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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
- 9. 99 Retentive clip MecanismRetentive clip Mecanism
- 10. 1010 30 N30 N impactionimpaction > 3000 N> 3000 N pull-out Resistance 2153 N2153 N PossiblePossible DislocationDislocation Resistance LimitsResistance Limits
- 11. 1111 Limited Angular Displacement Retentive CupRetentive Cup Usual CupUsual Cup DisavantageDisavantage
- 13. Tripolar Cups
- 16. Tripolar THA : 6 types of failure
- 17. Variety of Double Mobility Cups NOVAE
- 18. CONCEPT : Dual Mobility THA Mobile insert (polyethylene) Femoral stem Femoral head Acetabular cup
- 19. CONCEPT : Dual Mobility First mobility Second Mobility Femoral head - Insert Cup - Insert (Charnley’s concept) (Mac Kee’s concept)
- 20. AIMS: Mobility Standard PE Insert Increasing the Range of Motion
- 21. AIMS: Mobility Dual mobility cup Increasing the Range of Motion
- 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.
Notes de l'éditeur
- 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.