The Role of SofTec® Coxa (PDF, 118 KB - Bauerfeind

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The Role of SofTec® Coxa (PDF, 118 KB - Bauerfeind

The Role of SofTec ® Coxa in the

Management of Hip Dislocation

Accelerated perioperative rehabilitation procedures expose to the risk of dislocations, whose

incidence, after primary and revision total hip arthroplasty, is likely to be higher than reported.

SofTec ® Coxa is a hip brace designed to improve safety and effectiveness of rehabilitation by

guiding extension-flexion and adduction-abduction within adjustable ranges of motion.

Not only patients with bilateral simultaneous - hip replacement or revision- may need orthotic

support but patients with periprostatic bone or soft tissue complications too. Rehabilitation of

an increasing number of patients needing multiple hip replacements increase risks and costs.

In this changing context SofTecCoxa ® can reduce costs and improve quality of life.

Total hip replacement (THRs) is one of the most

successful surgical interventions performed in

orthopedic departments worldwide.This is

confirmed by health-related quality-of-life data

showing that (THRs) resulted in pain relief,

improved physical function and enhanced healthrelated

quality of life regardless of patients'

characteristics, type of operation or type of

prosthesis.

(Health related quality of life in total hip and knee arthroplasty. A

qualitative and systematic review of the literature – Etgen O.

Bruyére O. Richy F. Dardennes C. Reginster JY. – J Bone Joint

Surg Am. 2004 May; 86-A (5):963-74)

(A Systematic review of empirical studies between 1966 and

2005 of patient outcomes of total hip arthroplasty and related

factors – Montin L, Leino-Kilpi H. Suominen T. Lepistö J – J Clin

Nurs. 2008 Jan;17(1):40-5.

THR is also a highly efficacious and cost-effective

procedure for moderate to severe arthritis in the

hip.

Considering the European demographic evolution

over the next 20 years, the above data are

encouraging since the demand of (THRs) will

increase substantially. The number of people over

65 will rise by 52% (40 million) between 2005 and

2030. The longer life expectation particularly, will

increase the number of revisions and/or secondary

(THRs) making hip dislocations an associated risk

which must be considered.

Information on the current epidemiology of hip

dislocation varies from 1% to 10% and studies

have associated it most consistently with additional

surgery.(Orthopaedic Knowledge Update 5- Ch.36.p 410).

Bozic et al. report that hip instability and

mechanical loosening are the most common

indications for revision total hip arthroplasty.

(The epidemiology of revision total hip arthroplasty in the USA.-

Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ.-J Bone

Joint Surg Am 2009 Jan; 91(1):128-33).

Particularly, the most common type of revision

total hip arthroplasty procedure performed was

all-component revision (41.1%), and the most

common causes of revision were instability /

dislocation (22.5%), mechanical loosening (19.7%),

and infection (14.8%).

The Role of SofTecCoxa ® in the Management of Hip Dislocation

It is important to consider that after

revision total hip arthroplasty not only the

risk of dislocation but also the related costs

are increased.

(Hospital resource utilisation for primary and revision

total hip arthroscopy – Bozic KJ; Katz P;Cisternas M;

Ono L; Ries MD; Showstack J.- J Bone Joint Surg

Am.-)

The prevention of dislocations concerns

the quality of life of an increasing number

of patients involving therefore consistent

financial resources. This is the reason why

hip braces are needed to support the

application of accelerated perioperative

rehabilitation protocols which are currently

being implemented worldwide.

(Cost effectiveness of accelerated perioperative care

and rehabilitation after total hip and knee

arthroplasty- Larsen K, Hansen TB, Thomsen

PB, Christiansen T, Søballe K.-J Bone Surg Am.

2009 Apri; 91(4):761-72)

Although data are limited and not

comparable -because of different

rehabilitation procedures - field testing

results of the new hip brace SofTec ® Coxa

indicate a possible conflict between

literature data of epidemiologic incidence

of hip dislocations - estimated too low- with

respect to current “real” demand.

Nevertheless, physicians generally

confirmed that the guided motion through

the adjustable ranges, limited by the use of

SofTec ® Coxa, improved safety and

effectiveness of the rehabilitation

procedure “consistently but for risk patients

particularly,” .

