The Journal of Hip Surgery
DOI: 10.1055/s-0043-1777061
Case Report

A Rare Complication of Intraprosthetic Dissociation of Cemented Bipolar Hemiarthroplasty during Closed Hip Reduction: Case Report and Literature Review

Amanda Mitchell
1   Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
,
Nicole Belkin
1   Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
,
Nana Sarpong
1   Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
,
Carl L. Herndon
1   Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York
,
Thomas R. Hickernell
2   Department of Orthopedic Surgery, Yale Medicine, New Haven, Connecticut
› Author Affiliations
Funding None.

Abstract

Hip hemiarthroplasty (HA) remains a frequently performed surgery for femoral neck fractures especially in the oldest, lowest demand patients. Debate persists concerning the optimal choice between unipolar and bipolar HA implants. A rare but important to recognize complication unique to bipolar HA is intraprosthetic dissociation (IPD). We review the literature on this rare phenomenon and identify predominant etiologies and implant components most involved in IPD, notably the role of hip dislocation and closed reduction in precipitating this complication. We also describe an elderly male patient with Parkinson's who experienced IPD of his bipolar HA during a closed reduction attempt. IPD typically requires open reduction and possibly revision of components, adding increased risk of reoperation/revision to those already frail and vulnerable to surgical complications.



Publication History

Received: 12 April 2023

Accepted: 12 September 2023

Article published online:
19 January 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 Fowler GC. Pfenninger & Fowler's Procedures for Primary Care. 4th ed.. Philadelphia: Elsevier; 2020
  • 2 Manaster BJ, May DA, Disler DG. Chapter 11: Hip and Femur. In: Manaster BJ, May DA, Disler DG. eds. Musculoskeletal Imaging: The Requisites. 4th ed.. Philadelphia: Saunders; 2013: 167-181
  • 3 Hedbeck CJ, Blomfeldt R, Lapidus G, Törnkvist H, Ponzer S, Tidermark J. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. Int Orthop 2011; 35 (11) 1703-1711
  • 4 Zi-Sheng A, You-Shui G, Zhi-Zhen J, Ting Y, Chang-Qing Z. Hemiarthroplasty vs primary total hip arthroplasty for displaced fractures of the femoral neck in the elderly: a meta-analysis. J Arthroplasty 2012; 27 (04) 583-590
  • 5 Dorr LD, Glousman R, Hoy AL, Vanis R, Chandler R. Treatment of femoral neck fractures with total hip replacement versus cemented and noncemented hemiarthroplasty. J Arthroplasty 1986; 1 (01) 21-28
  • 6 Gebhard JS, Amstutz HC, Zinar DM, Dorey FJ. A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck. Clin Orthop Relat Res 1992; (282) 123-131
  • 7 Bhandari M, Devereaux PJ, Tornetta III P. et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am 2005; 87 (09) 2122-2130
  • 8 Parker MJ, Rajan D. Arthroplasties (with and without bone cement) for proximal femoral fractures in adults. Cochrane Database Syst Rev 2010; 6: CD001706
  • 9 Yang B, Lin X, Yin XM, Wen XZ. Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: a systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol 2015; 25 (03) 425-433
  • 10 Inngul C, Hedbeck CJ, Blomfeldt R, Lapidus G, Ponzer S, Enocson A. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. Int Orthop 2013; 37 (12) 2457-2464
  • 11 Marcelino Gomes LS, do Carmo W, de Souza W. Femoral stem dislodgement during bipolar hemiarthroplasty dislocation. Orthopedics 2011; 34 (06) 203
  • 12 Yun HH, Park JH, Park JW, Lee JW. Femoral stem displacement during closed reduction of a dislocated bipolar hemiarthroplasty of the hip. Orthopedics 2010; 33 (02) 118-121
