Abstract
Purpose
Total hip arthroplasty (THA) has been efficacious for treating hip fractures in healthy older patients. However, in those patients with fractures a widely variable prevalence of dislocation has been reported, partly because of varying durations of follow up for this specific end-point. The purpose of the present study was to determine the cumulative risk of dislocation in these patients with fractures and to investigate if retentive cups decrease the risk of dislocation.
Methods
Between 2000 and 2005, 325 patients with neck fracture underwent primary THA using a retentive (325 hips) cup. The results of these 325 acetabular cups were compared to 180 THA without retentive cups performed for neck fractures in the same hospital between 1995 and 2000 by the same surgical team. The mean age of the 505 patients was 75 years (range 65–85). All patients were followed for a minimum of five years for radiographic evidence of implant failure. The patients were followed at routine intervals and were specifically queried about dislocation. The cumulative risk of dislocation and recurrent dislocation was calculated with use of the Kaplan–Meier method.
Results
For patients without retentive cups, the cumulative risk of a first-time dislocation was 5 % at one month and 12 % at one year and then rose at a constant rate of approximately 1 % every year to 16 % at five years. For patients with retentive cups, the cumulative risk of a first-time dislocation was 1 % at one month, 2 % at one year and then did not changed at five years. There were no differences in the mortality rates or in loosening rates among the treatment groups. The rate of secondary surgery was highest in the group without retentive (10 % for recurrent dislocation) compared with 1 % in the group treated with retentive cups. In absence of retentive cups, multivariate analysis revealed that the relative risk of dislocation for female patients (as compared with male patients) was 2.1 and that the relative risk for patients who were 80 years old or more (as compared with those who were less than 80 years old) was 1.5. Two underlying diagnoses occurring during follow up—cognitively impaired patients or neurologic disease—were also associated with a significantly greater risk of dislocation in absence of retentive cup. For these patients the risk was also decreased with a retentive cup.
Conclusion
With standard cups the incidence of dislocation is highest in the first year after arthroplasty and then continues at a relatively constant rate for the life of the arthroplasty. Patients at highest risk are old female patients and those with a diagnosis of neurologic disease. Retentive cups in these patients are an effective technique to prevent post-operative hip dislocation.
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References
Williams JT Jr, Ragland PS, Clarke S (2007) Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop 31:273–277
Baker RP, Squires B, Gargan MF, Bannister GD (2006) Total hip arthroplasty and retentive liner or in mobile, independent patients with a displaced intracapsular fracture of the femoral neck: a randomized controlled trial. J Bone Joint Surg Am 88A:2583–2589
Blumfeldt R, Tornkvist H, Ponzer S et al (2005) Comparison of internal fixation with total hip replacement for displaced femoral neck fractures: randomized controlled trial performed at four years. J Bone Joint Surg Am 87A:1680–1688
Macaulay W, Pagnotto MR, Iorio R et al (2006) Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty. J Am Acad Orthop Surg 14:287–293
Lee BP, Berry DJ, Harmsen WS et al (1998) Total hip arthroplasty for the treatment of an acute fracture of the femoral neck: long-term results. J Bone Joint Surg Am 80:70–75
Mabry TM, Prpa B, Haidukewych GJ et al (2004) Long-term results of total hip arthroplasty for femoral neck fracture nonunion. J Bone Joint Surg Am 86:2263–2267
Tarasevicius S, Jermolajevas V, Tarasevicius R et al (2005) Total hip replacement for the treatment of femoral neck fractures. Long-term results. Medicina (Kaunas) 41:465–469
Parvizi J, Morrey BF (2000) Bipolar hip arthroplasty as a salvage treatment for instability of the hip. J Bone Joint Surg Am 82:1132–1139
DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 121:20–32
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481
Berry DJ, Von Knoch M, Schleck CD, Harmsen WS (2004) The cumulative long-term risk of dislocation after primary charnley total hip arthroplasty. J Bone Joint Surg Am 86:9–14
Keating JF, Grant A, Masson M et al (2006) Randomized comparison of reduction and fixation, bipolar retentive liner or dual mobility, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am 88:249–260
Tidermark J, Ponzer S, Svensson O et al (2003) Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly: a randomized controlled trial. J Bone Joint Surg 85B:380–388
van Vugt AB, Oosterwijk WM, Goris RJ (1993) Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly. A randomised clinical trial. Arch Orthop Trauma Surg 113:39–45
Alberton GM, High WA, Morrey BF (2002) Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am 84:1788–1792
Hernigou P, Filippini P, Flouzat-Lachaniette CH, Batista SU, Poignard A (2010) Constrained liner in neurologic or cognitively impaired patients undergoing primary THA. Clin Orthop Relat Res 468(12):3255–3262
Meek RMD, Allan DB, McPhillips G, Kerr L, Howie CR (2006) Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res 447:9–18
Bosker BH, Ettema HB, Verheyen CC, Castelein RM (2009) Acetabular augmentation ring for recurrent dislocation of total hip arthroplasty: 60 % stability rate after an average follow-up of 74 months. Int Orthop 33(1):49–52
Philippot R, Camilleri JP, Boyer B, Adam P, Farizon F (2009) The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. Int Orthop 33(4):927–932
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Hernigou, P., Ratte, L., Roubineau, F. et al. The risk of dislocation after total hip arthroplasty for fractures is decreased with retentive cups. International Orthopaedics (SICOT) 37, 1219–1223 (2013). https://doi.org/10.1007/s00264-013-1911-8
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DOI: https://doi.org/10.1007/s00264-013-1911-8