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Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Study design

Retrospective review of prospectively collected data.

Objective

To investigate the incidence of hip dislocation 90 days after total hip arthroplasty in relation to time after surgery, mechanism of dislocation and predisposing factors.

Methods

Prospective data on preoperative patient characteristics from six Danish arthroplasty departments with similar fast-track approaches were cross-referenced with the Danish National Patient Registry for complete 90-day follow-up on readmissions, including emergency-room contacts. Complete patient files and postoperative radiographs were reviewed in case of dislocations. Unadjusted comparisons were made using t test/Chi-square analyses, while evaluation of risk factors potentially predisposing to dislocations was done using uni- and multivariate regression analysis.

Results

A total of 2,734 consecutive unselected procedures were available for analysis, of which 65 (2.4 %) had dislocations. Of these, eight were during index admission and five were treated and discharged from the emergency room. Mechanisms of dislocation were most often movement while supine or sitting for the first 30 days and due to squatting/bending from day 31 to 90. The 65 patients with dislocations had suboptimal cup placement in 34 (52.3 %), and a femoral head size of <36 mm in 20 (30.8 %) cases. Predisposing factors of dislocation were age ≥75 [OR:1.96 (1.18–3.38)], pharmacologically treated psychiatric disease [OR:2.37 (1.29–4.36)] and department of surgery [OR:2.27 (1.31–3.40)] but not hospital stay of <4 days. Departments with recommendations for activity restrictions had fewer dislocations than a department without restrictions.

Conclusions

Patients ≥75 years and with pharmacologically treated psychiatric disease may be at increased risk of dislocations after fast-track total hip arthroplasty. Further studies including detailed information on patient and prosthesis characteristics, and activity restrictions are needed to reduce the risk of dislocation.

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References

  1. The Danish Hip Arthroplasty Registry (2013) Danish Hip Arthroplasty Registry, annual report 2013. http://www.dhr.dk/Ny%20mappe/rapporter/DHR%20årsrapport%202013_full%20versionfinal_.pdf. Accessed 13 Nov 2013

  2. Kostensalo I, Junnila M, Virolainen P, Remes V, Matilainen M, Vahlberg T, Pulkkinen P, Eskelinen A, Makela KT (2013) Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty: a population-based analysis of 42,379 primary procedures from the Finnish Arthroplasty Register. Acta Orthop 84:342–347

    Article  PubMed  PubMed Central  Google Scholar 

  3. The Swedish Hip Arthroplasty Registry (2012) Swedish Hip Arthroplasty Register, annual report 2011. http://www.shpr.se/Files/Årsrapport%202011%20(eng)%20webb.pdf. Accessed 13 Nov 2013

  4. 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

    Article  PubMed  PubMed Central  Google Scholar 

  5. Berry DJ, Von KM, 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

    Article  PubMed  Google Scholar 

  6. Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ (2006) Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res 447:34–38

    Article  PubMed  Google Scholar 

  7. Howie DW, Holubowycz OT, Middleton R (2012) Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 94:1095–1102

    Article  PubMed  Google Scholar 

  8. Patel PD, Potts A, Froimson MI (2007) The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty 22:86–90

    Article  PubMed  Google Scholar 

  9. Brooks PJ (2013) Dislocation following total hip replacement: causes and cures. Bone Joint J 95-B(11 Suppl A):67–69

    Article  PubMed  CAS  Google Scholar 

  10. Jorgensen CC, Kehlet H (2013) Fall-related admissions after fast-track total hip and knee arthroplasty—cause of concern or consequence of success? Clin Interv Aging 8:1569–1577

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lachiewicz PF, Soileau ES (2006) Dislocation of primary total hip arthroplasty with 36 and 40-mm femoral heads. Clin Orthop Relat Res 453:153–155

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chiu FY, Chen CM, Chung TY, Lo WH, Chen TH (2000) The effect of posterior capsulorrhaphy in primary total hip arthroplasty: a prospective randomized study. J Arthroplasty 15:194–199

    Article  PubMed  CAS  Google Scholar 

  14. Leichtle UG, Leichtle CI, Taslaci F, Reize P, Wunschel M (2013) Dislocation after total hip arthroplasty: risk factors and treatment options. Acta Orthop Traumatol Turc 47:96–103

    Article  PubMed  Google Scholar 

  15. Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381:1600–1602

    Article  PubMed  Google Scholar 

  16. Husted H (2012) Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop Suppl 83:1–39

    Article  PubMed  Google Scholar 

  17. Ansari D, Gianotti L, Schroder J, Andersson R (2013) Fast-track surgery: procedure-specific aspects and future direction. Langenbecks Arch Surg 398:29–37

    Article  PubMed  Google Scholar 

  18. Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH (2007) Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am 89:27–32

    Article  PubMed  Google Scholar 

  19. Malviya A, Martin K, Harper I, Muller SD, Emmerson KP, Partington PF, Reed MR (2011) Enhanced recovery program for hip and knee replacement reduces death rate. Acta Orthop 82:577–581

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jorgensen CC, Kehlet H (2013) Role of patient characteristics for fast-track hip and knee arthroplasty. Br J Anaesth 110:972–980

    Article  PubMed  CAS  Google Scholar 

  21. den Hartog YM, Mathijssen NM, Vehmeijer SB (2013) Reduced length of hospital stay after the introduction of a rapid recovery protocol for primary THA procedures. Acta Orthop 84:444–447