The higher dependence on hip prosthetics

of a longer living population makes the

protection of periprosthetic bone tissue a

very important objective. Further, late

dislocations occurring five to ten years

after the operation may represent aging

soft tissue dependencies very difficult to

treat surgically.

In this changing context, SofTec ® Coxa can

contribute substantially to reduce costs

and improve quality of life.

1 enrico.cargalli@bauerfeind.com 09/02/2010


SofTec ® Coxa

Product Features

Hip brace system made of a semi-rigid shell

supporting an adjustable left or right hinge

- fixed by external knitted fabric belts – to

pelvis and thigh.

Two duraluminium hinges -centred on the

trochanter - are available for right and / or left

THRs (total hip replacements). Flexion-

Extension are adjustable between -10° and

+ 90° by an easy pin-lock scale while

Adduction-Abduction are adjustable

continuously.

The anatomically shaped pelvic polyurethane

shell allows for adaptable and safe positioning

of the brace on the iliac crest. Circumferential

adaptation is achieved inserting pins in suitable

holes corresponding to patient size.

The shell is fixed to the external knitted fabric

belt by a robust Velcro harness.

The external belts are made of moisture

dissipating knitted fabric and both pelvic and

thigh fastening components are adjustable and

fixed by double Velcro straps. The pelvic

fixation das not interferes with the area of

surgical intervention while supporting the

hinge-guided motion.

The specific features of these three elements

make the system much more then just the sum

of its components.

Proportion and design allows a perfect

adaptation and the length of the adjustable

hinges provides for the necessary robustness.

It is mandatory that patients experience

security and protection, during post OPrehabilitation.

This perception goes beyond the

anatomic fitting of the brace and can only be

achieved by perfect integration of the system

to the patient. The low weight of SofTec ® Coxa

represents just one of the features making

such integration complete.

SofTec ® Coxa is available in 3 sizes (small,

medium, large), depending on the

circumference and with 2 different joints fitting

female or male morphology.

The Role of SofTecCoxa ® in the Management of Hip Dislocation

Adjustable hinge

Semi-rigid shell

Knitted fabric support

2 enrico.cargalli@bauerfeind.com 09/02/2010


Indications

Prevention of dislocation

Total hip replacement surgery

Total hip revision surgery

Hip spacer in two-stage revision procedures

Femoral head resection (Girdlestone arthroplasty)

Reducing the load on the hip joint and securing the femoral head in the

acetabulum socket is the goal of SofTec ® Coxa as well as a requirement

for (most of) the above indications.

Particularly in cases of bilateral intervention the contribution of SofTec ® Coxa

could be substantial.

Compensating abductors muscle weakness after hip artroplasty is also

necessary to stabilize the hip in the frontal plane during unilateral stance,

including the stance phase of walking.

The biomechanical principle of SofTec ® Coxa is depicted in the above figure.

By fastening thigh and pelvis to the lateral hinge, SofTec ® Coxa prevents the

gravity of the mass superincoumbent to the hip joint to drop the pelvis on the

unsupported side. The resultant force, transferred by the hinge to the trocanther,

achieves the double effect of reducing abductor force and preventing hip joint

dislocation during unilateral stance.

Hip arthrodesis may change the body

mechanical axis causing compensatory

pelvis and spine behaviour.

In cases of arthrodesis with limited or

moderate adduction (A) trunk translation is

neutral and the centre of gravity remains in

S2.

The gravity line however changes

remarkably when pelvis and spine

compensate arthrodesis with important

adductions as (B) and (C).

The lumbo-sacral height of SofTec ® Coxa

can prevent this condition involving gait

patterns which cannot be tolerated over

long periods (Duchenne limp;

Trendelenburg gait or a gluteus mediums

limp)

Conservative rehabilitation of moderate coxarthrosis and / or osteoporosis also represents a very

important indication of SofTec ® Coxa.

The peak loading of the hip joint at higher gait velocity however suggest that patients with incipient or

advanced osteoporosis should be advised against unprotected fast walking, running or jogging.

