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Constrained liner

Wael A Rahman, Hussain A Kazi, Jeffery D Gollish
AIM: To investigate success of one stage exchange with retention of fixed acetabular cup. METHODS: Fifteen patients treated by single stage acetabular component exchange with retention of well-fixed femoral component in infected total hip arthroplasty (THA) were retrospectively reviewed. Inclusion criteria were patients with painful chronic infected total hip. The patient had radiologically well fixed femoral components, absence of major soft tissue or bone defect compromising, and infecting organism was not poly or virulent micro-organism...
March 18, 2017: World Journal of Orthopedics
Benjamin F Ricciardi, Peter W Henderson, Alexander S McLawhorn, Geoffrey H Westrich, Mathias P Bostrom, Lloyd B Gayle
The current study describes the surgical technique and early outcomes of a gluteus maximus advancement flap procedure for the treatment of posterior soft tissue insufficiency among patients with complex revision total hip arthroplasty. This retrospective case series was conducted with a prospective, single-institution arthroplasty registry. Patients who underwent a gluteus maximus advancement flap procedure in the setting of revision total hip arthroplasty between January 2012 and January 2016 were eligible for inclusion (N=7)...
March 14, 2017: Orthopedics
A Viste, K I Perry, M J Taunton, A D Hanssen, M P Abdel
AIMS: Loss or absence of proximal femoral bone in revision total hip arthroplasty (THA) remains a significant challenge. While the main indication for the use of proximal femoral replacements (PFRs) is in the treatment of malignant disease, they have a valuable role in revision THA for loosening, fracture and infection in patients with bone loss. Our aim was to determine the clinical outcomes, implant survivorship, and complications of PFRs used in revision THA for indications other than malignancy...
March 2017: Bone & Joint Journal
Krista A Goulding, Adam Schwartz, Steven J Hattrup, R Lor Randall, Donald Lee, Damian M Rispoli, Daniel M Lerman, Christopher Beauchamp
BACKGROUND: Endoprostheses using principles of compressive osseointegration have shown good survivorship in several studies involving the lower extremity; however, no series to our knowledge have documented the use of this technology in the management of massive bone loss in the upper limb. QUESTIONS/PURPOSES: (1) What proportion of upper extremity implants using compressive osseointegration fixation principles achieved durable short-term fixation, and what were the modes of failure? (2) What surgical complications resulted from reconstruction using this technique? METHODS: A multiinstitutional retrospective review identified nine patients (five women; four men) who underwent 13 endoprosthetic replacements between 2003 and 2014 using compressive osseointegration (Compliant(®) Pre-stress Device [CPS]; Biomet Inc, Warsaw, IN, USA) in the upper extremity, including two proximal humeri, two humeral diaphyses, seven distal humeri, and two proximal ulna...
February 13, 2017: Clinical Orthopaedics and related Research
Deren T Bagsby, L Daniel Wurtz
BACKGROUND: Patients with destructive acetabular lesions are at high risk for morbidity. Harrington described reinforcing acetabular diseased bone with methylmethacrylate, supplemented by metal fixation, to allow total hip reconstruction. However, all published studies using this technique report dislocations. We believe that initial use of constrained liners would help alleviate dislocation risk, without increasing component loosening or polyethylene wear. METHODS: Sixty-eight patients who underwent Harrington hip arthroplasties for metastatic cancer from August 2005 to March 2015 were identified...
November 27, 2016: Journal of Arthroplasty
Luigi Zagra, Eleonora Caboni
Dual mobility cups are getting increasing interest for the prevention, but also in the treatment of THA instability. Nevertheless when a dislocation occurs the main issue remains the knowledge and the correction of the causes of dislocation, including reorientation of the components and soft tissues treatment. There are several options of alternative implants to DMCs including upsizing of the head, and constrained liners. The Authors present how to evaluate patients with THA instability, the advantages and the disadvantages of each procedure and their experience in the treatment of cases without DMCs during a five years' time period...
