Results of surgical treatment in patients with aseptic instability of components of hip joint endoprosthesis
DOI:
https://doi.org/10.14739/2310-1210.2021.1.224895Keywords:
hip joint, endoprosthesis, instability, replacement, hip joint, endoprosthesis, instability, replacementAbstract
The aim. To study the results of revision endoprosthetics in patients with aseptic instability of the components of the hip joint endoprosthesis.
Materials and methods. The basis of this work was the analysis of the revision prosthetics results in 152 patients (158 cases) with aseptic instability of components of hip joint endoprosthesis, who underwent surgery at the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” between 2008 and 2018. Total instability in the endoprosthesis components was observed in 43 cases (27.2 %), acetabular component instability – in 65 cases (41.1 %), femoral component instability was detected in 50 cases (31.6 %). Endoprosthesis dislocation occurred mostly between 5 and 9 years after the primary surgery. Clinical, radiological and statistical methods were used in the work.
Results. Patients with acetabular component instability showed the best results of revision replacement for Paprosky I, II types acetabular defects (t = 9.3, P < 0.05). The vast majority of components became unstabile between 5 and 9 years after the primary replacement. The results of unstable femoral component revisions did not reveal any significant difference between cemented and cementless types of component fixation 10 years after the procedure. Recurrent aseptic instability was observed only in 7 cases, 5 of which (71.4 %) were fixated with cement. In the case of total instability, there was no difference in the revision implantation results between the use of primary components alone and in the combination with revision reconstructive systems. Component stability constituted the great majority (35 cases, which was 81.4 %) of cases after 10 years (t = 7.3, P < 0.05). The recurrent instability of one component was observed in 8 cases, which represented 18.6 % of the total number of revisions.
Conclusions. In patients with instability of acetabular and femoral components in the presence of Paprosky I–II bone defects, the results of the revision replacement were better when implanting primary components using cementless type of fixation. The use of revision antiprotrusion acetabular and elongate femoral modular or monoblock systems with cementless type of fixation achieved better results in Paprosky III type acetabular and femoral bone defects. The revision of cemented components showed significantly worse results and implant survival rate compared to cementless fixation technique.
References
Vasiuk, V. L., Vasylchyshyn, Ya. M., & Protsiuk, V. V. (2019). Osoblyvosti reviziinoho endoprotezuvannia kulshovoho suhloba v razi nestabilnosti komponentiv endoproteza [Revision hip joint arthroplasty specificity in case of endoprosthesis component aseptic instability]. Proceedings of the 18th Congress of Orthopedic Surgeons of Ukraine (p. 99). Ivano-Frankivsk. [in Ukrainian].
Gayko, G. V., Haluzynskyi, O. A., Kozak, R. A., Pidhaietskyi, V. M., & Burburska, S. V. (2018). Vykorystannia adytyvnykh tekhnolohii pry likuvanni khvorykh iz defektamy kulshovoi zapadyny [The use of additive technologies in the treatment of acetabulum defects]. Visnyk ortopedii, travmatolohii ta protezuvannia, (3), 4-10. [in Ukrainian].
Hertsen, H. I., Shtonda, D. V., Bilonozhkin, H. H., Movchan, O. S., Protsyk, A. I., & Ostapchuk, R. M. (2019). Poperedzhennia liuksatsii femoralnoho komponentu endoproteza kulshovoho suhloba pry skladnomu ta reviziinomu yoho endoprotezuvanni [Prevention of hip prosthesis femoral component luxations in cases of its complex and revision replacement]. Proceedings of the 18th Congress of Orthopedic Surgeons of Ukraine (pp. 103-104). Ivano-Frankivsk. [in Ukrainian].
Zazirnyi, I. M. (2019). Natsionalni rehistry endoprotezuvannia kulshovoho suhloba - suchasni tendentsii [National registries of hip joint replacement - current trends]. Proceedings of the 18th Congress of Orthopedic Surgeons of Ukraine (pp. 94-95). Ivano-Frankivsk. [in Ukrainian].
