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. Three main options that provide some protection against dislocation have emerged: constrained liners, dual mobility implants, and use of large diameter femoral heads. A literature review of each of these options follows with particular attention to the
Academic Unit of Bone Metabolism, University of Sheffield Medical School, Sheffield, UK
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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. Surgical considerations to address the increased risk of instability include larger heads, dual-mobility implants or constrained liners. 32 , 33 The option of cemented components should also be considered in osteoporotic individuals. In our systematic
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
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Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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clinical benefits when head sizes greater than 32 mm are used, and even adverse effects if big metallic heads are used. Lipped, inclined and constrained liners and dual mobility cups (DMC) have been available for decades to improve the stability of
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in obese (defined as a BMI exceeding 30 kg/m 2 ) patients undergoing primary THA with either DM (or constrained liner) or standard cup. At 7 years follow-up, a statistically significant reduction in dislocation was observed in obese patients who had
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. If a manufacturer only produces an acetabular component, using a femoral system from another is not unreasonable (e.g. dual mobility constructs, constrained liners). Informed consent is important. Mixing and matching in revision surgery
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fashion in 468 hips (11 studies, 461 patients). The type of liner fixation into the CTAC was not reported in five studies. The majority of studies (17 studies, 772 patients, 782 hips) reported a mix of standard, bipolar or constrained liners used in their
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manage. Surgery is required in most cases to reseat a disengaged locking ring, replace a broken one, or address a displaced liner or cup. Williams Jr, Ragland and Clarke 41 reported a mean rate of dislocation following revision with a constrained
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). Further options may include lateralisation/distalisation of the glenosphere, the use of more constrained liners and correcting the height and version of the humeral stem, if anomalous. Using a medial centre of rotation prosthesis and a
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mm and using a more constrained liner to retain stability. Whilst revision surgery is technically demanding, improvements in ROM and outcome can be achieved, particularly when the revision is within two years of the primary surgery. van Rensch
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. Dual-mobility or constrained liners are more effective than preoperative bariatric surgery in prevention of THA dislocation . Clin Orthop Relat Res 2016 ; 474 : 2202 – 2210 . 54. Carden MA Fay ME Lu X et al
