Skip to main content

Advertisement

SpringerLink
Log in

Outcome and risk factors of failures associated with revision total hip arthroplasty for recurrent dislocation

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

Abstract

Introduction

Recurrent dislocation represents the third most common cause of revision surgery after total hip arthroplasty (THA). However, there is a paucity of information on the outcome of revision total hip arthroplasty for recurrent dislocation. In this study, we investigated (1) clinical outcomes of patients that underwent revision THA for recurrent dislocation, and (2) potential risk factors associated with treatment failure in patients who underwent revision total hip arthroplasty for recurrent dislocation.

Methods

We retrospectively reviewed 211 consecutive cases of revision total hip arthroplasty for recurrent dislocation, 81 implanted with a constrained liner and 130 with a non-constrained liner with a large-diameter femoral head (> 32 mm). Patient- and implant-related risk factors were analyzed in multivariate regression analysis.

Results

At 4.6-year follow-up, 32 of 211 patients (15.1%) underwent re-revision surgery. The most common causes for re-revision included infection (14 patients) and dislocation (10 patients). Kaplan–Meier analysis demonstrates a 5-year survival probability of 77% for patients that underwent revision THA for recurrent dislocation. Osteoporosis, obesity (BMI ≥ 40), spine disease and abductor deficiency are independent risk factors for failure of revision surgery for recurrent dislocation. Liner type (constrained vs. non-constrained) was found not to be associated with failure of revision THA for recurrent dislocation (p = 0.44).

Conclusion

This study suggests that THA revision for recurrent dislocation is associated with a high re-revision rate of 15% at mid-term follow-up. Osteoporosis, obesity (BMI ≥ 40) spine disease and abductor deficiency were demonstrated to be independent risk factors for failure of revision THA for recurrent dislocation.

Level of evidence

Level III, case–control retrospective analysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Khan RJK, Fick D, Alakeson R et al (2006) A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br 88:870–876. https://doi.org/10.1302/0301-620X.88B7.17644

    Article  CAS  PubMed  Google Scholar 

  2. Carlson BC, Desy NM, Johnson JD et al (2018) Modern surgical treatment of recurrent posterior dislocation of the native hip. J Bone Joint Surg Am 100:1056–1063. https://doi.org/10.2106/JBJS.17.01170

    Article  PubMed  Google Scholar 

  3. Bonner B, Arauz P, Klemt C, Kwon Y-M (2020) Outcome of re-revision surgery for adverse local tissue reaction in metal-on-polyethylene and metal-on-metal total hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.02.006

    Article  PubMed  Google Scholar 

  4. Malik AT, Jain N, Scharschmidt TJ et al (2018) Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty 33:3329–3342. https://doi.org/10.1016/j.arth.2018.05.040

    Article  PubMed  Google Scholar 

  5. Elbuluk AM, Coxe FR, Schimizzi GV et al (2020) Abductor deficiency-induced recurrent instability after total hip arthroplasty. JBJS Rev 8:e0164. https://doi.org/10.2106/JBJS.RVW.18.00164

    Article  PubMed  Google Scholar 

  6. Dammerer D, Schneider F, Renkawitz T et al (2020) High risk of hip dislocation following polyethylene liner exchange in total hip arthroplasty-is cup revision necessary? Arch Orthop Trauma Surg 140:1837–1845. https://doi.org/10.1007/s00402-020-03603-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hamadouche M, Biau DJ, Huten D et al (2010) The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res 468:3248–3254. https://doi.org/10.1007/s11999-010-1404-7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fricka KB, Marshall A, Paprosky WG (2006) Constrained liners in revision total hip arthroplasty: an overuse syndrome. In the affirmative. J Arthroplasty. https://doi.org/10.1016/j.arth.2006.02.100

    Article  PubMed  Google Scholar 

  9. Kaplan SJ, Thomas WH, Poss R (1987) Trochanteric advancement for recurrent dislocation after total hip arthroplasty. J Arthroplasty 2:119–124. https://doi.org/10.1016/s0883-5403(87)80018-9

    Article  CAS  PubMed  Google Scholar 

  10. Klemt C, Smith EJ, Oganesyan R et al (2020) Outcome of dual mobility constructs for adverse local tissue reaction associated abductor deficiency in revision total hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.06.043

