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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
The outcome of revision total hip arthroplasty for instability
Rit Apinyankul1, Cierra Hong2, Katherine L Hwang2
1Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Insights
Recurrent dislocation after revision hip replacement is common. Higher American Society of Anesthesiologists (ASA) grades, BMI, specialized liners, lumbopelvic stiffness, and abductor weakness increase risk.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Reconstructive Surgery
Background:
- Instability is a frequent reason for revision total hip arthroplasty (THA).
- Recurrent dislocation can occur even after initial revision THA.
- Identifying risk factors for recurrent dislocation is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the risk of recurrent dislocation following revision total hip arthroplasty (THA) for instability.
- To identify patient and surgical factors associated with recurrent dislocation after revision THA.
Main Methods:
- A cohort of 163 patients undergoing revision THA for instability between 2009-2019 was analyzed.
- Cox proportional hazard models were used to evaluate risk factors, considering death and infection as competing events.
- Patient-reported outcomes included VR-12, Harris Hip Score (HHS), and HOOS, JR.
Main Results:
- The cumulative incidence of recurrent dislocation was 8.7% at 1 year, 18.8% at 5 years, and 31.9% at 10 years.
- Significant risk factors included high American Society of Anesthesiologists (ASA) grade, BMI 25-30 kg/m², specialized liners, lumbopelvic stiffness, and abductor weakness.
- Increasing acetabular component size by >1 mm reduced dislocation risk (HR 0.89).
Conclusions:
- Patients undergoing revision THA for instability face a substantial risk of recurrent dislocation.
- Higher ASA grade, overweight status, prior lumbopelvic fusion, specialized liners, and postoperative abductor weakness are key risk factors.
- Optimizing component size and addressing identified risk factors may help mitigate recurrent dislocations.
Aims:
Instability is a common indication for revision total hip arthroplasty (THA). However, even after the initial revision, some patients continue to have recurrent dislocation. The aim of this study was to assess the risk for recurrent dislocation after revision THA for instability.
Methods:
Between 2009 and 2019, 163 patients underwent revision THA for instability at Stanford University Medical Center. Of these, 33 (20.2%) required re-revision due to recurrent dislocation. Cox proportional hazard models, with death and re-revision surgery for periprosthetic infection as competing events, were used to analyze the risk factors, including the size and alignment of the components. Paired t-tests or Wilcoxon signed-rank tests were used to assess the outcome using the Veterans RAND 12 (VR-12) physical and VR-12 mental scores, the Harris Hip Score (HHS) pain and function, and the Hip disability and Osteoarthritis Outcome score for Joint Replacement (HOOS, JR).
Results:
The median follow-up was 3.1 years (interquartile range 2.0 to 5.1). The one-year cumulative incidence of recurrent dislocation after revision was 8.7%, which increased to 18.8% at five years and 31.9% at ten years postoperatively. In multivariable analysis, a high American Society of Anesthesiologists (ASA) grade (hazard ratio (HR) 2.72 (95% confidence interval (CI) 1.13 to 6.60)), BMI between 25 and 30 kg/m2 (HR 4.31 (95% CI 1.52 to 12.27)), the use of specialized liners (HR 5.39 (95% CI 1.97 to 14.79) to 10.55 (95% CI 2.27 to 49.15)), lumbopelvic stiffness (HR 6.03 (95% CI 1.80 to 20.23)), and postoperative abductor weakness (HR 7.48 (95% CI 2.34 to 23.91)) were significant risk factors for recurrent dislocation. Increasing the size of the acetabular component by > 1 mm significantly decreased the risk of dislocation (HR 0.89 (95% CI 0.82 to 0.96)). The VR-12 physical and HHS (pain and function) scores improved significantly at mid term.
Conclusion:
Patients requiring revision THA for instability are at risk of recurrent dislocation. Higher ASA grades, being overweight, a previous lumbopelvic fusion, the use of specialized liners, and postoperative abductor weakness are significant risk factors.
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