  • 13 Loubignac F, Boissier F. Dissociation de la cupule au cours de la réduction d'une luxation de prothèse de hanche intermédiaire. [Cup dissociation after reduction of a dislocated hip hemiarthroplasty] Rev Chir Orthop Repar Appar Mot 1997; 83 (05) 469-472
  • 14 Lee YK, Park CH, Ha YC, Koo KH. What is the frequency of early dissociation of bipolar cups and what factors are associated with dissociation?. Clin Orthop Relat Res 2018; 476 (08) 1585-1590
  • 15 Georgiou G, Siapkara A, Dimitrakopoulou A, Provelengios S, Dounis E. Dissociation of bipolar hemiarthroplasty of the hip after dislocation. A report of five different cases and review of literature. Injury 2006; 37 (02) 162-168
  • 16 Varley J, Parker MJ. Stability of hip hemiarthroplasties. Int Orthop 2004; 28 (05) 274-277
  • 17 Barmada R, Mess D. Bateman hemiarthroplasty component disassembly. A report of three cases of high-density polyethylene failure. Clin Orthop Relat Res 1987; 224: 147-149
  • 18 Calton TF, Fehring TK, Griffin WL, McCoy TH. Failure of the polyethylene after bipolar hemiarthroplasty of the hip. A report of five cases. J Bone Joint Surg Am 1998; 80 (03) 420-423
  • 19 Corteel J, Putz P. Luxation-dissociation d'une prothèse biarticuleé de hanche. [Dislocation-dissociation of a bipolar hip prosthesis] Acta Orthop Belg 1996; 62 (03) 173-176
  • 20 Guo JJ, Yang H, Yang T, Tang T. Disassembly of cemented bipolar prothesis of the hip. Orthopedics 2008; 31 (08) 813
  • 21 Sevinç HF. Dissociation of bipolar components following bipolar hemiarthroplasty: a report of two different cases and review of the literature. Ulus Travma Acil Cerrahi Derg 2021; 27 (05) 600-603
  • 22 Kim YH. Late separation of femoral head from bipolar acetabular assembly. Due to creep deformation of cup's inner bearing. Orthop Rev 1986; 15 (10) 673-676
  • 23 Lee HH, Lo YC, Lin LC, Wu SS. Disassembly and dislocation of a bipolar hip prosthesis. J Formos Med Assoc 2008; 107 (01) 84-88
  • 24 Tanaka K, Nakayama Y, Murashige R. et al. A dislocation of the inner head in bipolar prosthesis with a self-centering system: a case report. J Nippon Med Sch 2002; 69 (02) 192-195
  • 25 Shiga T, Mori M, Hayashida T, Fujiwara Y, Ogura T. Disassembly of a modular femoral component after femoral head prosthetic replacement. J Arthroplasty 2010; 25 (04) 659.e17-659.e19
  • 26 Uruç V, Özden R, Duman İG, Kalacı A. Five cases of early dissociation between the bipolar hip endoprosthesis cup components; either spontaneously or during reduction maneuvers. Acta Orthop Traumatol Turc 2017; 51 (02) 172-176
  • 27 Moores TS, Blackwell JR, Chatterton BD, Eisenstein N. Disassociation at the head-trunnion interface: an unseen complication of modular hip hemiarthroplasty. BMJ Case Rep 2013. Doi: bcr2013200387
  • 28 Star MJ, Colwell Jr CW, Donaldson III WF, Walker RH. Dissociation of modular hip arthroplasty components after dislocation. A report of three cases at differing dissociation levels. Clin Orthop Relat Res 1992; 278: 111-115
  • 29 Tabutin J, Damotte A. Dissociation progressive intra prothétique d'une prothèse intermédiaire de hanche. A propos de 4 cas. [Progressive intra-acetabular dislocation of bipolar hip prostheses: four cases] Rev Chir Orthop Repar Appar Mot 2004; 90 (01) 79-82
  • 30 Herzenberg JE, Harrelson JM, Campbell II DC, Lachiewicz PF. Fractures of the polyethylene bearing insert in Bateman bipolar hip prostheses. Clin Orthop Relat Res 1988; 228: 88-93
  • 31 Hasegawa M, Sudo A, Uchida A. Disassembly of bipolar cup with self-centering system: a report of seven cases. Clin Orthop Relat Res 2004; 425: 163-167
  • 32 Bhuller GS. Use of the Giliberty bipolar endoprosthesis in femoral neck fractures. Clin Orthop Relat Res 1982; 162: 165-169
