Abstract:
BACKGROUND:Historically, achieving stability for the unstable total hip arthroplasty (THA) with revision surgery has been achieved inconsistently. Most of what we know about this topic comes from reports of high-volume surgeons' results; the degree to which these results are achieved in the community is largely unknown, but insofar as most joint replacements are done by community surgeons, the issue is important. QUESTIONS/PURPOSES:We used a community joint registry to determine: (1) the frequency of repeat revision after surgery to treat the unstable THA; (2) what surgical approaches to this problem are in common use in the community now; (3) are there differences in repeat revision frequency that vary by approach used; and (4) has the frequency of repeat revision decreased over time as surgical technique and implant options have evolved? METHODS:We reviewed 6801 primary THAs performed in our community joint registry over the last 20 years. One hundred eighteen patients (1.7%) with a mean age of 67 years were revised within the registry for instability/dislocation. Failure was defined as a return to the operating room for rerevision surgery for instability. Minimum followup was 2 years (average, 9.4 years; range, 2-20 years) with six patients having incomplete followup. The frequency of rerevisions was calculated and compared using Pearson's chi-square test. Cumulative rerevision rates were calculated using the Kaplan-Meier method and types of revision procedures were compared using the log-rank test. RESULTS:The initial revision procedure was successful in 108 patients (92%); 10 patients underwent repeat surgery for recurrent dislocation after their initial revision surgery. The most frequently performed procedure was revision of the head and liner only (35 of 118 [30%]); constrained devices were used in 19% (22 of 118) of the procedures. There was no difference in the cumulative rerevision rates for instability or dislocation by type of revision procedure performed. Six of 22 constrained liners were rerevised for varying indications. There was no difference in frequency of repeat revision for instability between those patients revised for THAs performed before 2003 and those managed more recently. CONCLUSIONS:Revision surgery for unstable THA is successfully managed in the community with a variety of surgical interventions. Identifying the reason for dislocation and addressing the source remain paramount. Constrained liners should be used with caution; although typically used in the most problematic settings, rerevision for a variety of failure modes remains troublesome. LEVEL OF EVIDENCE:Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Salassa T,Hoeffel D,Mehle S,Tatman P,Gioe TJdoi
10.1007/s11999-013-3344-5subject
Has Abstractpub_date
2014-03-01 00:00:00pages
962-7issue
3eissn
0009-921Xissn
1528-1132journal_volume
472pub_type
杂志文章abstract::This Classic article is a reprint of the original work by Virgil P. Gibney, Chapter XVIII. Operative Treatment in Chronic Articular Ostitis. An accompanying biographical sketch of Virgil P. Gibney, MD, is available at DOI 10.1007/s11999-009-1166-2 . The Classic Article is (c)1884 and is abridged from Gibney VP. Operat...
journal_title:Clinical orthopaedics and related research
pub_type: 传,古典文章,历史文章,杂志文章
doi:10.1007/s11999-009-1165-3
更新日期:2010-02-01 00:00:00
abstract::Progressive loss of hip containment attributable to dysplasia epiphysealis hemimelica of the right proximal femur and macrodactyly of the right second toe was diagnosed and monitored by radiographs and magnetic resonance imaging in a 7-year-old boy. The patient had early surgical correction including shortening osteot...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000136904.78496.d9
更新日期:2004-10-01 00:00:00
abstract::The increasing clinical use of human demineralized bone matrix has brought about the desire to understand better the osteoinductivity of these graft materials. The rat heterotopic model has been used successfully to show the sequence of events involved in the endochondral ossification process resulting in osteoinducti...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199812000-00028
更新日期:1998-12-01 00:00:00
abstract::Specific congenital malformations of the spine are consistently associated with characteristic types of urinary tract malformation. Patients with defects of the spine such as spina bifida occulta, partial or complete absence of the sacrum, unilateral or bilateral failure of segmentation, and wedged vertebrae are not u...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1980-05-01 00:00:00
abstract::For determination of the optimal position in examining the ankle joint for anterior drawer sign and talar tilting, 12 legs freshly amputated above the knee were radiographically examined after successive transection of the lateral ankle ligaments in three different sequences. Apparatuses secured the position of the an...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-03-01 00:00:00
