The Prevention and Treatment of Dislocation following Total Hip Arthroplasty: Efforts to Date and Future Strategies

Abstract

Dislocation continues as one of the common complications following primary Total Hip Arthroplasty (THA). Considering revision THA, dislocation is also one of the leading causes of failure and the subsequent need for re-revision surgery. This article aims to highlight the efforts to date that surgeons have utilised together with the implants employed to both prevent and treat THA dislocation. A fundamental principal in the management of THA instability is identification of the risk factors for dislocation and these are considered in 5 subgroups; patient factors, surgeon factors, implant design, implant orientation and soft tissue factors. Risk stratification is proposed as a future method of deciding upon best treatment for those patients most at danger of THA dislocation and subsequent continued instability.

The Effects of Body Position on Pelvic Tilt Angles Measured with a Smartphone-Based Navigated Ultrasound System in Symptom-Free Young Adults

“…The prevalence rate of THA dislocations is affected by multiple factors that can be grouped in patient-specific [3,4], surgeon-specific [5] and factors related to the implant design [6,7], implant alignment [8], and surgery technique [9]. Acetabular component alignment is considered to play an important role in THA dislocations [10].…”

Dual-Mobility Cup Total Hip Arthroplasty for Displaced Femoral Neck Fractures: A Retrospective Study With a Median Follow-Up of 5 Years

“…2,7,8 The use of small cups can lead to prosthesis loosening or instability instigated by large forces, 9 which are associated with poor outcomes of THA and the markedly high incidence of revision THA, as well as the short time between failures. [10][11][12] Although THA has become less preferred, surgeons have attempted to overcome this issue of dislocation using diverse strategies to decrease the risk of post-surgical dislocation, including using large cups, modular components that can be exchanged, or components made of cross-linked polyethylene. 3,[13][14][15] The dual-mobility THA(DM-THA) has exceptional dislocation-free survivorship in primary or revision THA, ranging from 95% at 5 years to 80% at 15 years after primary THA and more than 95% at 10 years after revision THA; therefore, it has been used increasingly more frequently in clinical practice in recent decades.…”

Retrospective multi-centre study on head adapters in partial revision hip arthroplasty

“…Thus the results of operative treatment for an unstable total hip replacement can be optimised when precise determination of the cause of the instability is made and appropriate measures are taken; in fact, many surgical options for treatment of recurrent dislocation may be considered. [4][5][6][7][8] Since soft-tissue reinforcement and trochanteric advancement, mostly performed in the past, have variable and less successful results, they should be used carefully and only in selected cases; on the contrary, revision of the cup and/or the stem, exchange of modular components such as the acetabular liner and the femoral head, bi-and tripolar arthroplasty, large femoral heads and constrained liners are widely used as common solutions to address recurrent dislocation.…”

“…Thus the results of operative treatment for an unstable total hip replacement can be optimised when precise determination of the cause of the instability is made and appropriate measures are taken; in fact, many surgical options for treatment of recurrent dislocation may be considered. 4–8…”