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