TY - JOUR

T1 - Dislocation rate after hip arthroplasty due to metastatic bone disease

T2 - A retrospective cohort study evaluating the postoperative dislocation risk across different articulating solutions

AU - Iljazi, Afrim

AU - Sørensen, Michala Skovlund

AU - Ladegaard, Thea Hovgaard

AU - Overgaard, Søren

AU - Petersen, Michael Mørk

N1 - Funding Information: The Danish Patient Safety Authority (R-21041715) and the Data Protection Agency of the Capital Region of Copenhagen (P-2021-578) have approved this study. Data can be shared upon reasonable request. The study is funded from Rigshospi-talet’s Forskningspulje, which has provided a grant covering the salary for 1 PhD student (AI). The authors declare no conflicts of interest. Completed disclosure forms for this article following the ICMJE template are available on the article page, doi: 10.2340/17453674.2023.10311 Publisher Copyright: © 2023 The Author(s).

PY - 2023

Y1 - 2023

N2 - Background and purpose — Joint stability after hip replacement (HR) in patients with metastatic bone disease (MBD) is of special importance. Dislocation is the second leading cause of implant revision in HR, while survival after MBD surgery is poor with an expected 1-year survival of around 40%. As few studies have investigated the dislocation risk across different articulation solutions in MBD, we conducted a retrospective study on primary HR for patients with MBD treated in our department. Patients and methods — The primary outcome is the 1-year cumulative incidence of dislocation. We included patients with MBD who received HR at our department in 2003–2019. We excluded patients with partial pelvic reconstruction, total femoral replacement, and revision surgery. We assessed the incidence of dislocation with competing risk analysis with death and implant removal as competing risks. Results — We included 471 patients. Median follow-up was 6.5 months. The patients received 248 regular total hip arthroplasties (THAs), 117 hemiarthroplasties, 70 constrained liners, and 36 dual mobility liners. Major bone resection (MBR), defined as resection below the lesser trochanter, was performed in 63%. The overall 1-year cumulative incidence of dislocation was 6.2% (95% CI 4.0–8.3). Dislocation stratified by articulating surface was 6.9% (CI 3.7–10) for regular THA, 6.8% (CI 2.3–11) for hemiarthroplasty, 2.9% (CI 0.0–6.8) for constrained liner, and 5.6% (CI 0.0–13) for dual mobility liners. There was no significant difference between patients with and without MBR (p = 0.5). Conclusion — The 1-year cumulative incidence of dislocation is 6.2% in patients with MBD. Further studies are needed to determine any real benefits of specific articulations on the risk of postoperative dislocation in patients with MBD.

AB - Background and purpose — Joint stability after hip replacement (HR) in patients with metastatic bone disease (MBD) is of special importance. Dislocation is the second leading cause of implant revision in HR, while survival after MBD surgery is poor with an expected 1-year survival of around 40%. As few studies have investigated the dislocation risk across different articulation solutions in MBD, we conducted a retrospective study on primary HR for patients with MBD treated in our department. Patients and methods — The primary outcome is the 1-year cumulative incidence of dislocation. We included patients with MBD who received HR at our department in 2003–2019. We excluded patients with partial pelvic reconstruction, total femoral replacement, and revision surgery. We assessed the incidence of dislocation with competing risk analysis with death and implant removal as competing risks. Results — We included 471 patients. Median follow-up was 6.5 months. The patients received 248 regular total hip arthroplasties (THAs), 117 hemiarthroplasties, 70 constrained liners, and 36 dual mobility liners. Major bone resection (MBR), defined as resection below the lesser trochanter, was performed in 63%. The overall 1-year cumulative incidence of dislocation was 6.2% (95% CI 4.0–8.3). Dislocation stratified by articulating surface was 6.9% (CI 3.7–10) for regular THA, 6.8% (CI 2.3–11) for hemiarthroplasty, 2.9% (CI 0.0–6.8) for constrained liner, and 5.6% (CI 0.0–13) for dual mobility liners. There was no significant difference between patients with and without MBR (p = 0.5). Conclusion — The 1-year cumulative incidence of dislocation is 6.2% in patients with MBD. Further studies are needed to determine any real benefits of specific articulations on the risk of postoperative dislocation in patients with MBD.

U2 - 10.2340/17453674.2023.10311

DO - 10.2340/17453674.2023.10311

M3 - Journal article

C2 - 36877133

AN - SCOPUS:85153494066

VL - 94

SP - 107

EP - 114

JO - Acta Orthopaedica

JF - Acta Orthopaedica

SN - 1745-3674

ER -