Effectiveness of Constrained Liner Use During Harrington Hip Reconstruction in Oncology Patient

Deren T. Bagsby, Lawrence Wurtz

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Patients with destructive acetabular lesions are at high risk for morbidity. Harrington described reinforcing acetabular diseased bone with methylmethacrylate, supplemented by metal fixation, to allow total hip reconstruction. However, all published studies using this technique report dislocations. We believe that initial use of constrained liners would help alleviate dislocation risk, without increasing component loosening or polyethylene wear. Methods: Sixty-eight patients who underwent Harrington hip arthroplasties for metastatic cancer from August 2005 to March 2015 were identified. All patients had a constrained acetabular liner implanted during their index procedure. Electronic medical records and radiographs were reviewed. A literature review of studies with similar technique was used as a historical control. Results: Forty-seven patients (69.2%) died 22.7 ± 22.7 months after surgery, at age 62.4 ± 17.2 years. At an average clinical follow-up of 9.9 ± 14.2 months (range 2-50 months), we found no incidents of dislocation. No patients had component failure requiring revision or evidence of loosening on x-ray. Thirteen papers, comprising 185 patients, demonstrated 39 patients (21.1%) with dislocations and 13 patients (7.0%) requiring revision surgery for aseptic loosening. Conclusion: Modified Harrington technique has demonstrated relative durability when reconstructing metastatic acetabular disease, although dislocation occurs in approximately 20% of patients. This study demonstrates that initial use of a constrained liner can alleviate postoperative dislocations without increasing risk of perioperative complications. Even modest reduction in complications during the limited lifespan of oncologic patients can have dramatic positive effects on quality of life.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StateAccepted/In press - Aug 20 2016

Fingerprint

Hip
Methylmethacrylate
Electronic Health Records
Bone Diseases
Polyethylene
Reoperation
Arthroplasty
Metals
Quality of Life
X-Rays
Morbidity

Keywords

  • Aseptic loosening
  • Dislocation
  • Failure
  • Harrington
  • Hip arthroplasty
  • Oncology

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

@article{31013685030b4105963aefb898917cae,
title = "Effectiveness of Constrained Liner Use During Harrington Hip Reconstruction in Oncology Patient",
abstract = "Background: Patients with destructive acetabular lesions are at high risk for morbidity. Harrington described reinforcing acetabular diseased bone with methylmethacrylate, supplemented by metal fixation, to allow total hip reconstruction. However, all published studies using this technique report dislocations. We believe that initial use of constrained liners would help alleviate dislocation risk, without increasing component loosening or polyethylene wear. Methods: Sixty-eight patients who underwent Harrington hip arthroplasties for metastatic cancer from August 2005 to March 2015 were identified. All patients had a constrained acetabular liner implanted during their index procedure. Electronic medical records and radiographs were reviewed. A literature review of studies with similar technique was used as a historical control. Results: Forty-seven patients (69.2{\%}) died 22.7 ± 22.7 months after surgery, at age 62.4 ± 17.2 years. At an average clinical follow-up of 9.9 ± 14.2 months (range 2-50 months), we found no incidents of dislocation. No patients had component failure requiring revision or evidence of loosening on x-ray. Thirteen papers, comprising 185 patients, demonstrated 39 patients (21.1{\%}) with dislocations and 13 patients (7.0{\%}) requiring revision surgery for aseptic loosening. Conclusion: Modified Harrington technique has demonstrated relative durability when reconstructing metastatic acetabular disease, although dislocation occurs in approximately 20{\%} of patients. This study demonstrates that initial use of a constrained liner can alleviate postoperative dislocations without increasing risk of perioperative complications. Even modest reduction in complications during the limited lifespan of oncologic patients can have dramatic positive effects on quality of life.",
keywords = "Aseptic loosening, Dislocation, Failure, Harrington, Hip arthroplasty, Oncology",
author = "Bagsby, {Deren T.} and Lawrence Wurtz",
year = "2016",
month = "8",
day = "20",
doi = "10.1016/j.arth.2016.11.038",
language = "English (US)",
journal = "Journal of Arthroplasty",
issn = "0883-5403",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Effectiveness of Constrained Liner Use During Harrington Hip Reconstruction in Oncology Patient

AU - Bagsby, Deren T.

