, Volume 470, Issue 2, pp 482-489
Date: 27 Sep 2011

Is an Algorithmic Approach to the Treatment of Recurrent Dislocation After THA Effective?

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Topic
Hip

Abstract

Background

The indications for surgical techniques for treatment of recurrent hip dislocation after THA differ, and their rates of achievement of stability may not be similar.

Questions/purposes

We (1) describe our indications for different approaches for recurrent dislocation, (2) outline an algorithmic approach to the management of recurrently dislocating hips after THA, and (3) determine the overall rate of restoration of stability via this algorithmic approach and for each of four procedures with our indications.

Patients and Methods

We retrospectively reviewed 66 patients (69 hips) with revision THA for symptomatic recurrent dislocation from 1993 to 2008. We determined the rate of achievement of stability for the overall patient population and with each revision technique. Minimum followup was 2.8 years (mean, 7.8 years; range, 2.8–12.7 years).

Results

Fifty-one of the 69 hips (74%) had no further dislocations while nine (13%) required two revisions and nine (13%) required three or more revisions. Ultimately, all of the 69 hips (100%) were stable at followup. Use of a large (36-mm-diameter) head, constrained cup, trochanteric advancement, correction of malposition, and a combination of techniques was effective in achieving stability in 67%, 68%, 86%, 91%, and 90% of cases, respectively.

Conclusions

Separating the treatment of patients based primarily on the presence or absence of (1) component malposition, (2) an intact abductor mechanism, and (3) implants accommodating a large-diameter femoral head, we were able to achieve hip stability with one operation in 74% of cases.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Ehsan Saadat, Glenn Diekmann, and Steven Takemoto have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Michael D. Ries is a consultant with intellectual property (royalty income) from Smith and Nephew, Inc (Memphis, TN, USA) and products from Stryker Orthopaedics (Mahwah, NJ, USA).
Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained if required.
This work was performed at the University of California, San Francisco, Medical Center.