Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements

Kunutsor, Setor K; Barrett, Matthew; Beswick, Andrew D; Judge, Andrew; Blom, Ashley W; Wylde, Vikki; Whitehouse, Michael R

doi:10.1016/s2665-9913(19)30045-1

Cited by 98 publications

(113 citation statements)

References 57 publications

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“…Others reported a dislocation rate of 0.7% to 5.9% in primary THA [2][3][4]. Multiple factors are associated with dislocation including the component position, surgical approach, and patient factors [5,6]. A lateral approach to THA has historically been associated with a lower rate of dislocation than a posterior approach, but with contemporary surgical techniques and implant technology, the dislocation rate associated with the posterior approach appears to have been reduced [7,8].…”

Section: Introductionmentioning

confidence: 99%

A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach

Hernandez

Steele

et al. 2020

Arthroplasty Today

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Background: Dislocation is a challenging problem after total hip arthroplasty (THA). We sought to evaluate the incidence of early dislocation with 2 different posterior repair techniques after THA using a posterior approach. Methods: From September of 2008 to August of 2019, we evaluated 841 THAs performed by a single surgeon using a posterior approach. Before November of 2015, the capsule was repaired to the greater trochanter (group 1, 605 patients). Starting November 2015, the posterior capsule was repaired in a sideto-side fashion (direct soft-tissue repair) (group 2, 236 patients). There was a mean follow-up of 31.1 months (range, 2.5-122.5 months). A multivariable logistic regression model was constructed to assess the impact of baseline patient and operative factors on the dislocation rate. Results: There were 22 dislocations, all of which occurred in group 1. There were no dislocations in group 2. After adjusting for patient and operative factors, the direct soft-tissue repair had a large impact on the overall multivariable model as indicated by its effect likelihood ratio of 10.33 (P ¼ .001); however, the odds ratio was not calculable for this factor, given that there were no dislocations in hips with direct softtissue repair. Increasing age was associated with an increased odds of dislocation (odds ratio, 1.04, P ¼ .017), with an effect likelihood ratio of 6.25 (P ¼ .012). Conclusions: Switching from a capsular repair to the greater trochanter to a side-to-side capsular repair was associated with a decreased rate of dislocation in primary THA through a posterior approach.

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Section: Introductionmentioning

confidence: 99%

A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach

Hernandez

Steele

et al. 2020

Arthroplasty Today

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“…The published cases in the current literature with a chronic total hip replacement dislocation are less than ten, so increased awareness is needed before settling such a diagnosis [ 4 ]. The evidence-based risk factors for total hip arthroplasty dislocation are the increased age, rheumatoid arthritis, femoral head less than 28 mm, and posterior surgical approach [ 6 ]. The main causes for late onset hip arthroplasty instability concern polyethylene wear, malposition of the arthroplasty components, neurological deterioration, and dysfunction of the hip abductors [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Catastrophic Wear of an Acetabular Component Misdiagnosed as Total Hip Arthroplasty Dislocation

Papaioannou

Πανταζίδου

Chatziperi

et al. 2020

Cureus

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Total hip arthroplasty constitutes the operation of the century, although not without complications, which require revision surgery due to loosening, infection, dislocation, and wear. Hereby, we report a rare case of acetabular shell wear misdiagnosed as a dislocation. Patients who underwent total hip arthroplasty with ultra-high molecular weight polyethylene are more vulnerable to excessive wear, and close monitoring can prevent this catastrophic sequence. Timely and accurate diagnosis is mandatory to avoid any unnecessary interventions, such as useless reduction attempts. An anteroposterior radiograph is valuable, although computed tomography can settle the diagnosis with accuracy. Evaluation of any previous radiographic examination is very helpful to highlight any differences. Metal debris shown in the joint space, the bubble sign, and also the eccentric location of the prosthetic head are very helpful signs of the catastrophic wear presented to the X-rays. Since late onset dislocations are rare, orthopedic surgeons should be aware that catastrophic wear of the polyethylene and subsequently the acetabular shell can be presented as a late onset dislocation or protrusion. Furthermore, arthroplasty surgeons should adequately monitor patients who underwent hip arthroplasty with this particular polyethylene type.

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“…Hence, pain relief and restoration of a physiological range of motion (ROM) are the objectives of a total hip arthroplasty (THA) [1]. 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.…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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After a total hip arthroplasty, a limited range of motion and lower-limb disability continue to be observed, with these being mainly associated with the implant design and the head-to-neck ratio. Larger diameters of the head bearings were assumed to provide better stability, a larger range of motion, and smaller risks of dislocation and stem-to-liner impingement. However, these claims have never been demonstrated in real patients. The specific aim of this study was to assess, via multi-instrumental analysis, whether the range of motion of a replaced hip is limited by the stem-to-liner contact in patients with large femoral head diameters. Twenty-three patients with a total hip arthroplasty were evaluated at their one-year follow-ups using clinical and instrumental examinations. A combined three-dimensional gait analysis of the full body and videofluoroscopy analysis of the replaced hip were performed during the execution of standard, i.e., daily living, and more demanding motor tasks. The latter were meant to reach the extreme range of motion at the replaced hip site, thus revealing possible stem-to-liner contact. An original technique based on imaging and computer-aided design (CAD) models of the prosthesis components was developed to calculate the stem-to-liner distance. Excellent clinical scores were observed in the study. The gait analysis showed that the range of motion of the replaced hip in the sagittal plane, averaged over all patients, ranged from 28° to 78° in standard activities. In more demanding tasks, single peaks were as high as 110°, 39°, and 60° in the sagittal, frontal, and transverse anatomical planes, respectively. In all motor tasks, the stem-to-liner distances ranged from 8.7 to 13.0 mm on average, with one outlier minimum distance being 2.2 mm. This study shows that, even in demanding motor tasks and with an extreme range of motion, the hip joint replaced with large femoral head diameters did not experience impingement between the prosthesis components.

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Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements

Abstract: Risk factors for dislocation after primary total hip replacement: a systematic review and metaanalysis of 125 studies involving approximately five million hip replacements. The Lancet Rheumatology.

Cited by 98 publications

References 57 publications

A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach

A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach

Catastrophic Wear of an Acetabular Component Misdiagnosed as Total Hip Arthroplasty Dislocation

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

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