abstract::Contemporary knee designs differ considerably in the conformity that exists between the articulating surfaces of the femoral and tibial components. The thickness of the polyethylene components also varies from design to design. Conformity and thickness affect the stresses associated with surface damage and the subsequ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1995-08-01 00:00:00
abstract::Isolated human chondrocytes derived from healthy and osteoarthritic (OA) cartilage were cultured in high density in a newly designed microculture system. The severity of OA was graded according to a modified histopathologic score originally described by Mankin et al. Chondrocytes from adult patients with OA showed 35S...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-05-01 00:00:00
abstract:BACKGROUND:Positive-pressure exhaust suits cost more than standard surgical gowns, and recent evidence suggests that they do not decrease infection risk. As a result, some hospitals and surgeons have abandoned positive-pressure exhaust suits in favor of less expensive alternatives. We propose that in addition to their ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999.0000000000000253
更新日期:2018-06-01 00:00:00
abstract::In accepting this invitation to write a prefatory chapter as a mini professional autobiography, it has become all too obvious that this has touched a few nerve endings that had healed many years ago. Contemplating personal experiences, thoughts, and philosophies and then writing them should have a purpose. During thes...
journal_title:Clinical orthopaedics and related research
pub_type: 传,历史文章,杂志文章
doi:
更新日期:1994-03-01 00:00:00
abstract:BACKGROUND:Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several methods are available. A medial gastrocnemius flap commonly is used, although it may be associated with an extensor lag. This problem also is encountered, although perhaps to a lesser extent, with other...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-2851-8
更新日期:2013-07-01 00:00:00
abstract::Load-bearing porous-surfaced implants in dogs which failed were not incorporated by bone ingrowth. The implants were incorporated only by fibrous tissue ingrowth. Collagen fiber orientation within this fibrous tissue and Sharpey's fiber-like features at the interface between the fibrous tissue and a surrounding layer ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-05-01 00:00:00
abstract:BACKGROUND:Arthroplasty for shoulder fractures is a technically challenging and unpredictable procedure and its use is controversial. QUESTIONS/PURPOSES:We therefore asked (1) to what degree function would be restored, (2) whether tuberosity healing would reliably occur, and (3) whether stem design would influence fun...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-011-1919-6
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Disruption of the periosteum has been used to explain overgrowth after long bone fractures. Clinically, various periosteal procedures have been reported to accelerate growth with varied results. Differences between procedures and study populations, in these prior studies, make drawing conclusions regarding t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-015-4646-6
更新日期:2016-04-01 00:00:00
abstract:UNLABELLED:Most previous studies of THA in sickle cell disease report high risks of medical and orthopaedic complications, including infections and a higher incidence of failure than observed after THA for osteonecrosis related to other conditions. Based on our experience (1245 orthopaedic procedures during the last 25...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-007-0069-3
更新日期:2008-02-01 00:00:00
abstract::The optimal method of fixation during periacetabular osteotomy is unknown. Periacetabular osteotomies were created on both sides of six whole pelves from fresh cadavers and were fixed randomly either with three long 4.5-mm cortical screws from the iliac crest to the osteotomized fragment (iliac fixation) or with two s...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200210000-00032
更新日期:2002-10-01 00:00:00
abstract::A technique of computed tomography with intravenous contrast has proven useful in the differentiation between osteoid osteoma and other similar appearing lucent lesions of bone in 6 cases. The clinical evaluation of benign appearing radiolucent lesions of long bones has been greatly improved by the use of modern imagi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199606000-00030
更新日期:1996-06-01 00:00:00
abstract::A histologic study of vertebral end plates was performed on young rats' tails subjected to intensive passive motion. Seven six-week-old rats had two-hour motion cycles daily, for two months. Histologic changes of proximal caudal vertebrae in the experimental group were compared with those of a control group of seven r...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-06-01 00:00:00