  • 33 Figved W, Norum OJ, Frihagen F, Madsen JE, Nordsletten L. Interprosthetic dislocations of the Charnley/Hastings hemiarthroplasty–report of 11 cases in 350 consecutive patients. Injury 2006; 37 (02) 157-161
  • 34 Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma 2015; 29 (03) 121-129
  • 35 De Martino I, D'Apolito R, Waddell BS, McLawhorn AS, Sculco PK, Sculco TP. Early intraprosthetic dislocation in dual-mobility implants: a systematic review. Arthroplast Today 2017; 3 (03) 197-202
  • 36 Asselineau A, Da SC, Beithoon Z, Molina V. Prevention of dislocation of total hip arthroplasty: the dual mobility cup. Interact Surg 2007; 2 (3–4): 160-164
  • 37 Noyer D, Caton JH. Once upon a time.... Dual mobility: history. Int Orthop 2017; 41 (03) 611-618
  • 38 Philippot R, Boyer B, Farizon F. Intraprosthetic dislocation: a specific complication of the dual-mobility system. Clin Orthop Relat Res 2013; 471 (03) 965-970
  • 39 van der Sijp MPL, van Delft D, Krijnen P, Niggebrugge AHP, Schipper IB. Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: a meta-analysis. [published correction appears in J Arthroplasty 2020 Feb;35(2):603–604] J Arthroplasty 2018; 33 (05) 1617-1627.e9
  • 40 Light TR, Keggi KJ. Anterior approach to hip arthroplasty. Clin Orthop Relat Res 1980; 152: 255-260
  • 41 Weber M, Ganz R. The anterior approach to hip and pelvis. Orthop Traumatol 2002; 10 (04) 245-257
  • 42 Baba T, Shitoto K, Kaneko K. Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach. World J Orthop 2013; 4 (02) 85-89
  • 43 Bauer R, Kerschbaumer F, Poisel S, Oberthaler W. The transgluteal approach to the hip joint. Arch Orthop Trauma Surg 1979; 95 (1–2): 47-49
  • 44 Palan J, Beard DJ, Murray DW, Andrew JG, Nolan J. Which approach for total hip arthroplasty: anterolateral or posterior?. Clin Orthop Relat Res 2009; 467 (02) 473-477
  • 45 Gibson A. Posterior exposure of the hip joint. J Bone Joint Surg Br 1950; 32-B (02) 183-186
  • 46 Parker MJ. Lateral versus posterior approach for insertion of hemiarthroplasties for hip fractures: a randomised trial of 216 patients. Injury 2015; 46 (06) 1023-1027
  • 47 Enocson A, Tidermark J, Tornkvist H, Lapidus LJ. Dislocation of hemiarthroplasty after femoral neck fracture: better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthop 2008; 79 (02) 211-217
  • 48 Keene GS, Parker MJ. Hemiarthroplasty of the hip–the anterior or posterior approach? A comparison of surgical approaches. Injury 1993; 24 (09) 611-613
  • 49 Kunkel ST, Sabatino MJ, Kang R, Jevsevar DS, Moschetti WE. A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol 2018; 28 (02) 217-232
  • 50 Pajarinen J, Savolainen V, Tulikoura I, Lindahl J, Hirvensalo E. Factors predisposing to dislocation of the Thompson hemiarthroplasty: 22 dislocations in 338 patients. Acta Orthop Scand 2003; 74 (01) 45-48
  • 51 Leonardsson O, Kärrholm J, Åkesson K, Garellick G, Rogmark C. Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop 2012; 83 (05) 459-466
  • 52 Kristensen TB, Vinje T, Havelin LI, Engesæter LB, Gjertsen JE. Posterior approach compared to direct lateral approach resulted in better patient-reported outcome after hemiarthroplasty for femoral neck fracture. Acta Orthop 2017; 88 (01) 29-34
  • 53 Leonardsson O, Rolfson O, Rogmark C. The surgical approach for hemiarthroplasty does not influence patient-reported outcome : a national survey of 2118 patients with one-year follow-up. Bone Joint J 2016; 98-B (04) 542-547
  • 54 Simple Locking Ring Mechanism. Corentec. Updated Aug 20, 2023. Accessed August 21, 2023 at: http://www.corentec.com/product_view_eng.php?bid=6&c1=1
  • 55 Modular Bipolar Head. Design Rationale. Surgitech. Accessed August 21, 2023 at: http://surgitech.net/wp-content/uploads/2020/12/Modular-Bipolar-Head-Surgical-Technique.pdf