Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 3 Issue 1

Early Cup Shifts: A Previously Unrecognized Phenomenon in Hip Arthroplasty

Dani Gaillard-Campbell MS* and Thomas P Gross

Midlands Orthopaedics and Neurosurgery, Blanding Street, Columbia, SC, USA

*Corresponding Author: Dani Gaillard-Campbell MS, Midlands Orthopaedics and Neurosurgery, Blanding Street, Columbia, SC, USA.

Received: November 20, 2019; Published: December 11, 2019

×

Abstract

Background: Early postoperative acetabular component shifts are often missed due to inadequate x-rays. After initiating a policy at our practice to obtain standardized pelvic radiographs immediately after hip resurfacing surgery, we began noticing asymptomatic, spontaneous early cup shifts. With careful x-ray analysis, we discovered that the incidence of shift was 0.9% (12 of 1285 cases).

Methods: Our primary study purpose was to identify and evaluate risk factors for cup shift, with a secondary aim to determine if cup shifts affected clinical outcomes. We retrospectively collected radiographic data from our clinical database to determine cup shifts. We further analyzed follow-up data from this database to evaluate clinical outcomes.

Results: All cups became radiographically stable after the initial shift. Approximately 90% of these cases had excellent clinical outcomes, while 2 cases (9.5% of shifts) were revised: one early for extreme malposition, and the other late for impingement pain. In 95% of shifted cases, the acetabular component moved into a more horizontal position. Mean absolute value of shift was 17° (range 10° - 36°). There were no cases of abnormal metal ion levels, even in the case that steepened and exceeded the RAIL guideline. When we compared cases before and after the new wedge-fit protocol, we noticed a drop in the incidence of cup shifts from 0.9% to 0.2% (p = 0.004).

Conclusions: Cup shifts often occur early and are asymptomatic, making them difficult to diagnose. With a series of early x-rays, we discovered rate of shift at our practice was 0.9%. With a new wedge-fit method of preparing acetabula, rate of early cup shift decreased significantly to 0.2%.

Keywords: Previously; Unrecognized; Arthroplasty

×

References

  1. Le Duff MJ and Amstutz HC. “The Relationship of Sporting Activity and Implant Survivorship After Hip Resurfacing”. Journal of Bone and Joint Surgery 94 (2012): 911.
  2. Fisher NE and Killampalli VV. “Sporting and physical activity following hip resurfacing”. International Orthopaedics 35 (2011): 977-980.
  3. Amstutz HC., et al. “Resurfacing THA for patients younger than 50 year: results of 2- to 9-year followup”. Clinical Orthopaedics and Related Research 460 (2007): 159-164.
  4. Gaillard MD and Gross TP. “Metal-on-metal hip resurfacing in patients younger than 50 years: A retrospective analysis”. Journal of Orthopaedic Surgery and Research 1 (2017): 1-12.
  5. Kim PR., et al. “Causes of early failure in a multicenter clinical trial of hip resurfacing”. The Journal of Arthroplasty (2008).
  6. Morlock MM., et al. “Modes of implant failure after hip resurfacing: morphological and wear analysis of 267 retrieval specimens”. Journal of Bone and Joint Surgery3 (2008): 89-95.
  7. Langton DJ., et al. “Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement A Consequence of Excess Wear”. Journal of Bone and Joint Surgery 92 (2010): 38-46.
  8. Gross TP and Liu F. “Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index”. Journal of Orthopaedic Surgery and Research (2012): 7.
  9. Yue EJ., et al. “Hip Resurfacing Arthroplasty Risk Factors for Failure Over 25 Years”. Clinical Orthopaedics and Related Research 467 (2009): 992-999.
  10. Morlock MM., et al. “Date unknown Biomechanical, morphological, and histological analysis of early failures in hip resurfacing arthroplasty”. (2006).
  11. Mont MA., et al. Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Follow up (2008).
  12. Lewinnek GE., et al. “Dislocations after total hip-replacement arthroplasties”. Journal of Bone and Joint Surgery2 (1978): 217-220.
  13. Mont MA., et al. “Resurfacing is comparable to total hip arthroplasty at short-term followup”. Clinical Orthopaedics and Related Research 1 (2009): 66-71.
  14. Blaha JD. Well-Fixed Acetabular Component Retention or Replacement the Whys and the Wherefores.
  15. McGrath MS., et al. “Total hip resurfacing in patients who are sixty years of age or older”. The Journal of Bone and Joint Surgery American 3 (2008): 27-31.
  16. Liu F and Gross TP. “A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP Paul award”. The Journal of Arthroplasty 7 (2013): 1224-1230.
  17. Bottner F., et al. “Implant migration after early weightbearing in cementless hip replacement”. Clinical Orthopaedics and Related Research 436 (2005): 132-137.
  18. Aldinger PR., et al. “Uncemented grit-blasted straight tapered titanium stems in patients younger than fifty-five years of age. Fifteen to twenty-year results [Internet]”. The Journal of Bone and Joint Surgery American 6 1432-1439.
  19. Beaulé PE., et al. “Risk Factors Affecting Outcome of Metal - on - Metal Surface Arthroplasty of the”. Hip 418 (2004): 87-93.
  20. Takamura KM., et al. “Incidence and Significance of Femoral Neck Narrowing in the First 500 Conserve® Plus Series of Hip Resurfacing Cases: A Clinical and Histologic Study”. Orthopedic Clinics of North America 2 (2011): 181-193.
  21. Smolders JMH., et al. “Metal ion interpretation in resurfacing versus conventional hip arthroplasty and in whole blood versus serum. How should we interpret metal ion data?” HIP International 5 (2011): 587-595.
  22. Liu F and Gross TP. “A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: Winner of the 2012 HAP Paul award”. The Journal of Arthroplasty 7 (2013): 1224-1230.
  23. Pramanik S., et al. “Chronology of total hip replacement and materials development”. Trends in Biomaterials and Artificial Organs 19 (2005):15-26.
  24. Beaule PE., et al. “Risk factors affecting outcome of metal-on-metal surface arthroplasty of the hip”. Clinical Orthopaedics and Related Research 418 (2004): 87-93.
  25. Langton DJ., et al. “Reducing Metal Ion Release Following Hip Resurfacing Arthroplasty”. Orthopedic Clinics of North America 2 (2011):169-180.
  26. Malviya A and Holland JP. “Pseudotumours associated with metal-on-metal hip resurfacings”. Acta Orthopaedica Belgica 4 (2009):477-483.
×

Citation

Citation: Dani Gaillard-Campbell MS and Thomas P Gross. "Early Cup Shifts: A Previously Unrecognized Phenomenon in Hip Arthroplasty".Acta Scientific Orthopaedics 3.1 (2020): 02-09.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"

Contact US