Is there a rationale to use a dual mobility poly insert for failed Birmingham metal-on-metal hip replacements?
Clearances of the MDM poly insert in a BHR shell are reduced, and although the majority of combinations appear safe, the indication needs to be made on an individual base carefully considering alternative treatment options.
In HCM, systolic period increases abnormally with stress. This is not because of a loss of inotropy, but is directly related to the degree of LV outflow tract obstruction. As a result, the diastolic period fails to increase, reducing the time available for coronary flow, the LV filling pattern is modified, and the diastolic atrioventricular pressure gradient increases. These changes may contribute to symptom development and suggest why reducing LV outflow tract obstruction per se may be therapeutically useful in HCM.