The Journal of Bone and Joint Surgery 82:1132 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Bipolar Hip Arthroplasty as a Salvage Treatment for Instability of the Hip*
Javad Parvizi, M.D., F.R.C.S. and
Bernard F. Morrey, M.D.
Investigation performed at the Department of Orthopedics,
Mayo Clinic and Mayo Foundation, Rochester
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Department of Orthopedics, Mayo Clinic, 200 First Street S.W.,
Rochester, Minnesota 55905.
Background: Recurrent instability of the
hip in the absence of an identifiable cause is a challenging problem.
It has been proposed that bipolar hip arthroplasty may have a role
in the treatment of these complex cases. The purpose of our study
was to evaluate the results of bipolar hip arthroplasty for the
treatment of recurrent instability of the hip in a series of patients
at our institution.
Methods: We reviewed the records of twenty-seven
patients who had undergone bipolar hip arthroplasty as a salvage
procedure for the treatment of recurrent instability of the hip
after total hip replacement. All patients had undergone at least
two, and a mean of three, stabilizing operative procedures on the
hip prior to the bipolar arthroplasty. The mean duration of follow-up
was five years (range, two to twelve years), with no patient lost
to follow-up. There were six deaths, of unrelated causes.
Results: Bipolar arthroplasty prevented redislocation
in twenty-two hips (81 percent). At the time of final follow-up,
twenty-five patients (93 percent) had a stable hip. Five patients
(19 percent) had had episodes of subluxation or dislocation following
the bipolar arthroplasty. Two of these patients had only a single
episode of dislocation that was treated successfully by immobilization.
Two of the remaining three patients required a reoperation because
of the instability. The hip was stabilized with the use of a constrained
cup prosthesis in one of these patients, and the other patient eventually required
resection arthroplasty. The third patient had continuing instability
but improved function and pain relief, and a reoperation was not
performed. There were a total of seven reoperations; these included
revision because of disassembly of the cup in one hip, revision
bipolar arthroplasty because of continuing instability in two, resection arthroplasty
because of deep infection in two, revision arthroplasty because
of recalcitrant groin pain in one, and revision arthroplasty because
of deep infection and superior migration of the implant in one.
The Harris hip score improved significantly, from a mean of 24 points
(range, 5 to 45 points) preoperatively to a mean of 55 points (range,
35 to 80 points) postoperatively (p < 0.05).
Conclusions: We believe that, despite some potential
problems, bipolar hip arthroplasty can have a role in the salvage
management of recurrent instability of the hip in patients in whom
other stabilization procedures have failed.
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