Short-term outcome after total hip arthroplasty using dual-mobility cup: report from Lithuanian Arthroplasty Register

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesPURPOSE: The purpose of the study was to investigate how the use of dual-mobility cups (DMCs) affected the risk of revision due to dislocation as well as overall risk of revision compared with a conventional total hip arthroplasty (THA) system in the short term. METHODS: A total of 12,657 primary THAs were registered from the start of 2011 to the end of 2014. 620 THAs were with DMCs. For comparison, we included all registered THAs with Exeter cup and a cemented Exeter stem combined with 28-mm femoral head. Patients were followed up with respect to revision and/or death until 1 January 2016. For survival analysis, we used revision as an endpoint. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, surgical approach, THA model and pre-operative diagnosis). RESULTS: Of the 620 dual-mobility THAs and 2170 Exeter THAs, 100 had been revised. The overall unadjusted cumulative revision rate (CRR) for any reason of revision at five years after surgery was 3.9% in the dual-mobility group and 5.2% in the Exeter group. Cox regression analysis, adjusting for age, gender, THA type, surgical approach and pre-operative diagnosis, showed that the risk of revision was less in patients operated with DMCs and in patients having their operation for osteoarthritis. CONCLUSION: The DM implant had a lower short-term complication rate than a conventional well defined THA. Low dislocation rate suggests that it is a good choice for high risk patients

Use of stepwise versus straightforward clamping of biliary drainage tubes after living-donor liver transplantation: a prospective, randomized trial

Background/purpose: There has been no report describing the optimal clamping method for biliary drainage tubes in living-donor liver transplantation (LDLT), although biliary splinting and drainage plays an important role in this procedure. Methods: When performing LDLT, we generally use a 2-mm drainage tube for the splint at the biliary anastomosis, and externalize it through the lower common bile duct. In the present study, when the serum levels of total bilirubin were lower than 5 mg/dl, and negativity for biliary complications and good passage of contrast media to the duodenum were confirmed, the drainage tubes were clamped. To determine the optimal clamping method, patients were randomly divided into two groups; those whose drainage tubes were subjected to stepwise clamping for 3, 6, 12, and 24 h per day (n = 20), and those whose drainage tubes were subjected to straightforward clamping (n = 20). Results: The results of liver function tests and rates of clamping failure were not different between the two groups after the different clamping methods were used. Conclusions: Straightforward clamping could be a simple and reasonable method to close a biliary drainage tube after LDLT

Introduction of total knee arthroplasty in Lithuania: Results from the first 10 years

Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania

Bipolar hemiarthroplasty versus total hip arthroplasty in femoral neck fracture patients : results from Lithuanian Arthroplasty Register

Introduction: Elderly patients with displaced femoral neck fractures (FNF) are usually operated with arthroplasty but with various combinations of implants and approaches. Thus, the optimal treatment is still controversial. We aimed to compare the results between the cemented bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) patients operated for FNF regarding revision rate at 1 year postoperatively. Methods: The data were derived from the Lithuanian Arthroplasty Register. We included patients operated with cemented bipolar HA and compared them to the most frequently used cemented THA with 28-mm head during 2011–2016. For survival analysis, we used both revision for all reasons and for dislocations as an endpoint. Cox proportional hazards models were used to analyse the influence of covariates (age groups, gender, surgical approaches and arthroplasty groups). Results: There were 1177 bipolar HA and 514 THA included in our study. 26 (2.2%) revisions had occurred among the bipolar HAs as compared to 25 (4.9%) among the THAs 1 year after surgery. The main reason for revision was dislocation. The unadjusted cumulative revision rate for any reason at 1 year after surgery was 2.4% for the bipolar HA group and 5.1% for the THA group (p = 0.0054). Cox regression analysis showed that the use of bipolar HA, anterolateral approach and younger age groups had lower risk of revision for all reasons. Conclusion: Bipolar HA and anterolateral approach had a significantly lower overall 1-year risk of revision in femoral neck fracture patients as compared to THA with 28-mm femoral heads

Dynamics of femoral bone remodelling in well fixed total hip arthroplasty. A 20-year follow-up of 20 hips.