March 2017: International Orthopaedics
A J Harvey-Thompson, A B Sefkow, M S Wei, T Nagayama, E M Campbell, B E Blue, R F Heeter, J M Koning, K J Peterson, A Schmitt
We report experimental results and simulations showing efficient laser energy coupling into plasmas at conditions relevant to the magnetized liner inertial fusion (MagLIF) concept. In MagLIF, to limit convergence and increase the hydrodynamic stability of the implosion, the fuel must be efficiently preheated. To determine the efficiency and physics of preheating by a laser, an Ar plasma with n_{e}/n_{crit}∼0.04 is irradiated by a multi-ns, multi-kJ, 0.35-μm, phase-plate-smoothed laser at spot-averaged intensities ranging from 1...
November 2016: Physical Review. E
Mustafa Yassin, Avraham Garti, Muhammad Khatib, Moshe Weisbrot, Dror Robinson
OBJECTIVE: To evaluate the efficacy of the use of retentive cup primary total hip replacement (THR) in high-dislocation risk subcapital fracture patients. METHODS: During the years 2008 to 2012, 354 patients with displaced subcapital fracture were operated at our institute. The patients were selected to undergo primary constrained THR according to the following criteria: (1) a preinjury grade 4 or more on the Functional Independence Measure mobility item "5. Locomotion: walking/wheelchair" and grade 4 is defined as "4...
December 2016: Geriatric Orthopaedic Surgery & Rehabilitation
Kathryn Gill, Sarah L Whitehouse, Matthew J W Hubble, Matthew J Wilson
BACKGROUND: Dislocation following primary total hip arthroplasty (THA) is a complication with an incidence of 2%-5%. This study examines the clinical and radiological outcome of a constrained acetabular implant used in primary THA in high-risk patients to prevent dislocation. METHODS: 54 patients with 55 constrained implants for primary THA were reviewed clinically and radiologically. Oxford, Harris Hip and Charlson scores were recorded. RESULTS: 54 patients, with an average age of 83...
November 10, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
M Karvonen, H Karvonen, M Seppänen, A Liukas, M Koivisto, K T Mäkelä
BACKGROUND AND PURPOSE: Dislocation is one of the most common complications following total hip arthroplasty. The aim of our study was to assess failure rate of the Biomet Freedom constrained liner (Biomet, Warsaw, IN, USA) either in revision surgery for recurrent dislocation, or as a preventive method in high dislocation risk patients. PATIENTS AND METHODS: We assessed retrospectively 105 consecutive surgical procedures in 103 patients where a Freedom constrained liner or cup was used in Turku University Hospital over a 7-year period from 2007 to 2014...
July 25, 2016: Scandinavian Journal of Surgery: SJS
Wael A Rahman, Tomás Amenábar, Bandar M Hetaimish, Oleg A Safir, Paul R Kuzyk, Allan E Gross
BACKGROUND: This is a retrospective review of the functional outcomes and complications of revision total hip arthroplasty (THA) of failed metal-on-metal (MoM) hip arthroplasty. METHODS: A total of 20 revision THAs were performed in 19 patients. Of them, 2 cases were failed hip resurfacing, and 18 cases were failed (MoM) THA. The mean age at revision (THA) was 59.35 years (standard deviation [SD] 9.83). RESULTS: The mean follow-up was 45 months (SD 13...
November 2016: Journal of Arthroplasty
William G Hamilton
No abstract text is available yet for this article.
October 2016: Clinical Orthopaedics and related Research
J R Donaldson, F Tudor, J Gollish
AIMS: The aim of this study was to examine the results of revision total knee arthroplasty (TKA) undertaken for stiffness in the absence of sepsis or loosening. PATIENTS AND METHODS: We present the results of revision surgery for stiff TKA in 48 cases (35 (72.9%) women and 13 (27.1%) men). The mean age at revision surgery was 65.5 years (42 to 83). All surgeries were performed by a single surgeon. Stiffness was defined as an arc of flexion of < 70° or a flexion contracture of > 15°...
May 2016: Bone & Joint Journal
Roman C Stedman, Daniel Lim, Adeel Husain, Paul M Courtney, Charles L Nelson
PURPOSE: Dislocation is the most frequent complication following revision total hip arthroplasty (THA). Although several risk factors for dislocation in revision THA have been described, many cannot be modified at the time of surgery. Identifying modifiable risk factors for subsequent dislocation after revision THA provides opportunity for orthopedic surgeons to decrease instability. METHODS: A retrospective analysis of 203 consecutive revision THA procedures performed by a single surgeon with a minimum 2-year follow-up between May 2003 and June 2012 was performed...
