Ioannis Gkiatas1, Theofilos Karasavvidis2, Abhinav K Sharma3, William Xiang4, Michael-Alexander Malahias4, Brian P Chalmers3, Seth A Jerabek4, Peter K Sculco4. 1. Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA. gkiatasi@hss.edu. 2. School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. 3. Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10021, USA. 4. Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10021, USA.
Abstract
PURPOSE: Instability remains one of the most frequent complications requiring revision surgery after primary total hip arthroplasty (THA). Elevated liners are often utilized to reduce the risk of dislocation; however, the literature is inconclusive, with no systematic reviews summarizing the data. Thus, this systematic review aimed to establish a consensus for the efficacy of elevated liners in primary THA by determining rates of overall revision and revision specifically for recurrent dislocation. MATERIALS AND METHODS: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible randomized-controlled trials and observational studies reporting on the use of elevated liners in primary total hip arthroplasty were identified through May 2020. A random effects model meta-analysis was conducted, and the I2 statistic was used to assess for heterogeneity. RESULTS: Eight studies met inclusion criteria, and overall, 26,507 patients undergoing primary THA with use of an elevated liner were included. In aggregate, the most common cause of revision was recurrent hip dislocation (1.3%, N = 82/6,267) followed by joint infection (1.2%, N = 45/3,772) and acetabular loosening (0.3%, N = 10/3,772). Notably, elevated liners were associated with a lower risk of revision for recurrent dislocation compared to neutral liners (HR: 0.74; 95% CI: 0.55-1.00; p = 0.048). CONCLUSION: This review found that after primary THA with the use of elevated liners, hip dislocation and prosthetic joint infection continued to be the most frequent reasons for revision surgery. However, elevated liners had a lower risk of revision for recurrent dislocation compared to neutral liners.
PURPOSE: Instability remains one of the most frequent complications requiring revision surgery after primary total hip arthroplasty (THA). Elevated liners are often utilized to reduce the risk of dislocation; however, the literature is inconclusive, with no systematic reviews summarizing the data. Thus, this systematic review aimed to establish a consensus for the efficacy of elevated liners in primary THA by determining rates of overall revision and revision specifically for recurrent dislocation. MATERIALS AND METHODS: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible randomized-controlled trials and observational studies reporting on the use of elevated liners in primary total hip arthroplasty were identified through May 2020. A random effects model meta-analysis was conducted, and the I2 statistic was used to assess for heterogeneity. RESULTS: Eight studies met inclusion criteria, and overall, 26,507 patients undergoing primary THA with use of an elevated liner were included. In aggregate, the most common cause of revision was recurrent hip dislocation (1.3%, N = 82/6,267) followed by joint infection (1.2%, N = 45/3,772) and acetabular loosening (0.3%, N = 10/3,772). Notably, elevated liners were associated with a lower risk of revision for recurrent dislocation compared to neutral liners (HR: 0.74; 95% CI: 0.55-1.00; p = 0.048). CONCLUSION: This review found that after primary THA with the use of elevated liners, hip dislocation and prosthetic joint infection continued to be the most frequent reasons for revision surgery. However, elevated liners had a lower risk of revision for recurrent dislocation compared to neutral liners.
Authors: Aaron H Carter; Eoin C Sheehan; S M Javad Mortazavi; James J Purtill; Peter F Sharkey; Javad Parvizi Journal: J Arthroplasty Date: 2011-05-08 Impact factor: 4.757
Authors: Jonathan L Conroy; Sarah L Whitehouse; Stephen E Graves; Nicole L Pratt; Philip Ryan; Ross W Crawford Journal: J Arthroplasty Date: 2008-03-07 Impact factor: 4.757
Authors: Jevan Furmanski; Martin Anderson; Sonny Bal; A Seth Greenwald; David Halley; Brad Penenberg; Michael Ries; Lisa Pruitt Journal: Biomaterials Date: 2009-07-29 Impact factor: 12.479
Authors: Matias Hemmilä; Mikko Karvonen; Inari Laaksonen; Markus Matilainen; Antti Eskelinen; Jaason Haapakoski; Ari-Pekka Puhto; Jukka Kettunen; Mikko Manninen; Keijo T Mäkelä Journal: Acta Orthop Date: 2019-04-17 Impact factor: 3.717
Authors: Luigi Zagra; Francesco Benazzo; Dante Dallari; Francesco Falez; Giuseppe Solarino; Rocco D'Apolito; Claudio Carlo Castelli Journal: EFORT Open Rev Date: 2022-01-11