Кавалерский ГМ Серебряков АБ Лычагин АВСметанин СМ
Середа АП (presenting author)
Treatment and rehabilitation center Ministry of health care Moscow Russia
РМ Тихилов ИИ Шубняков АН Коваленко ЗА Тотоев Лю Бо СС Билык СТРУКТУРА РАННИХ
РЕВИЗИЙ ЭНДОПРОТЕЗИРОВАНИЯ ТАЗОБЕДРЕННОГО СУСТАВА Травматология и ортопедия
России 2014 ndash 2 (72)
0
5
10
15
20
25
30
35
40
45
50
первый второй третий четвертый пятый
Год после операции
0
2
4
6
8
10
12
14
16
18
первый второй третий четвертый пятый
Год после операции
инфекции
переломы
нестабильность
вывихи
другое
Первичные операции
в РНИИТО вне РНИИТО
1 Soong M Rubash HE Macaulay W Dislocation after total hip arthroplasty J Am Acad Orthop Surg2004 12 314-321
2 Sanchez-Sotelo J Berry DJ Epidemiology of instability after total hip replacement Orthop Clin North Am2001 32543-552 vii
3 Woo RY Morrey BF Dislocations after total hip arthroplasty J Bone Joint Surg Am1982 64 1295-1306
4 Sikes CV Lai LP Schreiber M Mont MA Jinnah RH Seyler TM Instability after total hip arthroplasty treatment with large femoral heads vs constrained liners J Arthroplasty 2008 23 59-63
5 Ali Khan MA Brakenbury PH Reynolds IS Dislocation following total hip replacement J Bone Joint Surg Br1981 63-B214-218
6 Berry DJ von Knoch M Schleck CD Harmsen WS Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty J Bone Joint Surg Am2005
87 2456-2463
7 Pulido L Restrepo C Parvizi J Late instability following total hip arthroplasty Clin Med Res2007 5 139-142
8 Bourne RB Mehin R The dislocating hip what to do what to do J Arthroplasty2004 19 111-114
9 Newington DP Bannister GC Fordyce M Primary total hip replacement in patients over 80 years of age J Bone Joint Surg Br1990 72 450-452
10 Woolson ST Rahimtoola ZO Risk factors for dislocation during the first 3 months after primary total hip replacement J Arthroplasty1999 14 662-668
Пациент-связанные
Рост-вес не связаны с риском вывиха [12]
У женщин риск вывиха ~ в 2 раза uarr чем у мужчин [3-7]
Изолированный возраст ndash не связан с риском вывиха [12]
связан с риском вывиха [8910]
Нейромышечные и когнитивные нарушения [много работhellip]
1 Phillips CB et al Incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total hip replacement J Bone Joint Surg [Am]200385-A20ndash26
2 Springer BD et al Why revision total hip arthroplasty fails Clin Orthop2009467166ndash173
3 Carter AH et alRevision for recurrent instability what are the predictors of failure J Arthroplasty201126(Suppl)46ndash52
Пациент-связанные
Частота вывихов после ревизионного THR -
74 - 25 [1-3]
До 35 при некоторых показаниях [2]
Риск вывиха после revTHR в 3 раза больше
чем после primTHR (144 versus 39) [1]
Хирург и имплант-связанные
Доступ
Наклон-антеверсия
Диаметр головки
Оффсет
Импинджемент
Козырек
Реконструкция laquoманжетыraquo
Хирург-связанные
Доступhellip
Задний доступ 41 (23 of 555) [1]
Omega доступ 0 (0 of 120) [1]
Доступ Hardinge 34 (30 of 892) [1]
Прямой передний доступ (MIS) 30 (6 of 200) [2]
Передний межмышечный (модифицированный
Smith-Petersen)
04 (4 of 986) [3]
Ashley W Blom Mark Rogers Adrian H Taylor Giles Pattison Sarah Whitehouse and Gordon C Bannister
Dislocation Following Total Hip Replacement The Avon Orthopaedic Centre Experience Ann R Coll Surg Engl 2008 November 90(8) 658ndash
662
Ola Hallert Yan Li Harald Brismar1 and Urban Lindgren The direct anterior approach initial experience of a minimally invasive technique for
total hip arthroplasty J Orthop Surg Res 2012 7 17
Berend KR Kavolus JJ Morris MJ Lombardi AV Jr Primary and revision anterior supine total hip arthroplasty an analysis of complications
and reoperations Instr Course Lect 201362251-63
Хирург-связанные
Доступhellip
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
РМ Тихилов ИИ Шубняков АН Коваленко ЗА Тотоев Лю Бо СС Билык СТРУКТУРА РАННИХ
РЕВИЗИЙ ЭНДОПРОТЕЗИРОВАНИЯ ТАЗОБЕДРЕННОГО СУСТАВА Травматология и ортопедия
России 2014 ndash 2 (72)
0
5
10
15
20
25
30
35
40
45
50
первый второй третий четвертый пятый
