Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 5, pp 605–612 | Cite as

Low dislocation rate of Saturne®/Avantage® dual-mobility THA after displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up

  • Steffan Tabori-JensenEmail author
  • Torben B. Hansen
  • Maiken Stilling
Orthopaedic Surgery
  • 146 Downloads

Abstract

Introduction

Dislocation is a serious and common complication and a great concern with the use of total hip arthroplasty (THA) when treating displaced femoral neck fracture (FNF). Dual-mobility (DM) THA might reduce the dislocation risk. We aim to report the dislocation and revision rate of primary DM THA in patients with displaced FNF.

Materials and methods

Between 2005 and 2015, 966 consecutive patients (676 women) at mean age 80.5 years (range 42–104) with displaced FNF were operated with DM articulation THA by posterolateral approach (PLA). Patient files and radiographs were evaluated for dislocations, revisions, and other complications until death of the patient or August 1st, 2017. Data were crosschecked with the National Patient Registry. Patient’s mental state was tested upon admissions. Surgeon’s educational level was noted and post-operative cup position was measured.

Results

At minimum 1.6-year follow-up, there were 45 (4.7%) dislocations and eight (0.8%) cup revisions. The 30-day mortality was 9.2% and 533 patients (55.2%) were dead at the time of last follow-up. We observed eight intraprosthetic dislocations (IPD); six occurred in relation to closed reduction. Cementless stem fixation was associated with higher dislocation risk (p = 0.04) and higher rate of stem complications (p = 0.002). There was no significant association between cognitive impairment and dislocation (OR 2.0, 95% CI 0.96–4.34, p = 0.06).

Conclusion

Overall, DM THA inserted via PLA results in an acceptable dislocation risk and low revision rate in fragile, old patients with acute FNF fracture, regardless of mental status. A unique complication in DM THA is IPD, which requires an immediate open reduction surgery.

