Causes of and treatment options for dislocation following total hip arthroplasty (Review)

Abstract

The second most common complication following total hip arthroplasty (THA) is dislocation. The majority of dislocations occur early in the post-operative period and are due to either patient-associated or surgical factors. The patient-associated factors that have been implicated as causes of post-operative dislocation include previous surgery, lumbar spine fusion surgery and/or neurological impairment. The surgical factors include surgical approach, component orientation and prosthetic and/or bony impingement. In order to delineate the cause of the hip instability a thorough history and physical and a radiographic assessment (possibly including advanced imaging) needs to be performed. Approximately two thirds of cases are successfully treated; one third of cases will require surgical treatment (e.g., revision arthroplasty (including constrained liners, the use of elevated rim liners and dual mobility implants or trochanteric advancement). In this review, we discuss the causes leading to dislocation following THA and evaluate the different treatment options available.

Mid-term results of revision surgery using double-trabecular metal cups alone or combined with impaction bone grafting for complex acetabular defects

“…Furthermore, we found the dislocation rate for acetabular revision (33.3%) was higher than that for revision THA (8.3%). It has been demonstrated that patient-derived factors, surgical factors, or both influences the rate of THA dislocation [ 32 ]. We believe the previous surgery and posterolateral surgical approaches are risk factors for dislocation following revision THA.…”

“…We believe the previous surgery and posterolateral surgical approaches are risk factors for dislocation following revision THA. The procedure of enhanced posterior soft tissue repair could reduce the dislocation rate [ 32 ]. Similarly, the malposition of the acetabular cup and femoral head size are common surgical factors for dislocation in revision THA [ 32 ].…”

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

“…Although this surgical procedure has a high success rate [1], particularly in the elderly population [2], a limited ROM at the replaced hip joint and lower-limb disability are still observed [3]. These drawbacks were associated with several critical factors [1, [3][4][5], but among these, the implant design and head-to-neck ratio were considered the most relevant. In particular, these factors seem to affect the hip joint ROM after replacement because of the possible undesired cup-to-neck prosthetic contact, also known as the stem-to-liner (StL) impingement [4,6].…”

“…These drawbacks were associated with several critical factors [1, [3][4][5], but among these, the implant design and head-to-neck ratio were considered the most relevant. In particular, these factors seem to affect the hip joint ROM after replacement because of the possible undesired cup-to-neck prosthetic contact, also known as the stem-to-liner (StL) impingement [4,6]. This introduces serious concerns when the indications for a THA are extended to younger patients, i.e., those subjects with a more active and demanding lifestyle, where a replaced hip ROM is expected to be large [7].…”

Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

“…Successful outcomes are routinely observed for total hip replacement (THR), with data from both case series and joint registries indicating that all-cause survivorship of > 85% can be achieved 15 years after primary surgery [1]. Nonetheless, there is a continual drive to improve upon these outcomes by addressing the underlying causes of component revision, a major source of which is instability/dislocation [2].…”