The Role of SofTecCoxa ® in the Management of Hip Dislocation

3 enrico.cargalli@bauerfeind.com 09/02/2010


Conclusion

The increasing life expectancies will substantially increase the demand for total hip replacement

in patients + 65. This fact along with a life style characterized by more mobility represents a

growing risk of hip joint dislocations.

SofTec ® Coxa represents a proportionate and efficient answer to the patients and physicians

demand of protection during perioperative rehabilitation. This phase, depending on the age of

patients, is quite variable but can be also long.

SofTec ® Coxa exploits a basic biomechanical principle though realized with efficiency and comfort

Adaptation is easy but the required precision makes the skill of an orthopaedic technician

necessary.

References

Musculoskeletal Biomechanics –Brinckmann P., Frobin W., Leivseth G.-Thieme

J Bone Joint Surg Am. 2003 Jan;85-A(1):27-32.

Rates and outcomes of primary and revision total hip replacement in the United States

medicare population.

Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris

WH, Poss R, Baron JA.

Can J Surg. 2008 Dec;51(6):428-36.

Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a

systematic review.

Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte

PC, Wright JG.

J Clin Nurs. 2008 Jan;17(1):40-5.

A systematic review of empirical studies between 1966 and 2005 of patient outcomes of total

hip arthroplasty and related factors.

Montin L, Leino-Kilpi H, Suominen T, Lepistö J.

The Role of SofTecCoxa ® in the Management of Hip Dislocation

4 enrico.cargalli@bauerfeind.com 09/02/2010


J Bone Joint Surg Am. 2004 May;86-A(5):963-74.

Health-related quality of life in total hip and total knee arthroplasty. A qualitative and

systematic review of the literature.

Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY

J Bone Joint Surg Am. 2009 Apr;91(4):761-72.

Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee

arthroplasty.

Larsen K, Hansen TB, Thomsen PB, Christiansen T, Søballe K

J Bone Joint Surg Br. 2009 Apr;91(4):451-8.

Revision following cemented and uncemented primary total hip replacement: a seven-year

analysis from the New Zealand Joint Registry.

Hooper GJ, Rothwell AG, Stringer M, Frampton C.

J Bone Joint Surg Am. 2009 Jan;91(1):128-33.

The epidemiology of revision total hip arthroplasty in the United States.

Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ

Chir Narzadow Ruchu Ortop Pol. 2008 May-Jun;73(3):163-6.Links

[Elective total hip arthroplasty for patients 75 years of age and older]

[Article in Polish]

Dorman T, Adamczyk E, Synder M, Sibiński M.

J Bone Joint Surg Am. 2005 Mar;87(3):570-6.

Hospital resource utilization for primary and revision total hip arthroplasty.

Bozic KJ, Katz P, Cisternas M, Ono L, Ries MD, Showstack J.

The Role of SofTecCoxa ® in the Management of Hip Dislocation

5 enrico.cargalli@bauerfeind.com 09/02/2010


Ned Tijdschr Geneeskd. 2007 Sep 1;151(35):1928-34.Links

Comment in:

Ned Tijdschr Geneeskd. 2007 Sep 1;151(35):1915-7.

[Complications within two years after revision of total hip prostheses]

[Article in Dutch]

Witjes S, Schrier JC, Gardeniers JW, Schreurs BW.

Clin Orthop Relat Res. 2006 Jun;447:24-7.Links

Dislocation of the hip after reimplantation for infection: an analysis of risk factors.

Hartman CW, Garvin KL.

J Bone Joint Surg Am. 2002 Oct;84-A(10):1788-92.

Dislocation after revision total hip arthroplasty : an analysis of risk factors and treatment

options.

Alberton GM, High WA, Morrey BF

J Bone Joint Surg Br. 2009 Mar;91(3):321-6.

Outcome of treatment for dislocation after primary total hip replacement.

Kotwal RS, Ganapathi M, John A, Maheson M, Jones SA.

Hip Int. 2009 Apr-Jun;19(2):109-13.

Revision for recurrent dislocation of total hip replacement.

Rogers M, Blom AW, Barnett A, Karantana A, Bannister GC.

The Role of SofTecCoxa ® in the Management of Hip Dislocation

6 enrico.cargalli@bauerfeind.com 09/02/2010

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