In the UK 80 000 Total Hip Replacements (THR’s) are undertaken annually. Ageing bone, wear in bearing surfaces, soft tissue laxity, trauma, and infection are common and mean that some THR’s need revising on average 10 years post op. Dislocation; often posteriorly, and subluxation are possible complications pre or post op; for a primary THR 1% or revision 5% experience dislocation. Proximal femur fractures and those aged over 70 increases the chance of dislocation.
Recent declining referrals for hip abduction bracing in the last decade is largely due to a combination of regulation to prevent sub optimal componentry being issued on patients, better surgical technique, and rehabilitation post op. Previous high revision rates were documented for some total hip replacement designs in the past and this highlighted the need for regulatory monitoring in response to NICE publishing its revised benchmark of revision surgery to be reduced from 10% to 5% at the 10 year point, currently it is thought to be as low as 2.5%. Often dislocation requires open or closed reduction, the cost of each closed reduction episode represented 19% of the cost of an uncomplicated THR and when revision / open surgery this percentage could rise to 148%.
Patients requiring bracing now normally have a complex history of single or multiple revisions and therefore ligamentous laxity, or are unsuitable for a revision surgery. It is these patients that we brace that need exceptional stability and compliance 24 hrs a day, for 6 – 12 weeks to prevent recurrent dislocation, both costly to the patient and NHS resources.
The only brace we have found to execute correct force principles and have patient compliance is the DynaCox Evolution, which builds on the high reputation of the flagship original DynaCox which is still available due to its unrivalled reputation. The EVO is completely modular so stock can be stored and built from a single measurement, or for ease it can be sent pre-assembled. New tamper proof and tool-less click n’ fit means simple set up on the day, available with the popular ROM or TRI flex hinge, similar to the original.
The brace has an improved lightweight frame which can be folded flat to fit a patient supine on a bed easily, with newly designed anatomical iliac banding, femoral pad, supra condylar clasp, and bandage. The brace distributes a 3 point stabilising force at the hip when it moves into an unsafe range of flexion and adduction, often lacking in competitor braces of this slim and light design. We rate its suspension due to the anatomical design to be the key to prevention of migration in sitting, additionally no migration of the thigh component into the pop fossa region in standing which is an all too common problem with heavy competitor braces with plastic thigh pieces, this is especially true with high BMI patients with excessive soft tissue.
The other improvement with Evolution is the fabric bandage which is intimate to the skin for compression and proprioception, useful if any post op numbness at the wound site. For early mobilisation whereby a drain is in situ a solid plastic brace could not be used, the bandage however does not interfere. It aids suspension, and due to being tensioned elastic further reduces excessive flexion at hip, rather than relying on the hinge solely. The bandage is breathable, contoured perfectly for toileting, and additional spares can be used for washing ensuring the brace is hygienic at the wound sites.
The well thought-out biomechanics and component design of this hip brace significantly reduces the risk of dislocation, while still allowing normal muscle action to promote rehabilitation. The simplicity of only 3 areas for the patient or carer to fasten ensures high compliance and correct donning. When further dislocation and complication is a high risk, why risk using any other brace than the DynaCox Evolution with a proven track record for safety.
For more information about the DynaCox Evolution® please visit the website or to arrange a demo please contact the customer services team on 0191 258 8944 or email firstname.lastname@example.org