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  • 1.
    Al-Amiry, Bariq
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Karolinska Univ Hosp, Dept Radiol, Stockholm, Sweden.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Krupic, Ferid
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?2017In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 58, no 9, 1125-1131 p., UNSP 0284185116684676Article in journal (Refereed)
    Abstract [en]

    Background: Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose: To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods: Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening >= 10mm (n = 41) or with reduced global FO >5mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results: Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC >= 0.69). Conclusion: Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

  • 2.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Leg length discrepancy and femoral offset after total hip arthroplasty: clinical and radiological studies2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Every year, about 1 million patients worldwide and 16000 patients in Sweden undergo total hip arthroplasty (THA). This surgical intervention is considered a successful, safe and cost-effective procedure to regain pain-free mobility and restore hip joint function in patients suffering from severe hip joint disease or trauma. Besides relieving the pain, restoration of biomechanical forces around the hip with appropriate femoral offset (FO), leg length and proper component position and orientation are important goals. The radiographic preoperative planning and postoperative evaluation of these parameters require good validity, interobserver reliability and intraobserver reproducibility. It remains controversial as to how much postoperative leg length discrepancy (LLD) and FO change are acceptable. Generally, lengthening of the operated leg ≥ 10mm and FO reduction of the operated hip > 5mm should be avoided by using preoperative radiological templating and intraoperative measurement methods. There is no consensus on the association between LLD and FO and outcome after THA.

    The aims of this thesis were to:

    1. To determine the influence of non-corrected LLD after THA on patients’ reported hip function and quality of life (QoL).

    2. To study the association of global FO changes after THA with patients’ reported hip function, QoL and abductor muscle strength.

    3. To evaluate the concurrent validity of the Sundsvall method of measuring postoperative global FO by comparing it to a standard method and to evaluate the interobserver reliability and intraobserver reproducibility of measurement of postoperative global FO, LLD and acetabular cup inclination and anteversion.

    4. To analyse the postoperative radiographs of THA patients with leg lengthening and FO reduction to determine whether the problem is located in the stem, cup or both.

    Study I: A prospective cohort study of 174 patients with unilateral osteoarthritis (OA), comparing patients with lengthening ≥ 10mm, restoration (between 9 mm lengthening and 5 mm shortening) or shortening > 5 mm of the operated leg after THA. Follow up was 12–15 months. We found that a LLD of up to 20 mm did not influence the functional outcome (WOMAC) or QoL (EQ-5D). However, the lengthening group showed less improvement in WOMAC and more use of a shoe lift.

    Study II: A prospective cohort study of 222 patients with unilateral hip OA, comparing patients with decreased global FO (> 5 mm reduction), restored FO (within 5 mm restoration), and increased FO (> 5 mm increment) after THA. Follow up was was 12–15 months. The unadjusted results showed that the decreased FO group had a worse WOMAC index, less abductor muscle strength, and more use of walking aids. When these results were adjusted for possible confounding factors, only global FO reduction was statistically significantly associated with reduced abductor muscle strength. The incidence of residual hip pain and analgesics use was similar in the 3 groups.

    Study III: A prospective cohort study of 90 patients with primary unilateral OA treated with THA. Global FO using the Sundsvall method, global FO (standard method), LLD, acetabular cup inclination and anteversion were measured on postoperative radiographs. The interobserver reliability and intraobserver reproducibility were tested using three independent observers. We found that the Sundsvall method is as reliable as the standard method and the evaluated radiographic measurement methods have the required validity and reliability to be used in clinical practice.

    Study IV: A prospective cohort study of 174 patients with unilateral primary OA treated with THA. LLD and global FO were measured on postoperative radiographs. Patients with lengthening of the operated leg ≥ 10mm (n=41) and patients with reduction of global FO > 5mm (n=58) were further studied to investigate the amount of lengthening and global FO reduction that took place in the stem and in the cup compared with the contralateral side. The interobserver reliability and intraobserver reproducibility were tested using two independent observers. We found that post-THA lengthening of the operated leg ≥ 10mm was mainly caused by improper placement of the femoral stem, whereas a decrease of global FO > 5 was caused by improper placement of both acetabular and femoral components. The radiological measurement methods used showed substantial to excellent interobserver reliability and intraobserver reproducibility and are therefore clinically useful.

    The main conclusions of this thesis are:

    LLD up to 20 mm and reduced global FO more than 5 mm did not influence the functional outcome or quality of life at 12–15 months postoperatively.