Год после операции
0
2
4
6
8
10
12
14
16
18
первый второй третий четвертый пятый
Год после операции
инфекции
переломы
нестабильность
вывихи
другое
Первичные операции
в РНИИТО вне РНИИТО
1 Soong M Rubash HE Macaulay W Dislocation after total hip arthroplasty J Am Acad Orthop Surg2004 12 314-321
2 Sanchez-Sotelo J Berry DJ Epidemiology of instability after total hip replacement Orthop Clin North Am2001 32543-552 vii
3 Woo RY Morrey BF Dislocations after total hip arthroplasty J Bone Joint Surg Am1982 64 1295-1306
4 Sikes CV Lai LP Schreiber M Mont MA Jinnah RH Seyler TM Instability after total hip arthroplasty treatment with large femoral heads vs constrained liners J Arthroplasty 2008 23 59-63
5 Ali Khan MA Brakenbury PH Reynolds IS Dislocation following total hip replacement J Bone Joint Surg Br1981 63-B214-218
6 Berry DJ von Knoch M Schleck CD Harmsen WS Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty J Bone Joint Surg Am2005
87 2456-2463
7 Pulido L Restrepo C Parvizi J Late instability following total hip arthroplasty Clin Med Res2007 5 139-142
8 Bourne RB Mehin R The dislocating hip what to do what to do J Arthroplasty2004 19 111-114
9 Newington DP Bannister GC Fordyce M Primary total hip replacement in patients over 80 years of age J Bone Joint Surg Br1990 72 450-452
10 Woolson ST Rahimtoola ZO Risk factors for dislocation during the first 3 months after primary total hip replacement J Arthroplasty1999 14 662-668
Пациент-связанные
Рост-вес не связаны с риском вывиха [12]
У женщин риск вывиха ~ в 2 раза uarr чем у мужчин [3-7]
Изолированный возраст ndash не связан с риском вывиха [12]
связан с риском вывиха [8910]
Нейромышечные и когнитивные нарушения [много работhellip]
1 Phillips CB et al Incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total hip replacement J Bone Joint Surg [Am]200385-A20ndash26
2 Springer BD et al Why revision total hip arthroplasty fails Clin Orthop2009467166ndash173
3 Carter AH et alRevision for recurrent instability what are the predictors of failure J Arthroplasty201126(Suppl)46ndash52
Пациент-связанные
Частота вывихов после ревизионного THR -
74 - 25 [1-3]
До 35 при некоторых показаниях [2]
Риск вывиха после revTHR в 3 раза больше
чем после primTHR (144 versus 39) [1]
Хирург и имплант-связанные
Доступ
Наклон-антеверсия
Диаметр головки
Оффсет
Импинджемент
Козырек
Реконструкция laquoманжетыraquo
Хирург-связанные
Доступhellip
Задний доступ 41 (23 of 555) [1]
Omega доступ 0 (0 of 120) [1]
Доступ Hardinge 34 (30 of 892) [1]
Прямой передний доступ (MIS) 30 (6 of 200) [2]
Передний межмышечный (модифицированный
Smith-Petersen)
04 (4 of 986) [3]
Ashley W Blom Mark Rogers Adrian H Taylor Giles Pattison Sarah Whitehouse and Gordon C Bannister
Dislocation Following Total Hip Replacement The Avon Orthopaedic Centre Experience Ann R Coll Surg Engl 2008 November 90(8) 658ndash
662
Ola Hallert Yan Li Harald Brismar1 and Urban Lindgren The direct anterior approach initial experience of a minimally invasive technique for
total hip arthroplasty J Orthop Surg Res 2012 7 17
Berend KR Kavolus JJ Morris MJ Lombardi AV Jr Primary and revision anterior supine total hip arthroplasty an analysis of complications
and reoperations Instr Course Lect 201362251-63
Хирург-связанные
Доступhellip
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
1 Soong M Rubash HE Macaulay W Dislocation after total hip arthroplasty J Am Acad Orthop Surg2004 12 314-321
2 Sanchez-Sotelo J Berry DJ Epidemiology of instability after total hip replacement Orthop Clin North Am2001 32543-552 vii
3 Woo RY Morrey BF Dislocations after total hip arthroplasty J Bone Joint Surg Am1982 64 1295-1306
4 Sikes CV Lai LP Schreiber M Mont MA Jinnah RH Seyler TM Instability after total hip arthroplasty treatment with large femoral heads vs constrained liners J Arthroplasty 2008 23 59-63
5 Ali Khan MA Brakenbury PH Reynolds IS Dislocation following total hip replacement J Bone Joint Surg Br1981 63-B214-218
