Revision for Recurrent Instability

The Cumulative Risk of Re-dislocation After Revision THA Performed for Instability Increases Close to 35% at 15years

“…Our study also showed better outcome when the acetabular component was revised and this is consistent with previous reports that showed worse outcome when isolated liner exchange was performed [6,21,22]. The higher failure rate observed when constrained liner was placed into a retained cup indicates that it is essential to optimize other factors that may contribute to instability in order to decrease the mechanical failure as was emphasized in the previous studies [23,24].…”

“…This is similar to 79% revision rate (26 out of 33) reported by a previous study in hips with history of instability [6] but significantly greater than 32-44% rerevision rate after revision arthroplasty for all cause [5,7]. Previous reports demonstrate that trochanteric nonunion [5][6][7], femoral head size [5][6][7]14], number of previous revisions [6,15], underlying rheumatoid arthritis [15] and acetabular bone loss based on the Paprosky acetabular classification [7] to be the predictor of dislocation after revision hip arthroplasty. In this study, history of more than 2 previous hip surgeries was identified as patient related risk factors associated with dislocation while use of a constrained liner, femoral head 36 or larger, or acetabular cup revision were surgical methods that were associated with a decreased risk of dislocation.…”

“…Also this study was done before contemporary methods such as constrained liners or larger femoral head sized were introduced. A more recent report from Carter et al [6] reported 21% dislocation rate in 156 hips at mean of 67 months from the surgery and a study from Wetter et al [7], in their subgroup analyses of revision hip arthroplasty, reported 19% failure rate in 129 hips undergoing surgery for instability but the follow up period in this subgroup was not specified. In our study, the overall re-dislocation rate was 22.6% in 5.5 years.…”

“…The dislocation rate following total hip arthroplasty (THA) ranges from 0.5 to 7% [1][2][3][4] for primaries and 6.6 to 21.2% [5][6][7][8][9][10] for revisions. In cases of revision surgery performed specifically for instability, the re-dislocation rate is significantly higher reaching 21 to 39% [6,11]. Previous studies describing this complication are limited because of the relatively small number of patients with short follow-up.…”

How to prevent dislocation after revision total hip arthroplasty: a systematic review of the risk factors and a focus on treatment options

“…of hips)Follow-up (years)Level of evidenceAlberton et al [12]1548Mean 8.1Level IVKhatod et al [6]277Minimum 1Level IIISah et al [14]204Mean 4.9Level IVHummel et al [15]242Mean 2.4Level IVSpringer et al [2]1100Mean 6Level IVCarter et al [7]156Mean 5.6Level IIICogan et al [8]61Mean 2.4Level IVKosashvili et al [9]749Mean 13.2Level IVGarbuz et al [16]184Mean 5Level IWetters et al [4]1152Mean 2Level IVKosashvili et al [17]749Mean 13.2Level IVJo et al [10]539Mean 5.5Level IVYoshimoto et al [11]178Mean 6.7Level IVStedman et al [18]187Mean 7.6Level IVYoshimoto et al [13]88Mean 4.4Level IV …”