    Lengthening ≥ 10mm was associated with increased use of a shoe lift. A reduction of global FO more than 5 mm compared to the contralateral hip was associated with weaker hip abductor muscles and more use of walking aids. Therefore both should be avoided.

    The radiographic measurement methods of LLD, global FO, cup inclination and anteversion have the required validity and reliability to be used in clinical practice.

    Lengthening of the operated leg is mainly caused by improper femoral stem positioning while global FO reduction results from improper positioning of both acetabular and femoral components. Surgeons should be aware of these operative pitfalls in order to minimize component malpositioning.

  • 3.
    Mahmood, Sarwar
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Al-Amiry, Bariq
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Karolinska University Hospital - Department of Radiology.
    Mukka, Sebastian S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Leg lengthening and femoral offset reduction after total hip arthroplasty: where is the problem located – stem or cup?Manuscript (preprint) (Other academic)
    Abstract [en]

    Background and aims:

    Restoration of the biomechanical forces around the hip with appropriate femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA). It is still controversial as to how much postoperative leg length discrepancy (LLD) and FO change are acceptable. The aim of this prospective study is to analyse whether the problem of postoperative leg lengthening and FO reduction is located in the stem or cup or both.

    Material and methods:

    Between September 2010 and April 2013, 174 patients with unilateral primary OA treated with THA were included. Postoperative LLD and global FO were measured using a standardized protocol of the antero-posterior hip radiograph. Patients whose operated leg became ≥ 10mm longer compared with the contralateral side (n=41) or reduction of the global FO > 5mm (n=58) were further studied to investigate the amount of leg lengthening and global FO reduction that took place in the stem and in the cup compared with the contralateral side. We compared the measurements made by an orthopaedic surgeon with the measurements made by a radiologist.

    Results:

    The leg lengthening was located in the stem while the FO reduction was located in both the stem and cup, for the two observers. For observer 1, the mean stem length of the operated side was 57.7 mm vs. 50.9 mm, p=0.003, while the mean cup length of the operated side was 19.0 mm vs. 18.9, p=0.95. For observer 2, the mean stem length of the operated side was 59.5 mm vs. 50.9 mm, p=0.001, while the mean cup length of the operated side was 18.2 mm vs. 18.8, p=0.90. The global FO reduction was located both in the stem and cup for the two observers. For observer 1, the mean stem offset of the operated side was 49.2 mm vs. 57.1 mm, p<0.001, while the mean cup offset of the operated side was 35.1 mm vs. 39.9, p<0.001. For observer 2, the mean stem offset of the operated side was 48.9 mm vs. 55.1mm, p<0.001, while the mean cup offset of the operated side was 35.5mm vs. 40.4mm, p<0.001. Both interobserver reliability and intraobserver reproducibility were substantial to excellent (ICC ≥ 0.79).

    Conclusion:

    Post THA lengthening of the operated leg is mainly caused by improper femoral stem positioning while global FO reduction results from improper positioning of both acetabular and femoral components. Surgeons should be aware of these observations in order to avoid them.

  • 4.
    Mahmood, Sarwar
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Mukka, Sebastian S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Crnalic, Sead
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: A Prospective Cohort Study2015In: The Journal of Arthroplasty, ISSN 0883-5403, E-ISSN 1532-8406, Vol. 30, no 9, 1638-1642 p.Article in journal (Refereed)
    Abstract [en]

    We investigated whether patients with lengthening (> 9 mm), restoration (between 9 mm lengthening and 5 mm shortening) or shortening (> 5 mm) of the operated leg after total hip arthroplasty (THA) had different function (WOMAC score), quality of life (EQ-5D), residual hip pain, use of shoe lift and walking aid and leg length discrepancy (LLD) awareness, 12-15 months postoperatively. All patients had a significant postoperative improvement in WOMAC and EQ-5D regardless the LLD. However, the lengthening group showed less improvement in WOMAC, more use of shoe lift, residual hip pain and LLD awareness compared with the other two groups. No differences in EQ-5D were found. In spite of the improvement in function and quality of life, lengthening had adverse effects and should therefore be avoided.

