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Constrained components for the unstable hip following total hip arthroplasty: a literature review
J T Williams1, P S Ragland, S Clarke
1Department of Orthopaedic Surgery, Albert Einstein Medical Center, Willowcrest Bldg. 4th floor, 5501 Old York road, Philadelphia, PA 19141, USA. Williajo@einstein.edu
Insights
Constrained liners can effectively manage chronic hip instability after total hip arthroplasty, offering a solution for recurrent dislocations. This review provides evidence-based recommendations for their use in revision surgeries.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Revision Arthroplasty
Background:
- Chronic instability and late dislocation are significant complications following total hip arthroplasty (THA).
- Revision surgery for THA instability carries a high risk of recurrent dislocation.
- Constrained devices are increasingly considered for managing THA instability, but literature is limited.
Purpose of the Study:
- To systematically review the literature over the past 15 years on the use of constrained devices in revision THA.
- To identify indications and contraindications for constrained liners based on large, long-term studies.
- To provide evidence-based recommendations for managing THA instability with constrained implants.
Main Methods:
- Systematic literature review of studies published in the last 15 years.
- Inclusion criteria focused on larger, long-term studies of revision THA with constrained devices.
- Analysis of eight reports involving 1,199 hips in 1,148 patients.
Main Results:
- Mean follow-up duration was 51 months.
- The average rate of dislocation after revision with a constrained liner was 10%.
- The mean re-operation rate for non-dislocation reasons was 4%.
Conclusions:
- Constrained liners are a viable option for managing persistent THA instability.
- Indications include failed previous instability management, unclear etiology, cognitive impairment, abductor deficiency, and elderly/low-demand patients.
- These devices offer a solution for complex cases requiring revision THA.
Abstract:
Patients with chronic instability or late dislocation following total hip arthroplasty often require operative management. Unfortunately, there is an increased risk of recurrent dislocation following revision in these patients. Over the past decade the use of constrained devices for patients with chronic instability has gained increased interest; however, there is a paucity of studies available in the literature regarding the use of these devices. The purpose of this study was to analyze the available literature over the past 15 years, focusing on larger, long-term studies, to obtain recommendations from the respective articles for indications and contraindications for the use of constrained devices. Our review of eight reports included 1,199 hips in 1,148 patients with a total mean follow-up of 51 months (range, 24 to 124 months). The mean rate of dislocation following revision with a constrained liner was 10% and the mean re-operation rate for reasons other than dislocation was 4%. We concluded that constrained liners are an option for patients who have failed management of instability with other implants, those with instability of unclear etiology, those with cognitive problems who are unable to follow dislocation precautions, those with deficient abductors, and elderly or low-demand individuals with well-positioned implants requiring revision.
