Abstract
Purpose
Dislocating hip prosthesis remains a substantial clinical problem. The aim of this study is to describe the risk of recurrent instability after a primary dislocation of primary hip arthroplasty performed for osteoarthritis (OA) or femoral neck fracture (FNF).
Methods
Seventy patients (male/females: 25/45; mean age 77 [range 46–94]) with dislocating hip arthroplasties were included in a prospective cohort study and followed for four years. Radiographs and all surgical records were reviewed. We compared stable hips to those who either continued to dislocate or were revised due to recurrent instability (unstable group).
Results
Forty-two hips (60 %) had episodes of recurrent instability leading to repeated closed reductions or major revision surgery and were classified as unstable.
A diagnosis of FNF and cognitive dysfunction (OR 9.3 [95 % CI 1.4–64.1]) or postoperative radiological discrepancies such as leg-lengthening and offset reduction increased the risk of further instability (OR 13.5 [95 % CI 1.3–148.1]). The surgical approach at primary surgery and ASA class did not significantly influence the risk of continued instability.
Conclusions
Patients with a FNF and cognitive dysfunction or with sub-optimal postoperative radiographs after hip arthroplasty surgery are at high risk of recurrent instability after a primary dislocation. For hip fracture patients, all efforts should be made to avoid the first dislocation.
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References
Sanchez-Sotelo J, Haidukewych GJ, Boberg CJ (2006) Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 88(2):290–294. doi:10.2106/JBJS.D.02799
Enocson A, Pettersson H, Ponzer S, Tornkvist H, Dalen N, Tidermark J (2009) Quality of life after dislocation of hip arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up. Qual Life Res 18(9):1177–1184. doi:10.1007/s11136-009-9531-x
Hedlundh U, Fredin H (1995) Patient characteristics in dislocations after primary total hip arthroplasty. 60 patients compared with a control group. Acta Orthop Scand 66(3):225–228
Masaoka T, Yamamoto K, Shishido T, Katori Y, Mizoue T, Shirasu H, Nunoda D (2006) Study of hip joint dislocation after total hip arthroplasty. Int Orthop 30(1):26–30. doi:10.1007/s00264-005-0032-4
Itokawa T, Nakashima Y, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y (2013) Late dislocation is associated with recurrence after total hip arthroplasty. Int Orthop 37(8):1457–1463. doi:10.1007/s00264-013-1921-6
Brooks PJ (2013) Dislocation following total hip replacement: causes and cures. Bone Joint J 95-B (11 Suppl A):67–69. doi:10.1302/0301-620X.95B11.32645
Hedlundh U, Ahnfelt L, Hybbinette CH, Weckstrom J, Fredin H (1996) Surgical experience related to dislocations after total hip arthroplasty. J Bone Joint Surg (Br) 78(2):206–209
Association WM (2008) WMA Declaration of Helsinki-Ethical Principles for Medical Research Involving Human Subjects. Available from:http://www.wma.net/en/30publications/10policies/b3/index.html. Accessed 03 November 2014.
Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau H (2011) The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 469(2):319–329. doi:10.1007/s11999-010-1487-1
Kjellberg M, Al-Amiry B, Englund E, Sjoden GO, Sayed-Noor AS (2012) Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram. Skeletal Radiol 41(2):187–191. doi:10.1007/s00256-011-1166-7
Kjellberg M, Englund E, Sayed-Noor AS (2009) A new radiographic method of measuring femoral offset. The Sundsvall method. Hip Int 19(4):377–381
Skoldenberg O, Ekman A, Salemyr M, Boden H (2010) Reduced dislocation rate after hip arthroplasty for femoral neck fractures when changing from posterolateral to anterolateral approach. Acta Orthop 81(5):583–587. doi:10.3109/17453674.2010.519170
Bourne RB, Mehin R (2004) The dislocating hip: what to do, what to do. J Arthroplasty 19(4 Suppl 1):111–114
Philippot R, Camilleri JP, Boyer B, Adam P, Farizon F (2009) The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. Int Orthop 33(4):927–932. doi:10.1007/s00264-008-0589-9
Bosker BH, Ettema HB, Verheyen CC, Castelein RM (2009) Acetabular augmentation ring for recurrent dislocation of total hip arthroplasty: 60% stability rate after an average follow-up of 74 months. Int Orthop 33(1):49–52. doi:10.1007/s00264-007-0456-0
Hernigou P, Ratte L, Roubineau F, Pariat J, Mirouse G, Guissou I, Allain J, Lachaniette CH (2013) The risk of dislocation after total hip arthroplasty for fractures is decreased with retentive cups. Int Orthop 37(7):1219–1223. doi:10.1007/s00264-013-1911-8
Enocson A, Hedbeck CJ, Tidermark J, Pettersson H, Ponzer S, Lapidus LJ (2009) Dislocation of total hip replacement in patients with fractures of the femoral neck. Acta Orthop 80 (2):184–189. doi:910818371 [pii] 10.3109/1745367090293002
Petersen MB, Jorgensen HL, Hansen K, Duus BR (2006) Factors affecting postoperative mortality of patients with displaced femoral neck fracture. Injury 37(8):705–711. doi:10.1016/j.injury.2006.02.046
Howie DW, Holubowycz OT, Middleton R, Large Articulation Study G (2012) Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 94(12):1095–1102. doi:10.2106/JBJS.K.00570
Carter AH, Sheehan EC, Mortazavi SM, Purtill JJ, Sharkey PF, Parvizi J (2011) Revision for recurrent instability: what are the predictors of failure? J Arthroplasty 26(6 Suppl):46–52. doi:10.1016/j.arth.2011.03.021
Odumala AO, Iqbal MR, Middleton RG (2010) Failure of closed reduction after dislocation of Austin Moore hemiarthroplasty: an analysis of risk factors a 6-year follow-up study. J Arthroplasty 25(5):781–784. doi:10.1016/j.arth.2009.04.035
Lachiewicz PF, Soileau ES (2002) Stability of total hip arthroplasty in patients 75 years or older. Clin Orthop Relat Res 405:65–69
Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23(10):433–441
Tidermark J (2003) Quality of life and femoral neck fractures. Acta Orthop Scand Suppl 74(309):1–42
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Wallner, O., Stark, A., Muren, O. et al. Unstable hip arthroplasties. A prospective cohort study on seventy dislocating hips followed up for four years. International Orthopaedics (SICOT) 39, 1037–1044 (2015). https://doi.org/10.1007/s00264-014-2583-8
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DOI: https://doi.org/10.1007/s00264-014-2583-8