abstract::This investigation seeks to determine whether surfactants or detergents can be used to clean and disinfect orthopaedic wounds with implanted hardware. Thus, a stepwise investigation of biocompatible surfactants and detergents was performed to identify an irrigation agent for disinfecting orthopaedic wounds. Bacterial ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199608000-00032
更新日期:1996-08-01 00:00:00
abstract::Eleven intraoperative femur fractures occurred during 605 total hip replacements at Rancho Los Amigos Hospital, an incidence of 1.8%. Fractures occur more often in women, are usually located in the proximal femur, and mostly occur during femoral reaming. The main predisposing factors were osteoporosis and previous hip...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-11-01 00:00:00
abstract::A long-term review of 272 resections of the metatarsal heads and bases of the phalanges in 128 patients with severe rheumatoid feet is presented. The longest follow-up is 11 years and the average follow-up was 4.7 years. Recurrent deformity and callus formation was usually due to a long metatarsal shaft. The operation...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-197505000-00036
更新日期:1975-05-01 00:00:00
abstract::In the lateral malleolar ankle fracture without talar shift there is much uncertainty regarding the diagnosis of deltoid ligament injury severe enough to require surgical treatment. The current study evaluated the mechanical integrity of the ankle using a novel gravity-stress mortise radiographic view, which is practi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200106000-00024
更新日期:2001-06-01 00:00:00
abstract::The purpose of this study was to explore the relationship between the integrity of collagen and biomechanical properties of bone. In this study, age (range, 5-26 years old) and gender related changes in cortical bone samples from 33 baboon femurs (15 males and 18 females) were examined. The percentage of denatured col...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200002000-00027
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator cuffs may show improved healing when biologic factors are added during surgery. QUESTIONS/PURPOSES:We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1007/s11999-010-1323-7
更新日期:2010-06-01 00:00:00
abstract::Many situations in revision THA require the exchange of a PE liner in the setting of a well-fixed cementless acetabular shell. Unfortunately, a replacement liner is not always available, the locking mechanism of the metal shell may be damaged or incompatible with the desired liner, or the shell is malpositioned. Revis...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000096805.78689.8b
更新日期:2003-12-01 00:00:00
abstract::The purpose of this study was to evaluate the stability of different types of internal fixation requiring anterior, posterior, or combined surgical approaches for the T-type acetabular fracture. Eight specimens were loaded 25 times in a cyclic manner to 150 N for each type of fixation construct evaluated. The model at...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:Metastatic bone disease is a substantial burden to patients and the healthcare system as a whole. Metastatic disease can be painful, is associated with decreased survival, and is emotionally traumatic to patients when they discover their disease has progressed. In the United States, more than 250,000 patient...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-016-4739-x
更新日期:2016-07-01 00:00:00
abstract::The authors retrospectively reviewed 29 hip and 13 knee arthroplasties performed in 17 adolescents and young adults from 1973 through 1979. Most patients had severe multiple joint involvement; 16 had juvenile rheumatoid arthritis. Clinical and roentgenographic evaluations were performed before operation and at routine...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:Rotator cuff repair is a successful treatment in terms of patient satisfaction and pain relief regardless of the repair method. Although arthroscopic repair is commonly thought to be less painful than open or miniopen repair, studies disagree on this point. QUESTIONS/PURPOSES:We wished to compare the result...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-014-3715-6
更新日期:2014-09-01 00:00:00
abstract::The clinical benefits of electromagnetic fields have been claimed for 20 centuries, yet it still is not clear how they work or in what circumstances they should be used. There is a large body of evidence that steady direct current and time varying electric fields are generated in living bone by metabolic activity and ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-199810001-00011
更新日期:1998-10-01 00:00:00
abstract:BACKGROUND:Patients with severe lower extremity trauma have significant disability 2 years after injury that worsens by 7 years. Up to 15% seek late amputation. Recently, an energy-storing orthosis demonstrated improved function compared with standard orthoses; however, the effect when integrated with rehabilitation ov...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-014-3609-7
更新日期:2014-10-01 00:00:00