6 Berry DJ von Knoch M Schleck CD Harmsen WS Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty J Bone Joint Surg Am2005
87 2456-2463
7 Pulido L Restrepo C Parvizi J Late instability following total hip arthroplasty Clin Med Res2007 5 139-142
8 Bourne RB Mehin R The dislocating hip what to do what to do J Arthroplasty2004 19 111-114
9 Newington DP Bannister GC Fordyce M Primary total hip replacement in patients over 80 years of age J Bone Joint Surg Br1990 72 450-452
10 Woolson ST Rahimtoola ZO Risk factors for dislocation during the first 3 months after primary total hip replacement J Arthroplasty1999 14 662-668
Пациент-связанные
Рост-вес не связаны с риском вывиха [12]
У женщин риск вывиха ~ в 2 раза uarr чем у мужчин [3-7]
Изолированный возраст ndash не связан с риском вывиха [12]
связан с риском вывиха [8910]
Нейромышечные и когнитивные нарушения [много работhellip]
1 Phillips CB et al Incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total hip replacement J Bone Joint Surg [Am]200385-A20ndash26
2 Springer BD et al Why revision total hip arthroplasty fails Clin Orthop2009467166ndash173
3 Carter AH et alRevision for recurrent instability what are the predictors of failure J Arthroplasty201126(Suppl)46ndash52
Пациент-связанные
Частота вывихов после ревизионного THR -
74 - 25 [1-3]
До 35 при некоторых показаниях [2]
Риск вывиха после revTHR в 3 раза больше
чем после primTHR (144 versus 39) [1]
Хирург и имплант-связанные
Доступ
Наклон-антеверсия
Диаметр головки
Оффсет
Импинджемент
Козырек
Реконструкция laquoманжетыraquo
Хирург-связанные
Доступhellip
Задний доступ 41 (23 of 555) [1]
Omega доступ 0 (0 of 120) [1]
Доступ Hardinge 34 (30 of 892) [1]
Прямой передний доступ (MIS) 30 (6 of 200) [2]
Передний межмышечный (модифицированный
Smith-Petersen)
04 (4 of 986) [3]
Ashley W Blom Mark Rogers Adrian H Taylor Giles Pattison Sarah Whitehouse and Gordon C Bannister
Dislocation Following Total Hip Replacement The Avon Orthopaedic Centre Experience Ann R Coll Surg Engl 2008 November 90(8) 658ndash
662
Ola Hallert Yan Li Harald Brismar1 and Urban Lindgren The direct anterior approach initial experience of a minimally invasive technique for
total hip arthroplasty J Orthop Surg Res 2012 7 17
Berend KR Kavolus JJ Morris MJ Lombardi AV Jr Primary and revision anterior supine total hip arthroplasty an analysis of complications
and reoperations Instr Course Lect 201362251-63
Хирург-связанные
Доступhellip
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
1 Phillips CB et al Incidence rates of dislocation pulmonary embolism and deep infection during the first six months after elective total hip replacement J Bone Joint Surg [Am]200385-A20ndash26
2 Springer BD et al Why revision total hip arthroplasty fails Clin Orthop2009467166ndash173
3 Carter AH et alRevision for recurrent instability what are the predictors of failure J Arthroplasty201126(Suppl)46ndash52
Пациент-связанные
Частота вывихов после ревизионного THR -
74 - 25 [1-3]
До 35 при некоторых показаниях [2]
Риск вывиха после revTHR в 3 раза больше
чем после primTHR (144 versus 39) [1]
Хирург и имплант-связанные
Доступ
Наклон-антеверсия
Диаметр головки
Оффсет
Импинджемент
Козырек
Реконструкция laquoманжетыraquo
Хирург-связанные
Доступhellip
Задний доступ 41 (23 of 555) [1]
Omega доступ 0 (0 of 120) [1]
Доступ Hardinge 34 (30 of 892) [1]
Прямой передний доступ (MIS) 30 (6 of 200) [2]
Передний межмышечный (модифицированный
Smith-Petersen)
04 (4 of 986) [3]
Ashley W Blom Mark Rogers Adrian H Taylor Giles Pattison Sarah Whitehouse and Gordon C Bannister
Dislocation Following Total Hip Replacement The Avon Orthopaedic Centre Experience Ann R Coll Surg Engl 2008 November 90(8) 658ndash
662
Ola Hallert Yan Li Harald Brismar1 and Urban Lindgren The direct anterior approach initial experience of a minimally invasive technique for
total hip arthroplasty J Orthop Surg Res 2012 7 17
