International Orthopaedics

, Volume 39, Issue 6, pp 1073–1076 | Cite as

Choice of approach, but not femoral head size, affects revision rate due to dislocations in THA after femoral neck fracture: results from the Lithuanian Arthroplasty Register

  • Algimantas Cebatorius
  • Otto Robertsson
  • Justinas Stucinskas
  • Alfredas Smailys
  • Linas Leonas
  • Sarunas TaraseviciusEmail author
Original Paper



Hip dislocation after arthroplasty for femoral neck fractures (FNF) remains a serious complication. The aim of our study was to investigate FNF patients treated with THA, with a special focus of comparing the effect of surgical approach and femoral head size on the risk of revision for dislocation.


Data were derived from the Lithuanian Arthroplasty Register, and we calculated the cumulative revision rates after surgery. For survival analysis, we used revision due to dislocation as an end-point. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, femoral head size, surgical approach).


A total of 8,813 primary THAs were registered from 1 January 2011 to 31 December 2013, of which 1,412 were due to FNF: 899 involved 28-mm femoral heads and the remaining 513 received 32-mm heads. The posterior approach was used in 1,156 cases and the anterolateral approach in 256.. At the end of the follow-up period, 74 hips had been revised for recurrent dislocation. Cox regression adjusting for age, gender and head size showed that the posterior approach had 2.3-times [95% confidence interval (CI): 1.0–5.0, p = 0.04] greater risk of revision for dislocation


We conclude that in order to reduce the early dislocation rate in FNF patients treated with THA, it is more effective to use the anterolateral approach than it is to select a femoral head size of 32 mm instead of 28 mm.


Total hip arthroplasty Dislocation Revision Register 


Conflict of interest



  1. 1.
    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 80:184–189. doi: 10.3109/17453670902930024 PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Hailer NP, Weiss RJ, Stark A, Karrholm J (2012) The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. an analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop 83:442–448. doi: 10.3109/17453674.2012.733919 PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Charissoux JL, Asloum Y, Marcheix PS (2014) Surgical management of recurrent dislocation after total hip arthroplasty. Orthop Traumatol Surg Res OTSR 100:S25–S34. doi: 10.1016/j.otsr.2013.11.008 CrossRefGoogle Scholar
  4. 4.
    Tarasevicius S, Busevicius M, Robertsson O, Wingstrand H (2010) Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture. BMC Musculoskelet Disord 11:175. doi: 10.1186/1471-2474-11-175 PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Lachiewicz PF, Soileau ES (2013) Low early and late dislocation rates with 36- and 40-mm heads in patients at high risk for dislocation. Clin Orthop Relat Res 471:439–443. doi: 10.1007/s11999-012-2379-3 PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Alazzawi S, Sprenger De Rover WB, Brown J, Davis B (2012) The conversion rate of bipolar hemiarthroplasty after a hip fracture to a total hip arthroplasty. Clin Orthop Surg 4:117–120. doi: 10.4055/cios.2012.4.2.117 PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    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 PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    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 PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Berry DJ, von Knoch M, Schleck CD, Harmsen WS (2005) Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 87:2456–2463. doi: 10.2106/JBJS.D.02860 PubMedCrossRefGoogle Scholar
  10. 10.
    Sadoghi P, Leithner A, Labek G (2013) Overcoming boundaries of worldwide joint arthroplasty registers: the European Arthroplasty Register minimal dataset. J Arthroplast 28:1327–1328. doi: 10.1016/j.arth.2013.02.023 CrossRefGoogle Scholar
  11. 11.
    Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg British 64:17–19Google Scholar
  12. 12.
    Moore AT (1957) The self-locking metal hip prosthesis. J Bone Joint Surg Am 39-A:811–827PubMedGoogle Scholar
  13. 13.
    Dorey F, Nasser S, Amstutz H (1993) The need for confidence intervals in the presentation of orthopaedic data. J Bone Joint Surg Am 75:1844–1852PubMedGoogle Scholar
  14. 14.
    Hailer NP, Garellick G, Karrholm J (2010) Uncemented and cemented primary total hip arthroplasty in the Swedish Hip Arthroplasty Register. Acta Orthop 81:34–41. doi: 10.3109/17453671003685400 PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College StationGoogle Scholar
  16. 16.
    Bystrom S, Espehaug B, Furnes O, Havelin LI, Norwegian Arthroplasty R (2003) Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop Scand 74:514–524. doi: 10.1080/00016470310017893 PubMedCrossRefGoogle Scholar
  17. 17.
    Jameson SS, Lees D, James P, Serrano-Pedraza I, Partington PF, Muller SD, Meek RM, Reed MR (2011) Lower rates of dislocation with increased femoral head size after primary total hip replacement: a five-year analysis of NHS patients in England. J Bone Joint Surg British 93:876–880. doi: 10.1302/0301-620X.93B7.26657 CrossRefGoogle Scholar
  18. 18.
    Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, Saleh KJ (2001) Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clinical orthopaedics and related research:229–242Google Scholar
  19. 19.
    Hudson JI, Kenzora JE, Hebel JR, Gardner JF, Scherlis L, Epstein RS, Magaziner JS (1998) Eight-year outcome associated with clinical options in the management of femoral neck fractures. Clin Orthop Relat Res:59–66Google Scholar
  20. 20.
    Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J (2007) A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg British 89:160–165. doi: 10.1302/0301-620X.89B2.18576 CrossRefGoogle Scholar
  21. 21.
    Soreide O, Skjaerven R, Alho A (1982) The risk of acetabular protrusion following prosthetic replacement of the femoral head. Acta Orthop Scand 53:791–794PubMedCrossRefGoogle Scholar
  22. 22.
    Calder SJ, Anderson GH, Jagger C, Harper WM, Gregg PJ (1996) Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study. J Bone Joint Surg British 78:391–394Google Scholar

Copyright information

© SICOT aisbl 2014

Authors and Affiliations

  • Algimantas Cebatorius
    • 1
  • Otto Robertsson
    • 3
  • Justinas Stucinskas
    • 2
  • Alfredas Smailys
    • 2
  • Linas Leonas
    • 2
  • Sarunas Tarasevicius
    • 2
    Email author
  1. 1.Department of TraumaKlaipeda University HospitalKlaipedaLithuania
  2. 2.Department of OrthopaedicsLithuanian University of Health SciencesKaunasLithuania
  3. 3.Department of OrthopaedicsLund University and Lund University HospitalLundSweden

Personalised recommendations