Prevalence of Instability in Septic Revision THA
Poster Presentation Number: P021
AAOS San Diego Convention Center, Sails Pavilion 2007
Adult Reconstruction Hip
Stephen G Struble, MD Richmond VA (a - DePuy)
Susan Marie Odum, MED Charlotte NC (a - DePuy)
William L Griffin, MD Charlotte NC (a, b, c, e - DePuy)
Bryan Donald Springer, MD Charlotte NC (a - DePuy)
J Bohannon Mason, MD Charlotte NC (a, e - DePuy)
Thomas K Fehring, MD Charlotte NC (a, c, e, - DePuy)
The prevalence of instability following 2-stage reimplantation for sepsis was
evaluated. The instability rate of 17.7% is unacceptable. Strategies to minimize
this complication must be undertaken.
Hip instability is a common postoperative complication that is disturbing to
surgeon and patient alike. The prevalence of dislocation in aseptic revision THA
exceeds that of primary surgery. The increased dissection required in revision
surgery is a significant contributing factor in this difference. Two-stage
reimplantation with its concomitant shortening of the limb requires even more
extensive dissection. We have noted an increased prevalence of postoperative
instability following two-stage reimplantation despite appropriately placed
components. The purpose of this study was to define the prevalence of
postoperative hip instability following two-stage reimplantation and to develop
strategies to minimize this risk.
A joint registry review of 1515 revision THA identified 134 patients who
underwent two-stage reimplantation. The prevalence of dislocation was
documented. Femoral head size was documented. A radiographic analysis of
acetabular component position was also performed.
Of the 134 patients that underwent two-stage reimplantation, 17.7% dislocated.
77% had 28 mm. heads used, 3% had smaller heads used while 20% had larger head
sizes used. The average abduction angle for the patients who dislocated was 43°
(range 38-49). 45% of patients who dislocated required re-revision to obtain
stability.
This instability rate following two-stage reimplantation is clearly
unacceptable. Strategies to minimize this complication must be undertaken. The
routine use of postoperative bracing, the use of an articulating spacer to
maintain length between stages or the use of large head technology are treatment
methods that should be considered in this group of patients.
If noted, the author indicates something of value received:
a - Research or institutional support
b - Miscellaneous non-income support (e.g., equipment or services), commercially
derived honoraria, or other non-research related funding (e.g., paid travel)
c - Royalties have been received
d - Stock or stock options held
e - Consultant or employee
n - Nothing of value received
|
