The indications for treating total hip arthroplasty (THA) dislocations by cementing a constrained polyethylene liner into a well-fixed, retained acetabular component at the time of revision are narrow. That’s largely due to concerns about the durability of the resulting acetabular construct. Now, thanks to a study by Brown et al. in the April 3, 2019 issue of JBJS, hip surgeons have some hard data about the long-term outcomes of this approach.
After reviewing 125 cases in which a constrained liner was cemented into a retained, osseointegrated acetabular component during revision THA, with a mean follow-up of 7 years, the authors found that:
- Survivorship free from revision for instability was 86% at 5 years and 81% at 10 years. The cumulative incidence of instability at 7 years was 18%.
- Survivorship free from aseptic acetabular component revision was 78% at 5 years and 65% at 10 years. The most common failure mechanism was dissociation of the constrained liner from the retained component.
- Harris hip scores (HHS) did not improve significantly after revision. This finding is consistent with prior research that shows better post-revision HHS scores in patients whose revisions include the entire acetabular component.
- Position of the retained cup did not affect implant survivorship or risk of dislocation.
The authors mention alternative strategies for reducing the risk of dislocation after revision THA, such as the use of large-diameter heads and dual-mobility constructs. Still, they conclude that this constrained-liner approach, in the setting of a relatively well-positioned acetabular component, is a viable and durable THA revision option, especially for those “with a compromised abductor mechanism, recurrent instability, [and] a well-fixed and well-positioned acetabular component, for whom an acetabular revision would not be tolerated.”
Ankle sprain is a common musculoskeletal injury throughout the world, affecting tens of thousands of patients daily. What treatments for lateral inversion ankle injury are most effective? When is a wait-and-see approach more beneficial than a training program, and functional interventions more appropriate than surgical treatment? What surgical interventions yield better outcomes for function and instability compared with conservative treatment, particularly when the calcaneofibular ligament is disrupted, and does one postoperative regimen produce better results than another?
On Tuesday, September 19, 2017 at 5:00 PM EDT, these intriguing and clinically applicable questions will be addressed during a complimentary* LIVE webinar, hosted jointly by The Journal of Bone & Joint Surgery (JBJS) and the Journal of Orthopaedic & Sports Physical Therapy (JOSPT).
JBJS co-authors Mark E. Easley, MD, and Manuel J. Pellegrini, MD, will discuss findings from a systematic quantification of the stabilizing effects of subtalar joint soft-tissue constraints in a novel cadaveric model.
JOSPT co-author John M. van Ochten, MD, will share the results of a systematic review of randomized controlled and controlled clinical trials on the effectiveness of treatments for ankle sprains.
Moderated by Dr. Alexej Barg, a leading authority on the foot and ankle and traumatic injuries to the lower extremity, the webinar will include additional insights from expert commentators J. Chris Coetzee, MD, and Phillip A. Gribble, PhD, ATC, FNATA. The last 15 minutes will be devoted to a live Q&A session between the audience and panelists.
Seats are limited, so Register Now.
* This webinar is complimentary for those who attend the event live and will continue to be available at no charge for 24 hours following its conclusion.