Reverse hip replacement system may have promising outcomes
The patient was a 73-year-old man with progressively disabling right hip pain for 2.5 years. The patient had failed nonsurgical approaches to this condition.
In addition, the patient presented with a history of degenerative arthritic disease in the lumbar spine with accompanying chronic low back pain and stiffness.
Source: Stephen J. Zabinski, MD
Upon examination, the patient was noted to have stiffness and diminished motion of the lumbar spine, as well as loss of motion in the right hip, pain with rotation, a limp and a slight limb-length discrepancy. Radiographs confirmed advanced osteoarthritis with bone-on-bone change and osteophyte formation. Prior spinal studies revealed multilevel spondylosis and degenerative disc disease.
The patient was evaluated and met the criteria for enrollment in the Reverse Hip Replacement System (HRS; Hip Innovation Technology) investigational device exemption trial. The objective of this clinical trial was to assess the safety and effectiveness of the Reverse HRS in patients undergoing total hip replacement. Safety was evaluated through the collection of device-related adverse events and patient quality of life metrics. Effectiveness was measured using clinical, radiologic and patient-reported outcomes.
Our practice was one of the first centers to enroll patients in this trial. We now have nearly 2 years of experience using this reverse hip implant, and we were the first center to implant the device using the anterior approach.
Technique
The patient agreed to THR and chose to participate in our Reverse HRS IDE trial. The surgical approach for the hip joint employed the standard anterior technique without modification. We used a tableless method, slightly jackknifing the table for femoral preparation with fluoroscopic guidance as necessary throughout the procedure.
Acetabular reaming was line-to-line, and the acetabular shell was secured both by press fit and the addition of one or more locking screws.
For the femur, we used single, offset broach handles, specifically designed for the anterior surgical technique. In addition, femoral preparation entailed reaming the canal before broaching to accommodate the geometry of the femoral implant.
The surgery was performed as a same-day surgery. Upon immediate postoperative evaluation, his radiographs were normal and his leg lengths were restored. The patient was discharged from the post-anesthesia care unit approximately 3 hours postoperatively, utilizing a walker for ambulation. He was prescribed extra-strength Tylenol (Johnson & Johnson) and tramadol for pain control.
Recovery
The patient had a routine postoperative course. A home physical therapist visited the patient to ensure he was safe and following postoperative protocols. Aside from this visit, no formal rehabilitation was prescribed, and the patient was only required to perform a walking and functional exercise program. No hip precautions were given, and the patient was allowed to drive and sleep positionally as comfort and strength allowed.
Our walking and functional rehabilitation program requires walking with a walker followed by a cane, then progressively walking with increased duration and distance with the goal being 45 minutes to 1 hour of unassisted ambulation by 6 weeks postoperatively. This is supplemented by hip joint mobilization and stretching and activities such as biking, Pilates, yoga and/or gym exercises (depending on patient preference and preoperative habits).
A postoperative exam conducted at 6 weeks showed excellent range of motion and strength with a normal gait pattern. Radiographs indicated that the reverse hip implant was in good position with no abnormalities or changes from intraoperative positioning. The patient was physically independent and had returned home, resuming normal activities, such as biking, hiking and walking without restriction. The patient expressed high levels of satisfaction with his hip implant and the overall outcome.
Lessons learned
With appropriate restoration of leg length and soft tissue tension, the reverse hip implant delivers incredible stability and essentially eliminates impingement and static or dynamic cup malpositioning-related instability. Upon trial in the OR, the articulation was so stable that the only way to dislocate the implant was to keep the hip in neutral position and apply both traction and laterally directed force.
The inherent stability of the articulation of the reverse hip reduces restrictions, such as sitting on a low toilet, a low chair or in a car for extended periods. Since we have been using the Reverse HRS, we have not had to perform revision surgeries due to dislocation.
In addition, extensive reverse hip arthroplasty data publised by Thomas T. Turgeon, BSc, MD, MPH, FRCS, and colleagues strongly support the bony stability and ingrowth of the implant with no femoral subsidence or cup migration.
Insights: Pelvic spinal disorder
Finally, based on our experience, the issue of spinal pelvic disorder and the increasing occurrence of instability and dislocation in these patients seems to be mitigated. Based on our experience, the Reverse HRS should eliminate this issue.
Current primary implants available for spinopelvic disorders (such as large ball or dual mobility) can dislocate at extremes of rotation or during pelvic tilt and rotation. With the Reverse HRS, the femoral cup becomes more stable at extreme rotation or during pelvic tilt and rotation, as it rotatoes around the acetabular ball.
- References:
- Hip Innovation Technology LLC. https://hipinnovationtechnology.com. Accessed Feb. 4, 2025.
- Turgeon TR, et al. Bone Jt Open. 2023;doi:10.1302/2633-1462.45.BJO-2023-0018.R1.
- For more information:
- Stephen J. Zabinski, MD, is the director of the division of orthopedic surgery at Shore Medical Center in Ocean City, New Jersey. Zabinski’s email: sjzabinski@comcast.net.
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