INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION

David Roberts; Nicholas Garlick

doi:10.1302/1358-992X.94BSUPP_XXXVII.EFORT2011-557

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INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION

European Federation of National Associations of Orthopaedics and Traumatology (EFORT) - 12th Congress

David Roberts
Nicholas Garlick

INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION

Roberts D, Garlick N. INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION. Orthop Procs. 2012;94-B(SUPP_XXXVII):557-557. doi:10.1302/1358-992X.94BSUPP_XXXVII.EFORT2011-557

Roberts, David, and Nicholas Garlick. “INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION.” Orthopaedic Proceedings, vol. 94-B, no. SUPP_XXXVII, 2012, pp. 557-557., https://doi.org/10.1302/1358-992X.94BSUPP_XXXVII.EFORT2011-557

Roberts, D., & Garlick, N. (2012). INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION. Orthopaedic Proceedings, 94-B(SUPP_XXXVII), 557-557. https://doi.org/10.1302/1358-992X.94BSUPP_XXXVII.EFORT2011-557

Roberts, D. and Garlick, N. (2012) “INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION.” Orthopaedic Proceedings, 94-B(SUPP_XXXVII), pp. 557-557. Available at: https://doi.org/10.1302/1358-992X.94BSUPP_XXXVII.EFORT2011-557

Roberts, David, and Nicholas Garlick. “INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION.” Orthopaedic Proceedings 94-B, no. SUPP_XXXVII (2012): 557-557. https://doi.org/10.1302/1358-992X.94BSUPP_XXXVII.EFORT2011-557

Roberts D, Garlick N. INCREASED RATE OF TOTAL HIP REPLACEMENT DISLOCATION WITH CEMENTED COMPONENTS: ACCURACY OF ACETABULAR INCLINATION. Orthop Procs. 2012 Sep 1;94-B(SUPP_XXXVII):557-557. https://doi.org/10.1302/1358-992X.94BSUPP_XXXVII.EFORT2011-557

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Abstract

Introduction

Dislocation following total hip arthroplasty THA is a major short term complication not infrequently resulting in revision arthroplasty. Malposition of the acetabular component in THA results in a higher rate of dislocation as well as increased wear and osteolysis. The aim of this study was to assess the effect of mode of fixation on positioning of the acetabular component.

Patients, materials and methods

For all THAs performed at our hospital in 2008, angle of acetabular inclination was measured using PACS by two independent observers. Interobserver and intraobserver reliability were assessed (Pearson's correlation coefficient, r). We determined whether the number of acetabular components outside the target angle range (eg:45±5°) was significantly different between cemented and cementless THA (chi squared test). An enquiry was made to the National Joint Registry (NJR) in respect to incidence of revision for dislocation of THA using cemented and cementless acetabular components, 2004–2009.

Results

During 2008 126 THA were performed, 80 cemented and 46 cementless. There was good reliability of angle measurement (interobserver: r=0.89; intraobserver: r=0.87 and 0.97). More cemented acetabular components were within target angle range compared to cementless (cemented 32/80, cementless 29/46; chi squared=6.39, p<0.05). Using data from NJR comparing the number of primary hip replacement operations with number of revisions due to dislocation found a higher rate for cementless THA, 0.381% (266/69,822) than for cemented, 0.282% (262/92,928) (Odds ratio: 1.35 (95% CI 1.14–1.60; P<0.05).

Conclusion

Positioning of the acetabular component is more difficult when using cementless systems as implant position is determined by orientation of reaming whereas with cement there is potential for fine implant position adjustment on insertion. The choice of a cementless acetabular component significantly increases the incidence of dislocation post THA. Acetabular component malposition is likely to be a factor in this increased incidence.