Berend KR Kavolus JJ Morris MJ Lombardi AV Jr Primary and revision anterior supine total hip arthroplasty an analysis of complications
and reoperations Instr Course Lect 201362251-63
Хирург-связанные
Доступhellip
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Хирург и имплант-связанные
Доступ
Наклон-антеверсия
Диаметр головки
Оффсет
Импинджемент
Козырек
Реконструкция laquoманжетыraquo
Хирург-связанные
Доступhellip
Задний доступ 41 (23 of 555) [1]
Omega доступ 0 (0 of 120) [1]
Доступ Hardinge 34 (30 of 892) [1]
Прямой передний доступ (MIS) 30 (6 of 200) [2]
Передний межмышечный (модифицированный
Smith-Petersen)
04 (4 of 986) [3]
Ashley W Blom Mark Rogers Adrian H Taylor Giles Pattison Sarah Whitehouse and Gordon C Bannister
Dislocation Following Total Hip Replacement The Avon Orthopaedic Centre Experience Ann R Coll Surg Engl 2008 November 90(8) 658ndash
662
Ola Hallert Yan Li Harald Brismar1 and Urban Lindgren The direct anterior approach initial experience of a minimally invasive technique for
total hip arthroplasty J Orthop Surg Res 2012 7 17
Berend KR Kavolus JJ Morris MJ Lombardi AV Jr Primary and revision anterior supine total hip arthroplasty an analysis of complications
and reoperations Instr Course Lect 201362251-63
Хирург-связанные
Доступhellip
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Хирург-связанные
Доступhellip
Задний доступ 41 (23 of 555) [1]
Omega доступ 0 (0 of 120) [1]
Доступ Hardinge 34 (30 of 892) [1]
Прямой передний доступ (MIS) 30 (6 of 200) [2]
Передний межмышечный (модифицированный
Smith-Petersen)
04 (4 of 986) [3]
Ashley W Blom Mark Rogers Adrian H Taylor Giles Pattison Sarah Whitehouse and Gordon C Bannister
Dislocation Following Total Hip Replacement The Avon Orthopaedic Centre Experience Ann R Coll Surg Engl 2008 November 90(8) 658ndash
662
Ola Hallert Yan Li Harald Brismar1 and Urban Lindgren The direct anterior approach initial experience of a minimally invasive technique for
total hip arthroplasty J Orthop Surg Res 2012 7 17
Berend KR Kavolus JJ Morris MJ Lombardi AV Jr Primary and revision anterior supine total hip arthroplasty an analysis of complications
and reoperations Instr Course Lect 201362251-63
Хирург-связанные
Доступhellip
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Хирург-связанные
Доступhellip
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
В Клинике травматологии ортопедии и
патологии суставов Первого МГМУ им ИМ
Сеченова с 2012 года по 10914 выполнено
1312 эндопротезирований тазобедренного
сустава
Год laquoПереднийraquo
доступ
laquoЗаднийraquo доступ Первичных Ревизионных Всего
2012 282 246 528 9 537
2013 247 243 490 19 509
2014 130 125 255 11 266
Сумма 659 614 1273 39 1312
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
53 вывиха у 38 пациентов
laquoПереднийraquo доступ ndash 88
(12)
laquoЗаднийraquo доступ ndash 4530
(48) χ2=148 p=00001
В группе заднего доступа -
больше некомплайентных
пациентов больше
пациентов с нарушенной
функцией мышечной
laquoманжетыraquo
Закрытое вправление +
иммобилизация оказались
эффективными у 19
пациентов
Закрытое вправление +
иммобилизация оказались
НЕэффективными у 19 пациентов
ndash Открытое вправление Ревизия
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
2007-2012 гг
19 449 пациентов
(22 097 операций)
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Esposito Christina I et al
Cup Position Alone Does Not Predict Risk of Dislocation after Hip Arthroplasty
Journal of Arthroplasty (2014) doi 101016jarth201407009
LEAS ndash шкала
оценки физической
активности (до
операции)
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
527 THR
Задний доступ
Риск вывиха не связан с диаметромhellip
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Неправильная позиция
компонентов
Правильная
позиция компонентов
РЕВИЗИЯ
Импинджемент uarr диаметр головки
Козырек
Антеверсия
Латерализация
Дисфункция абдукторов
laquoСлабостьraquo uarr оффсет
laquoОтрывraquo Остеосинтез
миотенопластика
laquoОтсутствиеraquo Constrain