Kavalersky, G. M., Sereda, A. P., Murylev, V. Yu., Rukin, Ya. A., Gavrilov, A. V., Arkhipov, I. V., Yatchenko, A. M., & Bychkov, I. Yu. (2015). 2D-planirovanie endoprotezirovaniya tazobedrennogo sustava [2D planning for hip arthroplasty]. Travmatologiya i ortopediya Rossii, (4), 95-102. https://doi.org/10.21823/2311-2905-2015-0-4-95-102 [in Russian].
Kovalenko, A. N., Shubnyakov, I. I., Tikhilov, R. M., & Cherny, A. Zh. (2015). Obespechivayut li novye i bolee dorogie implantaty luchshii rezul'tat endoprotezirovaniya tazobedrennogo sustava? [Do new and more expensive implants provide better outcomes in total hip arthroplasty?]. Travmatologiya i ortopediya Rossii, (1), 5-20. https://doi.org/10.21823/2311-2905-2015-0-1-30-36 [in Russian].
Loskutov, A. E., Loskutov, O. A., & Syniehubov, D. A. (2018). Dvustoronnee endoprotezirovanie tazobedrennykh sustavov pri displasticheskom koksartroze u patsientov s osteopeniei i osteoporozom [Bilateral hip joint arthroplasty in dysplastic hip arthritis in patients with osteopenia and osteoporosis]. Ortopediya, travmatologiya i protezirovanie, (4), 58-63. https://doi.org/10.15674/0030-59872018458-63 [in Russian].
Loskutov, O. A. (2018). Vybor pozitsii atsetabulyarnogo komponenta pri endoprotezirovanii bol'nykh s displasticheskim koksartrozom [The choice of the position of the acetabular component in endoprosthetics among patients with dysp lastic coxarthrosis]. Visnyk ortopedii, travmatolohii ta protezuvannia, (3), 27-31. [in Russian].
Tikhilov, R. M., Bozhkova, S. A., & Shubnyakov, I. I. (Eds.). (2019). Materialy Vtoroi mezhdunarodnoi soglasitel'noi konferentsii po skeletno-myshechnoi infektsi [Proceedings of the Second International Consensus Meeting on Musculoskeletal Infection]. RNIITO im. R. R. Vredena. [in Russian].
Murylyov, V. Yu., Elizarov, P. M., Rukin, Ya. A., Rubin, G. G., & Kukovenko, G. A. (2017). Endoprotezirovanie tazobedrennogo sustava kak vozmozhnost' uluchsheniya kachestva zhizni patsientov starcheskogo vozrasta s lozhnym sustavom sheiki bedrennoi kosti [Hip arthroplasty as a chance to improve quality of life in eldery group of patients]. Uspekhi gerontologii, 30(5), 725-732. [in Russian].
Poluliakh, M. V., Herasymenko, S. I., Babko, A. M., Herasymenko, A. S., & Poluliakh, D. M. (2019). Reviziine protezuvannia atsetabuliarnoho komponenta proteza kulshovoho suhloba [Revision replacement of the acetabular component of hip joint prosthesis]. Proceedings of the 18th Congress of Orthopedic Surgeons of Ukraine (p. 105). Ivano-Frankivsk. [in Ukrainian].
Rukin, Ya., Murylev, V., Lychagin, A., Elizarov, P., Grichyuk, A., & Yavlieva, R. (2017). Revizionnoe endoprotezirovanie tazobedrennogo sustava u patsientov s dissotsiatsiei kostei taza [Revision hip arthroplasty in patients with pelvic dissociation]. Vrach, (12), 66-70. [in Russian].
