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      Cementation of a monoblock dual mobility bearing in a newly implanted porous revision acetabular component in patients undergoing revision total hip arthroplasty

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          Abstract

          Background

          The most common indications for revision total hip arthroplasty are instability/dislocation and mechanical loosening. Efforts to address this have included the use of dual mobility (DM) articulations. The aim of this study is to report on the use of cemented DM cups in complex acetabular revision total hip arthroplasty cases with a high risk of recurrent instability.

          Methods

          A multicenter, retrospective study was conducted. Patients who received a novel acetabular construct consisting of a monoblock DM cup cemented into a fully porous metal shell were included. Outcome data included 90-day complications and readmissions, revision for any reason, and Harris Hip Scores.

          Results

          Thirty-eight hips in 38 patients were included for this study. At a median follow-up of 215.5 days (range 6-783), the Harris Hip Score improved from a mean of 50 ± 12.2 to 78 ± 11.2 ( P < .001). One (2.6%) patient experienced a dislocation on postoperative day 1, and was closed reduced with no further complications. There was 1 (2.6%) reoperation for periprosthetic joint infection treated with a 2-stage exchange.

          Conclusions

          In this complex series of patients, cementation of a monoblock DM cup into a newly implanted fully porous revision shell reliably provided solid fixation with a low risk of dislocation at short-term follow-up. Although longer term follow-up is needed, utilization of this novel construct should be considered in patients at high risk for instability.

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          Most cited references39

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          Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation.

          From 1982 to 1988, 147 cemented acetabular components were revised with cementless hemispheric press-fit components, with an average follow-up period of 5.7 years (range, 3-9 years). Acetabular defects were typed from 1 to 3 and reconstructed with a bulk or support allograft. Type 1 defects had bone lysis around cement anchor sites and required particulate graft. Type 2A and B defects displayed progressive bone loss superiorly and required particulate graft, femoral head bulk graft, or cup superiorization. Type 2C defects required medial wall repair with wafer femoral head graft. Type 3A and B defects demonstrated progressive amounts of superior rim deficiencies and were treated with structural distal femur or proximal tibia allograft. Six of the 147 components (4.0%), all type 3B, were considered radiographically and clinically unstable, warranting revision. Three of the six were revised. Moderate lateral allograft resorption was noted on radiographs, but host-graft union was confirmed at revision. Size, orientation, and method of fixation of the allografts play an important role in the integrity of structural allografts, while adequate remaining host-bone must be present to ensure bone ingrowth.
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            Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013

            Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. THA failure has evolved and displays variability throughout the literature. In order to understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large scale. Thus, we report: (1) etiologies for revision THA; (2) frequencies of revision THA procedures; (3) patient demographics, payor type, and US Census region of revision THA patients; and (4) the length of stay and total costs based on the type of revision THA procedure.
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              Risk factors for dislocation after revision total hip arthroplasty.

              Despite dislocation being the most frequent complication after revision THA, risk factors for its occurrence are not completely understood.
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                Author and article information

                Contributors
                Journal
                Arthroplast Today
                Arthroplast Today
                Arthroplasty Today
                Elsevier
                2352-3441
                14 June 2019
                September 2019
                14 June 2019
                : 5
                : 3
                : 341-347
                Affiliations
                [a ]Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
                [b ]Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
                [c ]Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
                Author notes
                []Corresponding author. 301 E 17th Street, New York, NY 10003, USA. Tel.: +1 212 598 6000. ran.schwarzkopf@ 123456nyulangone.org
                Article
                S2352-3441(19)30046-9
                10.1016/j.artd.2019.05.001
                6728441
                31516979
                dbe062c8-0d1c-46ab-a936-80beb4d63160
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 26 February 2019
                : 27 April 2019
                : 5 May 2019
                Categories
                Original Research

                revision hip arthroplasty,dual mobility,cemented dual mobility,dislocation,instability

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