The aim of our study was to investigate the dynamics of cortical thinning around well fixed cemented Muller straight stems without osteolysis at different time periods during long term follow-up. We investigated patients operated on for osteoarthritis with a cemented Muller straight stem, all with more than 15 years follow-up and no radiological signs of osteolysis. Cortical thinning in 20 THA hips (19 patients) followed for a mean of 20 (16 to 22) years was measured medially and laterally at six levels from the first postoperative, five, 10 years and the last follow-up x-rays. Sixty percent of observed cortical thinning occurred during the first five postoperative years, which was more evident proximally. We conclude that significantly greater cortical bone loss occurs around cemented Muller straight stems during the first five years, than is seen subsequently. We feel that this is a non-pathological process mainly related to the Muller straight stem

Long-Term Femoral Bone Remodeling After Cemented Hip Arthroplasty With the Müller Straight Stem in the Operated and Nonoperated Femora.

We investigated the cortical bone changes in 35 patients with total hip arthroplasty operated on only for osteoarthritis with more than 10 years of follow-up and with nonrevised femoral components and without radiologic signs of loosening. The mean follow-up was 16 ± 5 years. The thicknesses of femoral cortices were measured medially and laterally at 6 levels from the first postoperative and the last follow-up x-rays. A comparison with 10 patients who had a nonoperated contralateral hip was performed. We found a significant decrease in cortical thicknesses in total hip arthroplasty. The cortical thinning was significant at all periprosthetic levels but less expressed distally. Prosthetic femora were associated with greater cortical thinning as compared with the contralateral nonoperated femora, exceeding that caused by natural aging

Comparison of dual mobility cup and other surgical construts used for three hundred and sixty two first time hip revisions due to recurrent dislocations : five year results from Lithuanian arthroplasty register

Purpose: Recently, there has been increasing interest in the use of dual mobility systems in the treatment of hip instability. The aim of this study was to investigate the re-revision rate of dual mobility cup compared to different surgical concepts when used for first-time hip revisions due to recurrent dislocations. Methods: The data were derived from the Lithuanian Arthroplasty Register. For survival analysis, we used both re-revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age, gender, and implant concept). Results: A total of 1388 revisions were recorded from 2011 to 2015, of which 362 were performed due to recurrent dislocation. Of the revisions, 247 were performed using dual mobility cups, while 115 were performed using a variety of other surgical constructs including constrained acetabular cups, conventional cups, femoral head exchanges, stem exchanges or anti-luxation rings. There were 27 re-revisions of which 15 were for additional dislocations. There were only 2% re-revisions due to dislocation with dual mobility vs 9% when using other surgical constructs. Cox regression adjusting for age and gender showed that in the short-term, dual mobility cup had a lower risk of revision due to dislocation as well as for all reasons compared to the other surgical constructs. Conclusion: In revision of total hip arthroplasties for dislocation, significantly lower short-term re-revision rate was observed for patients revised with dual mobility cup

The analysis of posterior soft tissue repair durability after total hip arthroplasty in primary osteoarthritis patients

Background and purpose: The posterior soft tissue repair is 1 of the preventing factors for dislocation after total hip arthroplasty (THA). The aim of our study was to analyse THA patients with posterior soft tissue repair in terms of suture durability, time of suture failure and correlate the changes in leg length and offset postoperatively to suture durability. Methods: A total of 37 consecutive THA patients operated for osteoarthritis were included in the study. The posterior repair included reattaching the piriformis, conjoined tendons and posterior capsule to the greater trochanter through 2, 2 mm drill holes with 2 grasping stitches. A metal indicator wire was stitched into the piriformis tendon at distance of 1 cm from the greater trochanter after the prosthesis had been implanted and the joint reduced. Anteroposterior radiographs were taken immediately after the patients returned from the operating theatre to the intensive care unit, the next day after mobilisation, and at the 5th day of stay and at 3 months postoperatively. Results: Out of 37 THA hips, 6 (16%) had failed immediately after surgery, 25 (68%) at the 1st postoperative day after mobilisation, 2 (5%) at the 5th postoperative day, and 1 (3%) repairs had failed at 3 months after THA. In the remaining 3 hips no failure occurred. Interpretation: We conclude that posterior soft tissue repair in THA often fails and suggest that new posterior soft tissue repair methods be developed