In patients who have recurrent hip instability following total hip arthroplasty (THA) with a Charnley prosthesis, the posterior lip augmentation device (PLAD) is a minimally invasive surgical treatment option. Minimal data exists regarding the long-term outcome after PLAD application and variable success rates reported. This study aimed to further evaluate the role of PLAD application for recurrent hip instability following THA and its long-term outcomes.
Patients undergoing PLAD application at Fairfield General Hospital (Bury, UK) for hip instability after THA were identified using hospital records coding data. Radiological and clinical data were analysed retrospectively using the patient’s hospital case-notes and electronic PACS system.
Data was available for 15 PLAD applications in 15 patients with an average age of 75.1 years. The mean follow-up period was 21.9 months. PLAD application prevented further dislocation in 73% (11/15) of patients. Girdlestone procedure was performed in 2 patients who experienced further hip dislocation. Long-term follow-up of patients with PLAD remaining in-situ demonstrated that 100% of patients were independently mobile at 2-4 years postoperatively, and all patients were pain-free during long-term follow-up after 1-year. Sub-group analysis of risk factors identified only a significantly higher ASA grade to be associated with further episodes of dislocation in patients undergoing PLAD application.
Our study provides further evidence supporting the role of PLAD as a safe minimally-invasive procedure for elderly patients with recurrent hip instability after Charnley THA in whom prosthetic components are well-positioned and well-fixed. Our results demonstrate that the majority of patients undergoing PLAD application return to independent mobility with no long-term hip pain. PLAD application should be used with caution in patients with an ASA grade of 3 or greater.
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Association Label: coa
Category: Hip and Knee
Keywords: Recurrent dislocation, Charnley arthroplasty, PLAD
Date Added: 16-Jun-2010
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