What Is the Mid-term Failure Rate of Revision ACL Reconstruction? A Systematic Review

Clinical Orthopaedics and Related Research® - When anterior cruciate ligament (ACL) reconstruction fails, a revision procedure may be performed to improve knee function, correct instability,...     

Does Approach Influence the Dislocation Rate Following Head and Liner Exchange in Revision Hip Arthroplasty?

BackgroundRevision total hip arthroplasty with modular component exchange can limit morbidity by retaining well-fixed components but dislocation has been a relatively frequent postoperative complication. This study evaluated the effect of surgical approach on dislocation rate in a modern revision cohort.MethodsFrom 2010 to 2020, 248 aseptic head and liner exchanges were performed at a single institution. The mean patient age at revision was 64.9 ± 10.4 years and 50% (123/248) were performed among males. Indications for revision included 140 (56%) for polyethylene wear, 68 (27%) for failed metal-on-metal components, and 40 (16%) for instability. The mean follow-up after revision was 2.3 years.ResultsThirty (12%) hips dislocated at a mean of 0.6 years (range 0.01-4.6) postoperatively. The dislocation rate by revision approach was 17% (9/54) for the direct anterior, 6% (5/80) for the direct lateral, and 14% (16/114) for the posterolateral approach (P = .13). Hips revised by the direct anterior approach that dislocated were more abducted (51 ± 8 vs 45 ± 8, P = .05) and more anteverted (26 ± 9 vs 20 ± 7, P = .04) than non-dislocators. Among all 248 hips, cups with more than 48° of abduction were 2.6 times more likely to dislocate (P = .01). Head diameter, neck length, patient age, and gender were not associated with dislocation (P ≥ .20).ConclusionDislocation remains a common complication after head and liner exchange regardless of approach. Cup position is associated with postoperative instability and must be critically evaluated during preoperative planning.     

What Is the Natural History of Asymptomatic Pseudotumors in Metal-on-metal THAs at Mid-term Followup?

Clinical Orthopaedics and Related Research® - The risk of early revision because of pseudotumors in patients who have undergone large-head metal-on-metal (MoM) total hip arthroplasty (THA) is...     

Is the Dislocation Rate Higher after Bipolar Hemiarthroplasty in Patients with Neuromuscular Diseases?

Background  

Patients with neuromuscular disease reportedly have a higher incidence of postoperative dislocation after bipolar hemiarthroplasty. Although the literature has focused on a high prevalence of preoperative neurologic conditions in patients who had dislocations after bipolar hemiarthroplasties, the relative incidence of dislocation in patients with neuromuscular disease and without is unclear.     

CORR Insights®: What Is the Mid-term Failure Rate of Revision ACL Reconstruction? A Systematic Review

Clinical Orthopaedics and Related Research® -     

What is the Rate of Revision Discectomies After Primary Discectomy on a National Scale?

Clinical Orthopaedics and Related Research® - Lumbar discectomy has been shown to be clinically beneficial in numerous studies for appropriately selected patients. Some patients, however,...     

What Are the Causes of Revision Total Knee Arthroplasty in Japan?

Background

There is limited information regarding the cause of revision TKA in Asia, especially Japan. Owing to differences in patient backgrounds and lifestyles, the modes of TKA failures in Asia may differ from those in Western countries.

Questions/purposes

We therefore determined (1) causes of revision TKA in a cohort of Japanese patients with revision TKA and (2) whether patient demographic features and underlying diagnosis of primary TKA are associated with the causes of revision TKA.

Methods

We assessed all revision TKA procedures performed at five major centers in Hokkaido from 2006 to 2011 for the causes of failures. Demographic data and underlying diagnosis for index primary TKA of the revision cases were compared to those of randomly selected primary TKAs during the same period.

Results

One hundred forty revision TKAs and 4047 primary TKAs were performed at the five centers, indicating a revision burden of 3.3%. The most common cause of revision TKA was mechanical loosening (40%) followed by infection (24%), wear/osteolysis (9%), instability (9%), implant failure (6%), periprosthetic fracture (4%), and other reasons (8%). The mean age of patients with periprosthetic fracture was older (77 versus 72 years) and the male proportion in patients with infection was higher (33% versus 19%) than those of patients in the primary TKA group. There was no difference in BMI between primary TKAs and any type of revision TKA except other causes.

Conclusions

The revision burden at the five referral centers in Hokkaido was 3.3%, and the most common cause of revision TKA was mechanical loosening followed by infection. Demographic data such as age and sex might be associated with particular causes of revision TKA.     

Recurrence of Dislocation Following Total Hip Arthroplasty Revision Using Dual Mobility Cups Was Rare in 180 Hips Followed Over 7?Years

Background

Dual mobility (DM) cups of mobile polyethylene were introduced to prevent total hip arthroplasty (THA) dislocation, but no large series with this design to treat recurrent instability have been reported.

Purpose

Our retrospective investigation ascertained the efficiency of DM cups in correction of recurrent dislocation and assessed any adverse effects.

Methods

One hundred eighty THAs with recurrent instability were revised to DM cups in 180 patients (mean age, 67.4 ± 11.7 years; range, 19 to 92 years). Thirty-one patients (17.2%) underwent at least one earlier THA revision, and 15 (10.3%) incurred non-union of the greater trochanter. Of the initial group in 2009, 145 patients had completed evaluations which included assessment of the Harris Hip Score and a radiographic assessment at a mean follow-up of 7.7 ± 2.2 years (range, 4 to 14 years). The rate of survival was calculated considering any reason for revision as failure.

Results

At follow-up, Harris hip score was 83.9 ± 16.1 (range, 21 to 100). Dislocation of the large articulation occurred in seven hips (4.8%), and only two recurred (1.4%) (one requiring additional revision). In addition, two intra-prosthetic dislocations of the small articulation (1.4%) were observed and needed revision surgery. The large number of earlier surgeries and non-union of the greater trochanter were related to recurrent instability. Two cups (1.4%) showed signs of definite loosening; six (4.1%) presented signs of possible loosening. Twenty-nine hips manifested femoral or acetabular osteolysis (20%), but only three were severe. Eight-year survival rate considering revision for any reason was 92.6% (95% CI, 85.5–96.4%).

Conclusions

This series indicates that DM cups are a viable option to treat recurrent THA instability. Their design provides a low risk of recurrent instability without increasing mechanical complications.     

What Is the Infection Rate of the Posterior Approach to Type C Pelvic Injuries?

Background  

Pelvic ring injuries with complete disruption of the posterior pelvis (AO/OTA Type C) benefit from reduction and stabilization. Open reduction in early reports had high infectious complications and many surgeons began using closed reduction and percutaneous fixation. Multiple smaller studies have reported low infection rates after a posterior approach, but these rates are not confirmed in larger series of diverse fractures.