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Trilogy-Constrained Acetabular Component for Recurrent Dislocation

DOI: 10.1155/2013/629201

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Abstract:

32 patients received a Trilogy- or Trilogy-Longevity-constrained acetabular liner for recurrent dislocations after total hip replacement. The constrained liner was inserted into a well-fixed Trilogy acetabular shell with snap fit. At 1.8-year followup (range 3–63 months), 4 patients had suffered further dislocation(s) (12%), and one patient had revision surgery for a loosened acetabular shell. Radiologic evaluation detected no definitively loose components, but one patient with progressing radiolucent lines around the femoral component and one patient with an acetabular cyst were found, as well as a patient with a loose locking ring (but otherwise no failure). The nineteen patients who were available for the present followup had a mean Harris Hip Score of 81. The constrained liner is an effective method of dealing with recurrent dislocations in well-fixed components. 1. Introduction Dislocation remains one of the most common complications after primary and especially revision hip arthroplasty. The rate of dislocation is influenced by many different factors and ranges between 0.3 and 10% in primary arthroplasty [1–5] and between 4 and 28% after revision arthroplasty [1–4]. The incidence varies greatly in different studies with a much higher risk for patients with neuromuscular disease or lack of compliance resulting from dementia or substance abuse [1, 2]. However, the rate of recurring dislocations has also been associated with surgical approach (including soft tissue repair) [6], surgical volume [4], and choice of implant [2]. Many different methods have been used to solve the problem, both nonoperative and surgical methods. Nonoperative in the form of different kinds of immobilizing devices. Surgically by repositioning malpositioned components, inserting jumbo or bipolar heads, or longer necks and last but not least by using a constrained liner [1–3]. None of the methods mentioned above have been without complications. The use of different kinds/brands of constrained liners has been reported with mixed results. We report on the use of the Trilogy constrained liner (Trilogy and Trilogy Longevity) in a consecutive series of patients operated on because of recurrent dislocations. 2. Materials and Methods We performed a retrospective review of all patients treated with a Trilogy constrained liner in the Hip Clinic H?rsholm Hospital, Denmark, in the period 2005–2009. The cohort comprised 38 patients all treated with a constrained acetabular insert because of recurrent dislocations (average 4.6 dislocations; range (1–10)), one was treated twice. The

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