May 16, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Philippe Hernigou, Matthieu Trousselier, François Roubineau, Charlie Bouthors, Charles Henri Flouzat Lachaniette
BACKGROUND: Obesity is associated with an increased risk of dislocation after total hip arthroplasty (THA). However, in patients with obesity, it is not known whether the risk is only in the early postoperative period or whether it persists several years after surgery, and whether having bariatric surgery before undergoing THA and/or receiving a specific device (such as a dual-mobility or constrained acetabular liner) is more effective in terms of decreasing the risk of dislocation. QUESTION/PURPOSES: (1) What is the cumulative risk of dislocation in patients with obesity after THA in the absence of a dual-mobility or constrained liner, and is this related to component positioning? (2) Does bariatric surgery before undergoing THA decrease dislocation risk in patients with obesity? (3) Are dual-mobility and constrained liners efficient in preventing dislocation in patients with obesity? METHODS: At our university-based practice, all surgeons adhered to the following treatment approaches: Before 2000 no dual-mobility implants or constrained liners were used for primary THAs...
October 2016: Clinical Orthopaedics and related Research
Darren R Plummer, Jonathan M Christy, Scott M Sporer, Wayne G Paprosky, Craig J Della Valle
BACKGROUND: The purpose of this study was to evaluate the performance of dual-mobility articulations in patients at high risk for dislocation after revision total hip arthroplasty. METHODS: We reviewed the results of 36 consecutive revision total hip arthroplasties performed on patients considered high risk for instability. Indications for inclusion included abductor insufficiency, recurrent instability, failure of constrained liner, or inadequate intraoperative stability when trialing...
September 2016: Journal of Arthroplasty
Peter K Sculco, Matthew S Austin, Carlos J Lavernia, Aaron G Rosenberg, Rafael J Sierra
Restoration of equal leg lengths and dynamic hip stability are essential elements of a successful total hip arthroplasty. A careful clinical examination, a preoperative plan, and appropriate intraoperative techniques are necessary to achieve these goals. Preoperative identification of patients at risk for residual leg length discrepancy allows surgeons to adjust the surgical approach and/or the type of implant and provide better preoperative patient education. The use of larger femoral heads, high-offset stem options, and enhanced soft-tissue repairs have improved impingement-free range of motion as well as dynamic hip stability and have contributed to an overall reduction in dislocation...
2016: Instructional Course Lectures
Arnaud Clavé, David Maurer, Ludovic Tristan, Frederic Dubrana, Christian Lefèvre, Hemant Pandit
BACKGROUND: Constrained liners are used as part of a salvage procedure to provide stability for patients at high risk for dislocation after a total hip arthroplasty. However, no recent studies exist highlighting their effectiveness and/or limitations. METHOD: This prospective review included 166 consecutive hip arthroplasties, either primary (27%) or revision (73%), with a unique design of a constrained liner: Lefèvre retentive cup. There were 113 females (69%), and the average age at index surgery was 75...
September 2016: Journal of Arthroplasty
Francisco Ferrero Manzanal, Antonio Murcia Asensio, Raquel Lax Pérez, José Eduardo Gil Gómez, Mariano Fernández Fairén
Constrained liners are a salvage procedure for treating or preventing recurrent dislocations. The Longevity® constrained liner (Zimmer) has a special design with cut-outs on its circumference for avoiding impingement in certain areas and a metallic constraining ring that has to be impacted. The ring impaction may be technical demanding. We recommend preassembly with the head component prior to seating into the acetabular cup, thus avoiding the soft tissue or cement interference and malposition due to bad angle of incidence of impaction force...
March 23, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Brian P Chalmers, Diren Arsoy, Rafael J Sierra, David G Lewallen, Robert T Trousdale
BACKGROUND: Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty. One treatment method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, redislocation rate, and revisions of a focally constrained liner in a high-risk patient cohort. METHODS: Fifty-eight hips between 2008 and 2011 underwent implantation of a focally constrained liner...
September 2016: Journal of Arthroplasty
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