Tikhilov, R. M., Shubnyakov, I. I., Denisov, A. O., Pliev, D. G., Shubnyakov, M. I., Vahramyan, A. G., & Avdeev, A. I. (2019). Imeetsya li klinicheskii smysl v razdelenii vrozhdennogo vyvikha bedra u vzroslykh na tipy C1 i C2 po Hartofilakidis? [Is the Any Clinical Importance for Separation Congenitally Dislocated Hip in Adults into Types C1 and C2 by Hartofilakidis?]. Travmatologiya i ortopediya Rossii, 25(3), 9-24. https://doi.org/10.21823/2311-2905-2019-25-3-9-24 [in Russian].
Tikhilov, R. M., Shubnyakov, M. I., Boyarov, A. A., Denisov, A. O., & Shubnyakov, I. I. (2018). Vliyanie razlichnykh faktorov na tempy iznosa polietilenovogo vkladysha v endoprotezakh tazobedrennogo sustava [Impact of Various Factors on the Polyethylene Wear Rate in Total Hip Arthroplasty]. Travmatologiya i ortopediya Rossii, 24(1), 18-28. https://doi.org/10.21823/2311-2905-2018-24-1-18-28 [in Russian].
Shubnyakov, I. I., Tikhilov, R. M., Nikolaev, N. S., Grigoricheva, L. G., Ovsyankin, A. V., Cherny, A. Zh., Drozdova, P. V., Denisov, A. O., Veber, Е. V., & Kuz’mina, I. V. (2017). Epidemiologiya pervichnogo endoprotezirovaniya tazobedrennogo sustava na osnovanii dannykh registra artroplastiki RNIITO im. R. R. Vredena [Epidemiology of Primary Hip Arthroplasty: Report from Register of Vreden Russian Research Institute of Traumatology and Orthopedics]. Travmatologiya i ortopediya Rossii, 23(2), 81-101. https://doi.org/10.21823/2311-2905-2017-23-2-81-101 [in Russian].
Shubnyakov, I. I., Tikhilov, R. M., Denisov, A. O., Akhmedilov, M. A., Cherny, A. Zh., Totoev, Z. A., Javadov, A. A., Karpukhin, A. S., & Muravyeva, Yu. V. (2019). Chto izmenilos' v strukture revizionnogo endoprotezirovaniya tazobedrennogo sustava v poslednie gody? [What Has Changed in the Structure of Revision Hip Arthroplasty?]. Travmatologiya i ortopediya Rossii, 25(4), 9-27. https://doi.org/10.21823/2311-2905-2019-25-4-9-27 [in Russian].
Afzal, I., Radha, S., Smoljanović, T., Stafford, G. H., Twyman, R., & Field, R. E. (2019). Validation of revision data for total hip and knee replacements undertaken at a high volume orthopaedic centre against data held on the National Joint Registry. Journal of Orthopaedic Surgery and Research, 14(1), Article 318. https://doi.org/10.1186/s13018-019-1304-9
Arden, N., Altman, D., Beard, D., Carr, A., Clarke, N., Collins, G., Cooper, C., Culliford, D., Delmestri, A., Garden, S., Griffin, T., Javaid, K., Judge, A., Latham, J., Mullee, M., Murray, D., Ogundimu, E., Pinedo-Villanueva, R., Price, A., … Raftery, J. (2017). Lower limb arthroplasty: can we produce a tool to predict outcome and failure, and is it cost-effective? An epidemiological study. Programme Grants for Applied Research, 5(12). https://doi.org/10.3310/pgfar05120
Dale, H., Børsheim, S., Kristensen, T. B., Fenstad, A. M., Gjertsen, J. E., Hallan, G., Lie, S. A., & Furnes, O. (2020). Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women - data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register. Acta Orthopaedica, 91(1), 33-41. https://doi.org/10.1080/17453674.2019.1682851
Delanois, R. E., Gwam, C. U., Piuzzi, N. S., Chughtai, M., Malkani, A. L., Bonutti, P. M., & Mont, M. A. (2018). Hip and Knee Arthroplasty Orthopedic Literature in Medical Journals-Is It Negatively Biased? The Journal of Arthroplasty, 33(2), 615-619. https://doi.org/10.1016/j.arth.2017.09.017
