title: Constrained liner in neurologic or cognitively impaired patients undergoing primary THA.
abstract: BACKGROUND
  THA performed in patients with cognitive deficits or neuromuscular diseases has been associated with a high postoperative dislocation rate. The constrained liner reportedly provides stability in patients with recurrent dislocation. However, achieving stability could be offset by early loosening when used in patients with neurologic diseases.
  
  
  OBJECTIVE
  We therefore asked whether constrained liners had a higher risk of loosening when used in primary THA for patients with neurologic diseases.
  
  
  METHODS
  We retrospectively reviewed a 144 patients (164 hips) with neuromuscular disease who had a constrained polyethylene insert from 1999 to 2004 and compared them to another 120 patients (132 hips) with neuromuscular disease operated on immediately before this period (from 1994 to 1998) who had a conventional polyethylene insert.
  
  
  RESULTS
  Thirty-three (25%) of the 132 hips without a constrained liner were known to have had at least one dislocation and 21 had revision for recurrent dislocation. Ten other hips had revision for loosening of the cup. The survival rate was 82% at 5 years and 77% at 10 years with revision due to recurrent dislocation or loosening of the cup as the endpoint. With a constrained liner, at minimum 5-year followup (mean, 7 years; range, 5-10 years), the incidence of complications, particularly dislocation, was decreased (three dislocations among 164 hips; 2%), with one revision for recurrent dislocation and one revision for loosening.
  
  
  CONCLUSIONS
  This constrained acetabular component provides durable protection against dislocation without substantial increased loosening at midterm followup.
authors.affiliation: Department of Orthopaedic Surgery, University Paris XII, Hôpital Henri Mondor, 94010, Creteil, France. philippe.hernigou@wanadoo.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Hernigou
authors.forename: Paolo
authors.initials: P
authors.lastname: Filippini
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Flouzat-Lachaniette
authors.forename: Sobrinho Uirassu
authors.initials: SU
authors.lastname: Batista
authors.forename: Alexandre
authors.initials: A
authors.lastname: Poignard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D005602:France; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D007593:Joint Instability / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000150:complications*; D020959:Polyethylene; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020959:Polyethylene