    Article  Google Scholar 

  22. Husted H, Solgaard S, Hansen TB, Soballe K, Kehlet H (2010) Care principles at four fast-track arthroplasty departments in Denmark. Dan Med Bull 57(7):A4166

    PubMed  Google Scholar 

  23. Johannesdottir SA, Horváth-Puhó E, Schmidt M, Ehrenstein V, Pedersen L, Sørensen HT (2012) Existing data sources for clinical epidemiology: the Danish National Database of Reimbursed Prescriptions. Clin Epidemiol 4:1–11

    Google Scholar 

  24. Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 46:263–268

    PubMed  CAS  Google Scholar 

  25. Dorr LD, Wan Z (1998) Causes of and treatment protocol for instability of total hip replacement. Clin Orthop Relat Res 355:144–151

    Article  PubMed  Google Scholar 

  26. Plate JF, Seyler TM, Stroh DA, Issa K, Akbar M, Mont MA (2012) Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty. BMC Res Notes 5:553

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lachiewicz PF, Soileau ES (2002) Stability of total hip arthroplasty in patients 75 years or older. Clin Orthop Relat Res 405:65–69

    Article  PubMed  Google Scholar 

  28. Hosmer DW, Lemenshow S (eds) (2000) Applied logistic regression. John Wiley & Sons, New York

    Google Scholar 

  29. Sharma V, Morgan PM, Cheng EY (2009) Factors influencing early rehabilitation after THA: a systematic review. Clin Orthop Relat Res 467:1400–1411

    Article  PubMed  PubMed Central  Google Scholar 

  30. Phillips CB, Barrett JA, Losina E, Mahomed NN, Lingard EA, Guadagnoli E, Baron JA, Harris WH, Poss R, Katz JN (2003) Incidence rates of dislocation, pulmonary embolism, and deep infection during the first 6 months after elective total hip replacement. J Bone Joint Surg Am 85-A(1):20–26

    PubMed  Google Scholar 

  31. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stockl B (2005) Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br 87:762–769

    Article  PubMed  CAS  Google Scholar 

  32. Husted H, Otte KS, Kristensen BB, Orsnes T, Kehlet H (2010) Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg 130:1185–1191

    Article  PubMed  Google Scholar 

  33. Darowski A, Chambers SA, Chambers DJ (2009) Antidepressants and falls in the elderly. Drugs Aging 26:381–394

    Article  PubMed  CAS  Google Scholar 

  34. He RX, Yan SG, Wu LD, Wang XH, Dai XS (2007) Position of the prosthesis and the incidence of dislocation following total hip replacement. Chin Med J Eng 120:1140–1144

    Google Scholar 

  35. 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 469:319–329

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220

    PubMed  CAS  Google Scholar 

  37. Choi HR, Anderson D, Foster S, Beal M, Lee JA, Barr C, Malchau H, McCarthy J, Kwon YM (2013) Acetabular cup positioning in revision total hip arthroplasty with Paprosky type III acetabular defects: martell radiographic analysis. Int Orthop 37:1905–1910

    Article  PubMed  PubMed Central  Google Scholar 

  38. Mikkelsen LR, Petersen MK, Soballe K, Mikkelsen S, Mechlenburg I (2014) Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study. Eur J Phys Rehabil Med [Epub ahead of print]

  39. Goldstein WM, Gleason TF, Kopplin M, Branson JJ (2001) Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorrhaphy. J Bone Joint Surg Am 83-A Suppl 2:2–7

    PubMed  CAS  Google Scholar 

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Conflict of interest

None.

Author information

Authors and Affiliations

  1. Section for Surgical Pathophysiology 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

    Christoffer C. Jørgensen & Henrik Kehlet

  2. Department of Orthopedics, Vejle Hospital, Vejle, Denmark

    Per Kjaersgaard-Andersen

  3. Department of Orthopedics, Gentofte University Hospital, Gentofte, Denmark

    Søren Solgaard

  4. The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark

    Christoffer C. Jørgensen, Per Kjaersgaard-Andersen, Søren Solgaard & Henrik Kehlet

Authors
  1. Christoffer C. Jørgensen
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  2. Per Kjaersgaard-Andersen
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  3. Søren Solgaard
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  4. Henrik Kehlet
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Consortia

on behalf of the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

Corresponding author

Correspondence to Christoffer C. Jørgensen.

Additional information

Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group are given in the Appendix.

Appendix: Members of the Lundbeck Foundation Centre for Fast-track Hip and Knee replacement

Appendix: Members of the Lundbeck Foundation Centre for Fast-track Hip and Knee replacement

Henrik Husted, Orthopedic Department, Hvidovre, Denmark.

Kjeld Soeballe, Department of Orthopedics, Aarhus, Denmark.

Lars T. Hansen, MD, Orthopedic Department, Grindsted, Denmark.

Mogens B. Laursen, Orthopedic Division, Aalborg, Denmark.

Torben B. Hansen, Department of Orthopedics, Holstebro, Denmark.

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Jørgensen, C.C., Kjaersgaard-Andersen, P., Solgaard, S. et al. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors. Arch Orthop Trauma Surg 134, 1615–1622 (2014). https://doi.org/10.1007/s00402-014-2051-3

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