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Review Question - QID 5986

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QID 5986 (Type "5986" in App Search)
A 59-year-old woman who underwent a total hip arthroplasty 5 years ago now has recurrent dislocation following bariatric surgery and a weight loss of 200 lb. An attempt at converting to a larger head size and trochanteric advancement has failed. Her components are well aligned. What is the best course of action?

Resection arthroplasty

1%

7/696

Hip abduction brace

2%

17/696

Constrained acetabular liner

87%

603/696

Thermal ablation of the posterior capsule

1%

5/696

Conversion to a bipolar prosthesis

9%

60/696

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When a patient has well-aligned components and soft-tissue tensioning with a larger femoral head and trochanteric advancement has failed, options are limited. The use of a constrained acetabular liner is the best option in this situation. Goetz and associates and Shrader and associates have demonstrated good results with these implants. Shrader used this device on 109 patients with recurrent instability with a successful outcome in all but 2 patients. Resection arthroplasty is a salvage situation and is not the best option at the present time. A hip abduction brace does not address the soft-tissue laxity. Conversion to a bipolar arthroplasty, although possibly minimizing the incidence of dislocation, will lead to groin pain and migration of the component with diminished functional results.

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