A New York University Langone Health study suggests a new risk prediction model and treatment algorithm can help identify patients at high risk of implant dislocation after hip replacement surgery who may benefit from alternative implants.
Here are five things to know.
1. The findings were detailed in a poster selected as the Best Poster in the Adult Reconstruction Hip classification at the American Academy of Orthopaedic Surgeons 2018 Annual Meeting in New Orleans. The research has not yet been published in a peer-reviewed journal and is currently in submission.
2. Each year, more than 310,000 hip replacements are performed in the U.S., with an estimated 2.5 million Americans currently living with hip replacements. Some newer hip implants are designed with dual mobility cups to enable an increased range of motion, helping to reduce dislocation risk. No guidelines currently exist, however, to aid clinicians in deciding when to use these more flexible implants, which can be more expensive than conventional implants and may pose additional risks if unnecessarily implanted.
3. The researchers reviewed data on 1,082 total hip replacements performed using computer navigation between January 2014 and December 2015. No dual-mobility implants were used during this period and the overall implant dislocation rate among this cohort was reported as1.8 percent. Of this group, 320 patients had spinal disease and deformity 10 of those patients experienced dislocations, suggesting a dislocation rate about three times higher than normal.
4. In 2016, surgeons began using the standardized risk prediction model and treatment algorithm developed at NYU Langone, which factored in preoperative imaging and other measures that may affect dislocation risk, including the presence of a previous lumbar fusion. Using the risk assessment tool, the researchers identified 192 of 1,009 patients at high risk for a postoperative dislocation. All 192 patients underwent a total hip replacement through the high-risk algorithm, with dual mobility implants used in 143 of the cases. The researchers reported only one dislocation in this high-risk pool, representing a sixfold decrease in the rate of dislocation.
5. Now all patients who undergo hip replacement at NYU Langone Orthopedic Hospital go through the risk assessment screening and treatment algorithm preoperatively. For the especially high-risk and complex cases identified through the algorithm, other technologies including laser-guidance and computer navigation are used to ensure the best possible outcome.
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