    Article  PubMed  Google Scholar 

  11. Hoskins W, Griffin X, Hatton A et al (2020) THA for a fractured femoral neck: comparing the revision and dislocation rates of standard-head, large-head, dual-mobility, and constrained liners. Clin Orthop Relat Res. https://doi.org/10.1097/CORR.0000000000001447

    Article  PubMed Central  Google Scholar 

  12. Chalmers BP, Pallante GD, Taunton MJ et al (2018) Can dislocation of a constrained liner be salvaged with dualmobility constructs in revision THA? Clin Orthop Relat Res 476:305–312. https://doi.org/10.1007/s11999.0000000000000026

    Article  PubMed  PubMed Central  Google Scholar 

  13. Brown TS, Tibbo ME, Arsoy D et al (2019) Long-term outcomes of constrained liners cemented into retained, well-fixed acetabular components. J Bone Jt Surg Am 101:620–627. https://doi.org/10.2106/JBJS.18.00607

    Article  Google Scholar 

  14. Plate JF, Seyler TM, Stroh DA et al (2012) Risk of dislocation using large- vs. small-diameter femoral heads in total hip arthroplasty. BMC Res Notes 5:553. https://doi.org/10.1186/1756-0500-5-553

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lewinnek GE, Lewis JL, Tarr R et al (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220

    Article  CAS  Google Scholar 

  16. Karvonen M, Karvonen H, Seppänen M et al (2017) Freedom constrained liner for the treatment and prevention of dislocation in total hip arthroplasty. Scand J Surg SJS Off organ Finnish Surg Soc Scand Surg Soc 106:165–172. https://doi.org/10.1177/1457496916660035

    Article  CAS  Google Scholar 

  17. Flecher X, Ollivier M, Argenson JN (2016) Lower limb length and offset in total hip arthroplasty. Orthop Traumatol Surg Res 102:S9-20. https://doi.org/10.1016/j.otsr.2015.11.001

    Article  CAS  PubMed  Google Scholar 

  18. Kusin DJ, Ungar JA, Samson KK, Teusink MJ (2019) Body mass index as a risk factor for dislocation of total shoulder arthroplasty in the first 30 days. JSES Open Access 3:179–182. https://doi.org/10.1016/j.jses.2019.07.001

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mendez JH, Mehrani A, Randolph P, Stagg S (2019) Throughput and resolution with a next-generation direct electron detector. IUCrJ 6:1007–1013. https://doi.org/10.1107/S2052252519012661

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kenney C, Dick S, Lea J et al (2019) A systematic review of the causes of failure of revision total hip arthroplasty. J Orthop 16:393–395. https://doi.org/10.1016/j.jor.2019.04.011

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mehta N, Selvaratnam V, Alsousou J et al (2020) Outcome of revision surgery in recurrent dislocation of primary total hip arthroplasty. Hip Int J Clin Exp Res hip Pathol Ther. https://doi.org/10.1177/1120700020911146

    Article  Google Scholar 

  22. Herman A, Masri BA, Duncan CP et al (2020) Multivariate analysis of risk factors for re-dislocation after revision for dislocation after total hip arthroplasty. Hip Int J Clin Exp Res hip Pathol Ther 30:93–100. https://doi.org/10.1177/1120700019831628

    Article  Google Scholar 

  23. Biviji AA, Ezzet KA, Pulido P, Colwell CWJ (2009) Modular femoral head and liner exchange for the unstable total hip arthroplasty. J Arthroplasty 24:625–630. https://doi.org/10.1016/j.arth.2008.03.015

    Article  PubMed  Google Scholar 

  24. Hernigou P, Trousselier M, Roubineau F et al (2016) Dual-mobility or constrained liners are more effective than preoperative bariatric surgery in prevention of THA dislocation. Clin Orthop Relat Res 474:2202–2210. https://doi.org/10.1007/s11999-016-4859-3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Huang C-C, Jiang C-C, Hsieh C-H et al (2016) Local bone quality affects the outcome of prosthetic total knee arthroplasty. J Orthop Res Off Publ Orthop Res Soc 34:240–248. https://doi.org/10.1002/jor.23003