Keywords

Femoral neck fracture Total hip arthroplasty Dislocation Dual-mobility cup 

Notes

Funding

This is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

References

  1. 1.
    Hopley C, Stengel D, Ekkernkamp A, Wich M (2010) Primary total hip arthroplasty versus hemiarthroplasty for displaced intracapsular hip fractures in older patients: systematic review. BMJ 340:c2332.  https://doi.org/10.1136/bmj.c2332 CrossRefGoogle Scholar
  2. 2.
    Rogmark C, Johnell O (2006) Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop 77(3):359–367.  https://doi.org/10.1080/17453670610046262 CrossRefGoogle Scholar
  3. 3.
    Jiang J, Yang CH, Lin Q, Yun XD, Xia YY (2015) Does arthroplasty provide better outcomes than internal fixation at mid- and long-term followup? A meta-analysis. Clin Orthop Relat Res 473(8):2672–2679.  https://doi.org/10.1007/s11999-015-4345-3 CrossRefGoogle Scholar
  4. 4.
    Rogmark C, Leonardsson O (2016) Hip arthroplasty for the treatment of displaced fractures of the femoral neck in elderly patients. Bone Jt J 98-b(3):291–297.  https://doi.org/10.1302/0301-620x.98b3.36515 CrossRefGoogle Scholar
  5. 5.
    Hansson S, Nemes S, Karrholm J, Rogmark C (2017) Reduced risk of reoperation after treatment of femoral neck fractures with total hip arthroplasty. Acta Orthop 88(5):500–504.  https://doi.org/10.1080/17453674.2017.1348095 CrossRefGoogle Scholar
  6. 6.
    Wang Z, Bhattacharyya T (2017) Outcomes of hemiarthroplasty and total hip arthroplasty for femoral neck fracture: a medicare cohort study. J Orthop Trauma 31(5):260–263.  https://doi.org/10.1097/bot.0000000000000814 CrossRefGoogle Scholar
  7. 7.
    Carroll C, Stevenson M, Scope A, Evans P, Buckley S (2011) Hemiarthroplasty and total hip arthroplasty for treating primary intracapsular fracture of the hip: a systematic review and cost-effectiveness analysis. Health Technol Assess 15(36):1–74.  https://doi.org/10.3310/hta15360 CrossRefGoogle Scholar
  8. 8.
    Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, Bhandari M, Poolman RW (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop 36(8):1549–1560.  https://doi.org/10.1007/s00264-012-1569-7 CrossRefGoogle Scholar
  9. 9.
    Grazioli A, Ek ET, Rudiger HA (2012) Biomechanical concept and clinical outcome of dual mobility cups. Int Orthop 36(12):2411–2418.  https://doi.org/10.1007/s00264-012-1678-3 CrossRefGoogle Scholar
  10. 10.
    Cross MB, Nam D, Mayman DJ (2012) Ideal femoral head size in total hip arthroplasty balances stability and volumetric wear. HSS J 8(3):270–274.  https://doi.org/10.1007/s11420-012-9287-7 CrossRefGoogle Scholar
  11. 11.
    Bystrom S, Espehaug B, Furnes O, Havelin LI, Norwegian Arthroplasty R (2003) Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop Scand 74(5):514–524.  https://doi.org/10.1080/00016470310017893 CrossRefGoogle Scholar
  12. 12.
    Boyer B, Philippot R, Geringer J, Farizon F (2012) Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips. Int Orthop 36(3):511–518.  https://doi.org/10.1007/s00264-011-1289-4 CrossRefGoogle Scholar
  13. 13.
    Prudhon JL, Verdier R, Caton JH (2017) Low friction arthroplasty and dual mobility cup: a new gold standard. Int Orthop 41(3):563–571.  https://doi.org/10.1007/s00264-016-3375-0 CrossRefGoogle Scholar
  14. 14.
    Palm H, Krasheninnikoff M, Holck K, Lemser T, Foss NB, Jacobsen S, Kehlet H, Gebuhr P (2012) A new algorithm for hip fracture surgery. Reoperation rate reduced from 18% to 12% in 2,000 consecutive patients followed for 1 year. Acta Orthop 83(1):26–30.  https://doi.org/10.3109/17453674.2011.652887 CrossRefGoogle Scholar
  15. 15.
    Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Jt surg Br 43 B(4):647–663CrossRefGoogle Scholar
  16. 16.
    Society DO (2008) Referenceprogram for patients with hipfractureGoogle Scholar
  17. 17.
    Philippot R, Adam P, Farizon F, Fessy MH, Bousquet G (2006) [Survival of cementless dual mobility sockets: ten-year follow-up]. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 92(4):326–331CrossRefGoogle Scholar
  18. 18.
    Guyen O, Pibarot V, Vaz G, Chevillotte C, Carret JP, Bejui-Hugues J (2007) Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation. J Arthroplast 22(6):849–858.  https://doi.org/10.1016/j.arth.2006.11.014 CrossRefGoogle Scholar
  19. 19.
    Wang F, Zhang H, Zhang Z, Ma C, Feng X (2015) Comparison of bipolar hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis. BMC Musculoskelet Disord 16:229.  https://doi.org/10.1186/s12891-015-0696-x CrossRefGoogle Scholar
  20. 20.
    Hansson S, Nemes S, Karrholm J, Rogmark C (2017) Reduced risk of reoperation after treatment of femoral neck fractures with total hip arthroplasty. Acta Orthop.  https://doi.org/10.1080/17453674.2017.1348095 Google Scholar
  21. 21.
  22. 22.
    Qureshi KN, Hodkinson HM (1974) Evaluation of a ten-question mental test in the institutionalized elderly. Age Ageing 3(3):152–157CrossRefGoogle Scholar
  23. 23.
    Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplast 17(3):282–288CrossRefGoogle Scholar
  24. 24.
    Paterno SA, Lachiewicz PF, Kelley SS (1997) The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Jt Surg Am 79(8):1202–1210CrossRefGoogle Scholar
  25. 25.
    Bensen AS, Jakobsen T, Krarup N (2014) Dual mobility cup reduces dislocation and re-operation when used to treat displaced femoral neck fractures. Int Orthop 38(6):1241–1245.  https://doi.org/10.1007/s00264-013-2276-8 CrossRefGoogle Scholar
  26. 26.
    Nich C, Vandenbussche E, Augereau B, Sadaka J (2016) Do dual-mobility cups reduce the risk of dislocation in total hip arthroplasty for fractured neck of femur in patients aged older than 75 years? J Arthroplast 31(6):1256–1260.  https://doi.org/10.1016/j.arth.2015.11.041 CrossRefGoogle Scholar