AU - Wurtz, Lawrence

PY - 2016/8/20

Y1 - 2016/8/20

N2 - Background: Patients with destructive acetabular lesions are at high risk for morbidity. Harrington described reinforcing acetabular diseased bone with methylmethacrylate, supplemented by metal fixation, to allow total hip reconstruction. However, all published studies using this technique report dislocations. We believe that initial use of constrained liners would help alleviate dislocation risk, without increasing component loosening or polyethylene wear. Methods: Sixty-eight patients who underwent Harrington hip arthroplasties for metastatic cancer from August 2005 to March 2015 were identified. All patients had a constrained acetabular liner implanted during their index procedure. Electronic medical records and radiographs were reviewed. A literature review of studies with similar technique was used as a historical control. Results: Forty-seven patients (69.2%) died 22.7 ± 22.7 months after surgery, at age 62.4 ± 17.2 years. At an average clinical follow-up of 9.9 ± 14.2 months (range 2-50 months), we found no incidents of dislocation. No patients had component failure requiring revision or evidence of loosening on x-ray. Thirteen papers, comprising 185 patients, demonstrated 39 patients (21.1%) with dislocations and 13 patients (7.0%) requiring revision surgery for aseptic loosening. Conclusion: Modified Harrington technique has demonstrated relative durability when reconstructing metastatic acetabular disease, although dislocation occurs in approximately 20% of patients. This study demonstrates that initial use of a constrained liner can alleviate postoperative dislocations without increasing risk of perioperative complications. Even modest reduction in complications during the limited lifespan of oncologic patients can have dramatic positive effects on quality of life.

AB - Background: Patients with destructive acetabular lesions are at high risk for morbidity. Harrington described reinforcing acetabular diseased bone with methylmethacrylate, supplemented by metal fixation, to allow total hip reconstruction. However, all published studies using this technique report dislocations. We believe that initial use of constrained liners would help alleviate dislocation risk, without increasing component loosening or polyethylene wear. Methods: Sixty-eight patients who underwent Harrington hip arthroplasties for metastatic cancer from August 2005 to March 2015 were identified. All patients had a constrained acetabular liner implanted during their index procedure. Electronic medical records and radiographs were reviewed. A literature review of studies with similar technique was used as a historical control. Results: Forty-seven patients (69.2%) died 22.7 ± 22.7 months after surgery, at age 62.4 ± 17.2 years. At an average clinical follow-up of 9.9 ± 14.2 months (range 2-50 months), we found no incidents of dislocation. No patients had component failure requiring revision or evidence of loosening on x-ray. Thirteen papers, comprising 185 patients, demonstrated 39 patients (21.1%) with dislocations and 13 patients (7.0%) requiring revision surgery for aseptic loosening. Conclusion: Modified Harrington technique has demonstrated relative durability when reconstructing metastatic acetabular disease, although dislocation occurs in approximately 20% of patients. This study demonstrates that initial use of a constrained liner can alleviate postoperative dislocations without increasing risk of perioperative complications. Even modest reduction in complications during the limited lifespan of oncologic patients can have dramatic positive effects on quality of life.

KW - Aseptic loosening

KW - Dislocation

KW - Failure

KW - Harrington

KW - Hip arthroplasty

KW - Oncology

UR - http://www.scopus.com/inward/record.url?scp=85009785223&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85009785223&partnerID=8YFLogxK

U2 - 10.1016/j.arth.2016.11.038

DO - 10.1016/j.arth.2016.11.038

M3 - Article

JO - Journal of Arthroplasty

JF - Journal of Arthroplasty

SN - 0883-5403

ER -