Robert B Bourne The Dislocating Hip What to Do What to Do The Journal
of Arthroplasty Vol 19 No 4 Suppl 1 June 2004
НЕТ ВЕДУЩЕГО ФАКТОРА НЕЛЬЗЯ ДЕЙСТВОАТЬ НА
ОДНО ЗВЕНО
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
1970-1975 ndash разработка концепции
(Gilles Bousquet Andreacute Rambert Jean Rieu)
1975 ndash Первая имплантация
Синонимы dual-mobility double-mobility or unconstrained
tripolar acetabular component
Gilles Bousquet
(1936-1996)
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
38 reduction in wear rate between
Restoration ADM Duration and Trident
N2Vac
98 reduction in wear rate between
Restoration ADM X3 and Trident
N2Vac
94 reduction in wear rate between
Restoration ADM X3 and Restoration
ADM Duration
Stryker Test Report RD-09-068
ADM - anatomic dual mobility (Stryker)
94 reduction in wear
rate between ADM X3
compared to MOM
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
IM Sechenov First Moscow State Medical University
Treatment and rehabilitation center Ministry of health care Moscow Russia
University clinic ndash teaching hospital
(studentsampresidents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
1600 surgeries per year
1200 major joint replacements per
year
500 THR a year
Teaching hospital (only residents)
70 beds in orthopaedic department
Only elective surgery
3 operating rooms
4200 surgeries per year
3800 major joint replacements per
year
2000 THR a year
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
First THR with DMndash September of 2011
September 2014 ndash more than 1600 primary THR with DM
88 cases of revision THR with DM
39 revisions for recurrent dislocations with DM (follow-up 161 months
min 12 months)
ImplantCast
ACCISpolaric head Serf
NOVAE
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Inclusion criteria pts with chronic dislocation of femoral
head after THR (ge2 episodes)
39 pts
19 female
bull 677plusmn81 yo
20 male
bull 556plusmn92 yo
2 patients lost
All 39 cups were removed for
new DM cups
34 stems were left (5
removed)
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
man 41 yo Left THR in 2005 Right THR in 2006 (chronic dislocations)
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Just after revTHR 13 mnths postop
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
man 59 yo Right THR in 2011 (chronic dislocations) RevTHR jan 2012
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
female 67 yo primary THR in 2006 (Zimmer cemented CPTampZCA) multiple dislocations since 2009 RevTHR in july of 2012
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
man 62 yo Right THR in 2010 (chronic dislocations) RevTHR feb 2012
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
female 71 yo primary THR in 2010 multiple dislocations Bone defect of prox femur (unknown history) RevTHR in oct of 2012
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Authors 1st revision with DM for dislocation Closed
reduction
wout further
surgery
Re-revision for dislocation
Mean follow-
up (mths)
n Dislocations
(n)
n Success (n)
Current study 16 37 (2 lost)
0 - - -
Leiber-Wackenheim et al 2011 96 59 1(17) 1 - -
Hamadouche et al 2010 51 51 2 (39) - 2 2
Massin and Besnier 2010 54 23 2 (87) 1 1 1
Guyen et al 2009 48 54 3 (56) 1 2 2
Philippot et al 2009 60 26 6 of 163 (only
26 revisions for
dislocations - 37)
6 - -
Langlais et al 2008 36 5 0 - - -
Leclercq et al 1995 40 13 1 (77) 1 - -
Levine et al 2008 24 20 1 (50) 0 1 1
Grigoris et al 1994 50 8 0 - - -
Vasukutty et al 2012 42 29 2 (69) 2 - -
Beaule et al 2003 65 21 1 (48) - 1 1
Total 346 13 of 320 41
12 of 19 7 7
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
What are these screws
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
Figure 1 Preoperative radiograph
showing loose acetabular
component with subluxed hip joint
and mature heterotopic
ossification
S Kamath and AC Campbell case
Спасибо
Thank you
S Kamath and AC Campbell case
Спасибо
Thank you
Спасибо
Thank you