  27. 27.
    Tarasevicius S, Busevicius M, Robertsson O, Wingstrand H (2010) Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture. BMC Musculoskelet Disord 11:175.  https://doi.org/10.1186/1471-2474-11-175 CrossRefGoogle Scholar
  28. 28.
    Enocson A, Hedbeck CJ, Tidermark J, Pettersson H, Ponzer S, Lapidus LJ (2009) Dislocation of total hip replacement in patients with fractures of the femoral neck. Acta Orthop 80(2):184–189.  https://doi.org/10.3109/17453670902930024 CrossRefGoogle Scholar
  29. 29.
    Skoldenberg O, Ekman A, Salemyr M, Boden H (2010) Reduced dislocation rate after hip arthroplasty for femoral neck fractures when changing from posterolateral to anterolateral approach. Acta Orthop 81(5):583–587.  https://doi.org/10.3109/17453674.2010.519170 CrossRefGoogle Scholar
  30. 30.
    Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Mole D, Fessy MH, Traumatology S (2012) French Society of Orthopaedic. Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. OTSR 98(3):296–300.  https://doi.org/10.1016/j.otsr.2012.01.005 Google Scholar
  31. 31.
    Registry DHR (2016) Danish Hip Replacement Registry—Annual report. http://danskhoftealloplastikregister.dk/wp-content/uploads/2015/11/DHR-%C3%A5rsrapport-2016.pdf (Danish Hip Replacement Registry—Annual report 2016)
  32. 32.
    Johansson T (2014) Internal fixation compared with total hip replacement for displaced femoral neck fractures: a minimum fifteen-year follow-up study of a previously reported randomized trial. J Bone Jt Surg Am 96(6):e46.  https://doi.org/10.2106/JBJS.K.00244 CrossRefGoogle Scholar
  33. 33.
    Jameson SS, Lees D, James P, Johnson A, Nachtsheim C, McVie JL, Rangan A, Muller SD, Reed MR (2013) Cemented hemiarthroplasty or hip replacement for intracapsular neck of femur fracture? A comparison of 7732 matched patients using national data. Injury 44(12):1940–1944CrossRefGoogle Scholar
  34. 34.
    Yu L, Wang Y, Chen J (2012) Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: meta-analysis of randomized trials. Clin Orthop Relat Res 470(8):2235–2243CrossRefGoogle Scholar
  35. 35.
    Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22(4):815–821.  https://doi.org/10.1016/j.orthres.2003.11.001 CrossRefGoogle Scholar
  36. 36.
    Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stockl B (2005) Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Jt Surg Br 87(6):762–769.  https://doi.org/10.1302/0301-620X.87B6.14745 CrossRefGoogle Scholar
  37. 37.
    Seagrave KG, Troelsen A, Malchau H, Husted H, Gromov K (2017) Acetabular cup position and risk of dislocation in primary total hip arthroplasty. Acta Orthop 88(1):10–17.  https://doi.org/10.1080/17453674.2016.1251255 CrossRefGoogle Scholar
  38. 38.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Jt Surg Am 60(2):217–220CrossRefGoogle Scholar
  39. 39.
    Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, Fessy MH, Lecuire F (2008) Survival of cementless dual mobility socket with a mean 17 years follow-up. Revue de chirurgie orthopedique et reparatrice de l’appareil moteur 94 (8):e23-27.  https://doi.org/10.1016/j.rco.2007.10.013
  40. 40.
    De Martino I, D’Apolito R, Waddell BS, McLawhorn AS, Sculco PK, Sculco TP (2017) Early intraprosthetic dislocation in dual-mobility implants: a systematic review. Arthroplast Today 3(3):197–202.  https://doi.org/10.1016/j.artd.2016.12.002 CrossRefGoogle Scholar
  41. 41.
    Hamadouche M, Arnould H, Bouxin B (2012) Is a cementless dual mobility socket in primary THA a reasonable option? Clin Orthop Relat Res 470(11):3048–3053.  https://doi.org/10.1007/s11999-012-2395-3 CrossRefGoogle Scholar
  42. 42.
    Tarasevicius S, Smailys A, Grigaitis K, Robertsson O, Stucinskas J (2017) Short-term outcome after total hip arthroplasty using dual-mobility cup: report from Lithuanian Arthroplasty Register. Int Orthop 41(3):595–598.  https://doi.org/10.1007/s00264-016-3389-7 CrossRefGoogle Scholar
  43. 43.
    Khan RJ, MacDowell A, Crossman P, Datta A, Jallali N, Arch BN, Keene GS (2002) Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures. Int Orthop 26(4):229–232.  https://doi.org/10.1007/s00264-002-0356-2 CrossRefGoogle Scholar
  44. 44.
    Parker MJ, Gurusamy KS, Azegami S (2010) Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev (6):CD001706.  https://doi.org/10.1002/14651858.CD001706.pub4
  45. 45.
    Chammout G, Muren O, Laurencikas E, Bodén H, Kelly-Pettersson P, Sjöö H, Stark A, Sköldenberg O (2017) More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. Acta Orthop 88(2):145–151.  https://doi.org/10.1080/17453674.2016.1262687 CrossRefGoogle Scholar
  46. 46.
    Yli-Kyyny T, Ojanpera J, Venesmaa P, Kettunen J, Miettinen H, Salo J, Kroger H (2013) Perioperative complications after cemented or uncemented hemiarthroplasty in hip fracture patients. SJS 102(2):124–128.  https://doi.org/10.1177/1457496913482249 Google Scholar
  47. 47.
    fracture DIRfH (2017) Danish Interdisciplinary Register for Hip fracture—National Annual Report 2017Google Scholar
  48. 48.
    Tabori-Jensen S, Hansen TB, Bovling S, Aalund P, Homilius M, Stilling M (2018) Good function and high patient satisfaction at mean 2.8 years after dual mobility THA following femoral neck fracture: a cross-sectional study of 124 patients. Clin Interv Aging 13:615–621.  https://doi.org/10.2147/CIA.S157671 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University Clinic for Hand, Hip and Knee SurgeryHospital Unit WestHolstebroDenmark
  2. 2.Department of Clinical MedicineAarhus UniversityAarhusDenmark

Personalised recommendations