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[Tripolar arthroplasty for recurrent total hip prosthesis dislocation].
P-E Beaulé1, X Roussignol, T-P Schmalzried
1Joint Replacement Institute at Orthopaedic Hospital, 2400S. Flower Street, Los Angeles, CA 90007, Etats-Unis.
Summary
Revision surgery using a tripolar prosthesis with a large mobile head effectively reduced recurrent dislocations in highly unstable hips. This technique offers a reliable solution, improving patient function and pain, though polyethylene wear remains a consideration.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
Background:
- Recurrent dislocation is a significant complication following total hip arthroplasty, particularly in patients with unstable hips and risk factors.
- Revision surgery aims to restore stability and function while minimizing morbidity.
Purpose of the Study:
- To evaluate the efficacy of revision surgery for recurrent total hip prosthesis dislocation using a tripolar prosthesis with a large-diameter mobile head and a modified cup.
Main Methods:
- Twenty-one hips in 21 patients with a history of recurrent dislocations underwent revision surgery with a tripolar prosthesis (40-47 mm mobile heads).
- Custom acetabular cups were used, with either cemented polyethylene (14 cases) or press-fit metal-backed cups (7 cases).
- Mean follow-up was 5.4 years.
Main Results:
- Twenty hips (95%) had no recurrent dislocations post-revision.
- Significant improvements were observed in pain, walking, function, and daily activities (UCLA score).
- One case of infection and one polyethylene insert fracture required revision; no certain or probable loosening occurred.
Conclusions:
- The tripolar prosthesis with a mobile cup and large head is a reliable solution for severely unstable hips, often allowing acetabular component revision only.
- Polyethylene cup thickness may impact long-term survival, necessitating research into wear-resistant bearing surfaces.