of well-fixed components of the endoprosthesis. If the surgeon, during a revision operation associated with dislocation of the head of the endoprosthesis, considers it possible to preserve the stably fixed components of the endoprosthesis, the method of choice may be the use of the proposed anti-luxation device.
Keywords: hip replacement, coxarthrosis, dislocation of the head of the hip replacement.
References
1. Kunutsor SK, Barrett MC, Beswick AD, et al. Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements. Lancet Rheumatol. 2019; 1(2): E111-E121. doi: 10.1016/S2665-9913(19)30045-1.
2. Peleganchuk AV, Turgunov EN, Mushkachev EA, et al. The influence of spinal-pelvic relationships on late dislocation of the head of the femoral component of the endoprosthesis after total hip arthroplasty. Spine Surgery. 2022; 19(1): 63-70. (In Russ.)
3. Maciej K, Grzegorz S, Wiesław T, Paweł M. Narrative Review of the Mechanism of Hip Prosthesis Dislocation and Methods to Reduce the Risk of Dislocation. Medical Science Monitor. 2022; 28: e935665. doi: 10.12659/MSM.935665.
4. Hao W, Jin-Feng L, Fengjing W, et al. A comparison of the clinical efficacy of total hip arthroplasty via direct anterior approach and posterior approach: A meta-analysis. Medicine (Baltimore). 2024; 103(32): e39237. doi: 10.1097/MD.0000000000039237.
5. Guide to hip arthroplasty R.M. Tikhilov, V.M. Shapovalov, editors. SPb: RNIITO im. R.P. Vreden, 2008. Р.63-64. (In Russ.)
6. Takashi T, Kenichi O, Hirokazu I, et al. Treatment strategies for recurrent dislocation following total hip arthroplasty: relationship between cause of dislocation and type of revision surgery. BMC Musculoskelet Disord. 2023; 24(1): 238. doi: 10.1186/s12891-023-06355-4. doi: 10.1186/s12891-023-06355-4.
7. Adolph VL, Joanne BA. Use of a Novel Reverse Hip Replacement System to Address Dislocation and Instability. Surg Technol Int. 2024: 44: 263-270. doi: 10.52198/24.STI.44.OS1798.
8. Kagramanov SV. Revision hip arthroplasty (problems, solutions). [dissertation] M; 2017. (In Russ.)
9. Patent RUS №2589612 C1. Varfolomeev D.I. Hip joint endoprosthesis. (In Russ.)
10. Girard J, Kern G, Migaud H, et al. Société française de chirurgie orthopédique et traumatologique. Primary total hip arthroplasty revision due to dislocation: prospective French multicenter study. Orthop Traumatol Surg Res. 2013; 99(5): 549-553. doi: 10.1016/j.otsr.2013.03.026.
11. Tsed AN, Mushtin NE, Dulaev AK, Shmelev AV. Use of dual mobility endoprostheses in patients with unsatisfactory treatment outcomes for trochanteric fractures fixed with a sliding hip screw system (SHS). Bulletin of Surgery. 2022; 181(1): 41-48. (In Russ.) doi: 10.24884/0042-4625-2022-181-1-41-48.
12. Efimov NN, Stafeev DV, Lasunsky SA, et al. Use of connected liners and dual mobility systems for the prevention of dislocations in revision hip arthroplasty. Journal of Traumatology and Orthopedics of Russia. 2018; 24(3): 22. (In Russ.) doi: 10.21823/2311-9505-2018-24-3-22-33.
13. Matteo R, Alberto G, Giuseppe GC, et al. The efficacy of dual-mobility cup in preventing dislocation after total hip arthroplasty: a systematic review and meta-analysis of comparative studies. Int Orthop. 2019; 43(5): 1071-1082. doi: 10.1007/s00264-018-4062-0.
14. Ragna CJ, et al. Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res. 2020; 106(3): 509-517. doi: 10.1016/j.otsr. 2019.12.019.
15. Mohammad P, Sahar Z, Mohammadreza R, et al. The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression. Arch Orthop Trauma Surg. 2024; 144(2): 947-966. doi: 10.1007/s00402-023-05087-3.
16. Callaghan JJ, Liu SS, Schularick NM. Shell retention with a cemented acetabular liner, Orthopedic, 2009.
17. Olerud S, Karlström G. Recurrent dislocation after total hip replacement. Treatment by fixing an additional sector to the acetabular component. J Bone Joint Surg Br. 1985; 67(3): 402-5. doi: 10.1302/0301-620X.67B3.3997949.
18. Kamath S, Campbell A. Acetabular Augmentation Using a Second Cup during Revision Hip Arthroplasty: An Unusual Case Report. J Orthop Surg (Hong Kong). 2005; 13(2): 207-10. doi: 10.1177/230949900501300221.
19. Miki H, Sugano N, Yonenobu K, et al. Detecting cause of dislocation after total hip arthroplasty by patient-specific four-dimensional motion analysis. Clin Biomech (Bristol, Avon). 2013; 28(2): 182-186. doi: 10.1016/ j.clinbiomech.2012.11.009.