  • 5.
    Mahmood, Sarwar S
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Al-Amiry, Bariq
    Department of Radiology, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
    Mukka, Sebastian S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Sundsvall and Norrland University Hospitals.
    Baea, Saida
    Department of Radiology, Sundsvall Teaching Hospital, Sundsvall, Sweden.
    Sayed-Noor, Arkan S
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Department of Orthopaedics, Sundsvall Teaching Hospital, Sundsvall, Sweden .
    Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty2015In: Skeletal Radiology, ISSN 0364-2348, E-ISSN 1432-2161, Vol. 44, no 3, 345-351 p.Article in journal (Refereed)
    Abstract [en]

    In total hip arthroplasty (THA), radiographic preoperative planning and postoperative evaluation of acetabular component, femoral offset (FO) and leg length discrepancy (LLD) require good validity, interobserver reliability and intraobserver reproducibility. In this study, we evaluated the validity of the Sundsvall method of FO measurement and the interobserver reliability and intraobserver reproducibility of measurement of FO, LLD, acetabular cup inclination and anteversion. Ninety patients with primary unilateral osteoarthritis (OA) were included in this prospective study. On postoperative radiographs FO by the Sundsvall method (femoral axis-pelvic midline), FO by a standard method (femoral axis-hip rotational centre-teardrop point), LLD (inter-teardrop line-lesser trochanter), acetabular cup inclination (on AP view the angle between the cup rim and transischial line) and anteversion (on lateral view the angle between the face of acetabulum and a line perpendicular to the horizontal plane) were measured. The interobserver reliability and intraobserver reproducibility were calculated for three independent observers. The concurrent validity and degree of prediction of the Sundsvall method are measured by comparing its results with the standard method. The interobserver reliability of all measurements was excellent (ICC > 0.80), except for LLD, which was substantial (ICC = 0.79). The intraobserver reproducibility of all measurements was excellent (ICC > 0.80). The concurrent validity of the Sundsvall method compared to the standard method was good with a positive correlation. The Sundsvall method is as reliable as the standard method. The evaluated radiographic measurement methods have the required validity and reliability to be used in clinical practice.

  • 6.
    Mahmood, Sarwar S.
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mukka, Sebastian S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall and Norrland University Hospitals.
    Crnalic, Sead
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Wretenberg, Per
    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
    Sayed-Noor, Arkan S.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Sundsvall and Norrland University Hospitals.
    Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength: A prospective cohort study of 222 patients2016In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, no 1, 36-41 p.Article in journal (Refereed)
    Abstract [en]

    Background and purpose - There is no consensus on the association between global femoral offset (FO) and outcome after total hip arthroplasty (THA). We assessed the association between FO and patients? reported hip function, quality of life, and abductor muscle strength.

    Patients and methods - We included 250 patients with unilateral hip osteoarthritis who underwent a THA. Before the operation, the patient?s reported hip function was evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life was evaluated with EQ-5D. At 1-year follow-up, the same scores and also hip abductor muscle strength were measured. 222 patients were available for follow-up. These patients were divided into 3 groups according to the postoperative global FO of the operated hip compared to the contralateral hip, as measured on plain radiographs: the decreased FO group (more than 5 mm reduction), the restored FO group (within 5 mm restoration), and the increased FO group (more than 5 mm increment).

    Results - All 3 groups improved (p < 0.001). The crude results showed that the decreased FO group had a worse WOMAC index, less abductor muscle strength, and more use of walking aids. When we adjusted these results with possible confounding factors, only global FO reduction was statistically significantly associated with reduced abductor muscle strength. The incidence of residual hip pain and analgesics use was similar in the 3 groups.

    Interpretation - A reduction in global FO of more than 5 mm after THA appears to have a negative association with abductor muscle strength of the operated hip, and should therefore be avoided.

  • 7.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Lindqvist, Jenny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Peyda, Sara
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Broden, Cyrus
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hassany, Hamid
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: A cohort study2015In: International Orthopaedics, ISSN 0341-2695, E-ISSN 1432-5195, Vol. 39, no 7, 1277-1282 p.Article in journal (Refereed)
    Abstract [en]

    Purpose To analyze postoperative global femoral offset (FO), leg length discrepancy (LLD) and Wiberg angle as risk factors for prosthetic dislocation after treatment with bipolar hemiarthoplasty (HA) through a postero-lateral approach for femoral neck fracture (FNF). Methods Three hundred and seventy three patients treated with a cemented bipolar HA through a postero-lateral approach between January 2006 and December 2013 were included in a cohort study with a follow-up time ranging from 6 months to 7 years. Radiographs and all surgical records were reviewed regarding Global FO, LLD and Wiberg angle. We compared stable hips without dislocation to those with either a single dislocation and those with recurrent instability. Results Three hundred and twenty eight hips fulfilled the inclusion criteria and were analyzed in the study. The incidence of prosthetic dislocation was 10.7 % (36/373). The mean time from surgery to first dislocation was 3.9 months (0-47) and 62.5 % had recurrent dislocations. Patients with dislocation had a statistically significantly decreased postoperative global FO (-6.4 mm vs. -2.8 mm, p = 0.04), LLD (-2 vs. 1.5 mm, p = 0.03) and smaller Wiberg angle (40A degrees vs. 46A degrees, p = 0.01) on the operated side compared with the rest of cohort. In comparison to age and sex-matched control groups from the cohort, the difference in the radiographic parameters were significant in patients with recurrent dislocations but not in patients with a single dislocation. Conclusion Patients with recurrent dislocations had a decreased postoperative global FO, shorter leg and shallower acetabulum on the operated side compared with their controls. These factors might decrease the soft-tissue tension around the operated hip and predispose to dislocation.