Gwam, C. U., Mistry, J. B., Mohamed, N. S., Thomas, M., Bigart, K. C., Mont, M. A., & Delanois, R. E. (2017). Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013. The Journal of Arthroplasty, 32(7), 2088-2092. https://doi.org/10.1016/j.arth.2017.02.046
Kovochich, M., Finley, B. L., Novick, R., Monnot, A. D., Donovan, E., Unice, K. M., Fung, E. S., Fung, D., & Paustenbach, D. J. (2018). Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Critical Reviews in Toxicology, 48(10), 839-887. https://doi.org/10.1080/10408444.2018.1563048
Mäkelä, K. T., Furnes, O., Hallan, G., Fenstad, A. M., Rolfson, O., Kärrholm, J., Rogmark, C., Pedersen, A. B., Robertsson, O., W-Dahl, A., Eskelinen, A., Schrøder, H. M., Äärimaa, V., Rasmussen, J. V., Salomonsson, B., Hole, R., & Overgaard, S. (2019). The benefits of collaboration: the Nordic Arthroplasty Register Association. EFORT Open Reviews, 4(6), 391-400. https://doi.org/10.1302/2058-5241.4.180058
Pabinger, C., Lothaller, H., Portner, N., & Geissler, A. (2018). Projections of hip arthroplasty in OECD countries up to 2050. Hip International, 28(5), 498-506. https://doi.org/10.1177/1120700018757940
Peters, R. M., van Steenbergen, L. N., Stewart, R. E., Stevens, M., Rijk, P. C., Bulstra, S. K., & Zijlstra, W. P. (2020). Patient Characteristics Influence Revision Rate of Total Hip Arthroplasty: American Society of Anesthesiologists Score and Body Mass Index Were the Strongest Predictors for Short-Term Revision After Primary Total Hip Arthroplasty. The Journal of Arthroplasty, 35(1), 188-192.E2. https://doi.org/10.1016/j.arth.2019.08.024
Podmore, B., Hutchings, A., van der Meulen, J., Aggarwal, A., & Konan, S. (2018). Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis. BMJ Open, 8(7), Article e021784. https://doi.org/10.1136/bmjopen-2018-021784
Postler, A. E., Beyer, F., Wegner, T., Lützner, J., Hartmann, A., Ojodu, I., & Günther, K. P. (2017). Patient-reported outcomes after revision surgery compared to primary total hip arthroplasty. Hip International, 27(2), 180-186. https://doi.org/10.5301/hipint.5000436
Renard, G., Laffosse, J. M., Tibbo, M., Lucena, T., Cavaignac, E., Rouvillain, J. L., Chiron, P., Severyns, M., & Reina, N. (2020). Periprosthetic joint infection in aseptic total hip arthroplasty revision. International Orthopaedics, 44(4), 735-741. https://doi.org/10.1007/s00264-019-04366-2
Varnum, C. (2017). Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome. Danish Medical Journal, 64(3), Article B5350.
Wilson, I., Bohm, E., Lübbeke, A., Lyman, S., Overgaard, S., Rolfson, O., W-Dahl, A., Wilkinson, M., & Dunbar, M. (2019). Orthopaedic registries with patient-reported outcome measures. EFORT Open Reviews, 4(6), 357-367. https://doi.org/10.1302/2058-5241.4.180080
Zeng, W. N., Liu, J. L., Jia, X. L., Zhou, Q., Yang, L., & Zhang, Y. (2019). Midterm Results of Total Hip Arthroplasty in Patients With High Hip Dislocation After Suppurative Hip Arthritis. The Journal of Arthroplasty, 34(1), 102-107. https://doi.org/10.1016/j.arth.2018.09.081
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