    Article  CAS  Google Scholar 

  26. Gill K, Whitehouse SL, Hubble MJW, Wilson MJ (2016) Short-term results with a constrained acetabular liner in patients at high risk of dislocation after primary total hip arthroplasty. Hip Int J Clin Exp Res hip Pathol Ther 26:580–584. https://doi.org/10.5301/hipint.5000396

    Article  Google Scholar 

  27. Malkani AL, Himschoot KJ, Ong KL et al (2019) Does timing of primary total hip arthroplasty prior to or after lumbar spine fusion have an effect on dislocation and revision rates? J Arthroplasty 34:907–911. https://doi.org/10.1016/j.arth.2019.01.009

    Article  PubMed  Google Scholar 

  28. Esposito CI, Carroll KM, Sculco PK et al (2018) Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation. J Arthroplasty 33:1449–1454. https://doi.org/10.1016/j.arth.2017.12.005

    Article  PubMed  Google Scholar 

  29. Limmahakhun S, Box HN, Arauz P et al (2019) In vivo analysis of spinopelvic kinematics and peak head-cup contact in total hip arthroplasty patients with lumbar degenerative disc disease. J Orthop Res 37:674–680. https://doi.org/10.1002/jor.24234

    Article  CAS  PubMed  Google Scholar 

  30. Klemt C, Limmahakhun S, Bounajem G et al (2020) Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J. https://doi.org/10.1302/0301-620X.102B9.BJJ-2020-0777.R1

    Article  PubMed  Google Scholar 

  31. Waterson HB, Whitehouse MR, Greidanus NV et al (2018) Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications. Bone Joint J 100-B:720–724. https://doi.org/10.1302/0301-620X.100B6.BJJ-2017-1466.R1

    Article  CAS  PubMed  Google Scholar 

  32. Gaillard R, Kenney R, Delalande J-L et al (2019) Ten- to 16-year results of a modern cementless dual-mobility acetabular implant in primary total hip arthroplasty. J Arthroplasty 34:2704–2710. https://doi.org/10.1016/j.arth.2019.06.051

    Article  PubMed  Google Scholar 

  33. Hartzler MA, Abdel MP, Sculco PK, et al (2018) Otto Aufranc award: dual-mobility constructs in revision THA reduced dislocation, rerevision, and reoperation compared with large femoral heads. In: Clinical Orthopaedics and Related Research

  34. Abdel MP (2018) Dual-mobility constructs in revision total hip arthroplasties. J Arthroplasty 33:1328–1330. https://doi.org/10.1016/j.arth.2018.01.030

    Article  PubMed  Google Scholar 

  35. Chalmers BP, Ledford CK, Taunton MJ et al (2018) Cementation of a dual mobility construct in recurrently dislocating and high risk patients undergoing revision total arthroplasty. J Arthroplasty 33:1501–1506. https://doi.org/10.1016/j.arth.2017.11.055

    Article  PubMed  Google Scholar 

  36. Fessy M-H, Jacquot L, Rollier J-C et al (2019) Midterm clinical and radiographic outcomes of a contemporary monoblock dual-mobility cup in uncemented total hip arthroplasty. J Arthroplasty 34:2983–2991. https://doi.org/10.1016/j.arth.2019.07.026

    Article  PubMed  Google Scholar 

  37. Klemt C, Bounajem G, Tirumala V et al (2020) Three-dimensional kinematic analysis of dislocation mechanism in dual mobility total hip arthroplasty constructs. J Orthop Res Off Publ Orthop Res Soc. https://doi.org/10.1002/jor.24855

    Article  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Christian Klemt, Wenhao Chen, Georges Bounajem, Venkatsaiakhil Tirumala, Liang Xiong & Young-Min Kwon

Authors
  1. Christian Klemt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenhao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georges Bounajem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Venkatsaiakhil Tirumala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liang Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Young-Min Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Young-Min Kwon.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained for the retrospective patient chart review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Klemt, C., Chen, W., Bounajem, G. et al. Outcome and risk factors of failures associated with revision total hip arthroplasty for recurrent dislocation. Arch Orthop Trauma Surg 142, 1801–1807 (2022). https://doi.org/10.1007/s00402-021-03814-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-03814-2

Keywords

Search

Navigation