  • 8.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Kadum, Bakir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sköldenberg, O
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Direct lateral vs posterolateral approach to hemiarthroplasty for femoral neck fractures2016In: Orthopaedics & Traumatology: Surgery & Research, ISSN 1877-0568, E-ISSN 1877-0568, Vol. 102, no 8, 1049-1054 p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Adopting the direct lateral (DL) instead of the posterolateral (PL) approach in hip arthroplasty for femoral neck fracture (FNF) patients could lower the rate of prosthetic dislocation. However, little is known about how the approach influences the functional outcome.

    HYPOTHESIS: We hypothesized that both approaches would give comparable results.

    MATERIAL AND METHODS: In a prospective cohort study, we enrolled 185 hips (183 patients, 128 women, median age 84 years) with a displaced FNF. Subjects were assigned to treatment using DL (n=102) or PL approach (n=83) with a hemiarthroplasty (HA). Functional outcome was assessed by Harris Hip Score (HHS), Western Ontario and McMaster Universities Arthritis (WOMAC) index, pain numeric rating scale (PNRS) for pain, mortality and hip complications. Patients were followed-up after 1 year.

    RESULTS: The HHS was 71 (SD 18) in the DL group and 72 (SD 17) in the PL group (P=0.59). We found no difference in WOMAC, PNRS and mortality. Seven patients (6.9%) in the DL group and 11 patients (13.3%) in the PL group had undergone a major reoperation (adjusted OR 0.51; 95% CI, 0.18-2.07; P=0.23).

    DISCUSSION: In this prospective cohort study, patients treated with HA for FNF using either the DL or PL approaches had comparable functional outcome after 1 year. The PL approach had a tendency towards a higher reoperation rate.

    TYPE OF STUDY: Prospective cohort study.

    LEVEL OF PROOF: Level 2.

  • 9.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Kadum, Bakir
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Sköldenberg, Olof
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Direct lateral versus posterolateral approach to hip hemiarthroplasty for femoral neck fractures: a prospective cohort studyArticle in journal (Refereed)
    Abstract [en]

    Background: Adopting the direct lateral (DL) instead of the posterolateral (PL) approach to thehip for femoral neck fractures (FNF) results in a lower rate of prosthetic dislocation. The aim ofthis study was to compare hip function and complications after hemiarthroplasty (HA) by eitherthe DL or the PL approach for a FNF.

    Methods: In a prospective cohort study, we enrolled 185 hips (183 patients, 128 women, medianage 84 years) with a displaced FNF. Subjects were, by the surgeons’ preference, assigned totreatment using DL (n=102) or PL approach (n=83) with a HA. Outcomes were Harris hip score(HHS), WOMAC, pain numeric rating scale (PNRS) for pain, limp, mortality and hipcomplications. Patients were followed-up after 1 year.

    Results: The HHS was 71 (SD 18) in the DL group and 72 (±17) in the PL group (p=0.59). Wefound no difference in HHS, WOMAC, PNRS and mortality. Seven patients (6.9%) in the DLgroup and 11 patients (13.3%) in the PL group had undergone a major re-operation (adjusted OR0.51; 95% CI, 0.18-2.07; p=0.23). The DL approach was associated with an increased frequencyof patient reported limp (adjusted OR 2.97,1,32-6.67;p=0.008).

    Interpretation: In this prospective cohort study, patients treated with HA for FNF using either theDL or PL approaches had comparable functional outcome after 1 year. The PL approach had ahigher re-operation rate while the DL approach had a higher incidence of limp.

  • 10.
    Mukka, Sebastian
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Mahmood, Sarwar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sjödén, Göran
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Sayed-Noor, Arkan
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital2013In: Orthopedic Reviews, ISSN 2035-8237, E-ISSN 2035-8164, Vol. 5, no 10, 48-51 p.Article in journal (Refereed)
    Abstract [en]

    Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

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