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2017-008
1. Les différents moyens d’éviter les luxations
des PTH
Diferentes formas de evitar luxaciones en
las PTC.
The different means to prevent THA
dislocation
JL Rouvillain, O Labrada Blanco, G Renard, M Severyns
(CHU Martinique)
2. 22
1- Muscular insufficiency1- Muscular insufficiency
2- No trochanter2- No trochanter
3- Neurologic desease3- Neurologic desease
??
THA and Dislocation RiskTHA and Dislocation Risk
Multifactorial ComplicationMultifactorial Complication
3. Different means to prevent dislocation
Planification: Avoid medialisation, Respect
of Off-set, Prefered cimented stem ?
Surgical Approachs
Anterior, Hardinge, Rottinger
Testing per-op of the prosthesis stability in
external rotation
4. 44
• Device anti-dislocation
• LPW CupLPW Cup (Long Posterior Wall)(Long Posterior Wall)
• Retentive cup
• Tripolar CupTripolar Cup
• double-mobility Cup (Bousquet)double-mobility Cup (Bousquet)
THA Dislocation : solutionsTHA Dislocation : solutions
8. 88
Retentive cupRetentive cup
PE Cup (UHMPWE) – for head diameter 22,2 and 28 mmPE Cup (UHMPWE) – for head diameter 22,2 and 28 mm
Slotted PE Ring (UHMPWE) = Retentive RingSlotted PE Ring (UHMPWE) = Retentive Ring
22. Stability
Series Dislocation Rate
Novae tripod 1st
generation
- PF stem
(Farizon et al 1998)
0 % at 10 years
NOVAE- PRO stem
(Philippot et al 2006 )
0 % at 10 years
NOVAE Titanium – PRO stem
(Philippot et al 2009)
0 % at 10 years
NOVAE – Charnley stem
(Vielpeau et al 2011)
2 % at 10 years
NOVAE E – CORAIL
(Kawaye et al, 2013)
2.85% at 10 years
NOVAE SUNFIT – CORAIL
(Meucci et al 2014)
2.1 % at 12 years
NOVAE SUNFIT TH – CORAIL
(Laurendon et al 2015)
0% at 5 years
23. DM aux USA
HSS New York; World J Orthop. Jul 18, 2014; 5(3): 180-187
Dual mobility acetabular component also known
as unconstrained tripolar implant
U.S. Food and Drug Administration approval until
2009
POLARCUP®
(Smith and Nephew)
Anatomic Dual Mobility (ADM®
) (Stryker)
Active Articulation E1®
(Biomet) IN)
Stick, SunFit, Coptos, Evolution SERF
24. conclusion
Tarasevicius et al
BMC Disord. 2010
Dual mobility cup reduces dislocation rate after arthroplasty for FNF
Compared dislocation rates of DM cups / conventional cups in patients with FNF
treated with THA through a posterior approach.
At 1 year follow-up, there were 8 dislocations (14.3%) in the conventional THA
group and no dislocations in DM group.
Editor's Notes
The concept of DM is to have a metal back cup like in a standard THA with a retentive mobile liner.
The Dual Mobility Total Hip Arthroplasty combines 2 concepts:
The first mobility: little mobility is between liner and femoral head
It’s Charnley concept: small head diameter to decrease the wear volume
- The second mobility: big mobility is between liner and cup, it is the true head diameter.
It’s McKee concept: large head diameter to increase range of motion, more stability and less dislocation
in this slide, the range of motion you can achieve with the standard THA is represented by the pink circle.
As you can see, some of the motion are not covered and this is where the risk of dislocation is.
The green circle show the range of motion you can have with a Dual mobility cup.
As you can see, all curents motion are covered and even more. That’s why DM is nearly impossible to dislocate.
Regarding dislocation in other series, all in our department:
Older-generation prostheses report better results in terms of dislocation.
Older age at implantation is higher in the last series might be responsible for such a finding.
Indeed, the mean age at implantation increased from 56 (fivety six) to 71 (seventy one) years, due to the new medical treatment for young patients .
Therefore age, as demonstratId, is a major risk factor for dislocation.
It is worth noting that we only use a posterolateral approach.
