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Body mass index, hip function and surgeon volume are independent predictors of dislocation: an analysis of 4334 total hip replacements

  • John AnnanEmail author
  • Nick Clement
  • Gavin J. Macpherson
  • Ivan J. Brenkel
  • James A. Ballantyne
  • Edward Dunstan
Original Article • HIP - ARTHROPLASTY

Abstract

The aim of this study was to identify pre-operative and intra-operative factors that are predictive of dislocation following primary total hip replacement (THR). Data were prospectively collected for a consecutive series of 4334 THRs undertaken over a 14-year period. Ninety-eight (2.3%) of the 4334 patients had one or more dislocation post-operatively. A body mass index (BMI) of ≥ 35 (p < 0.001), a Harris Hip Score (HHS) of ≤ 41 (p < 0.001) and a low-volume surgeon (p < 0.001), which was defined as performing fewer than 43 THRs per annum, were identified as independent predictors of dislocation using logistic regression analysis. Using these three variables in differing combinations the risk of dislocation varied from 0.5 to 10.4%. Patients at high risk of dislocation, with a BMI of ≥ 35 and a pre-operative HHS of ≤ 41, undergoing surgery by a low-volume surgeon had a dislocation rate of 10.5%, but this decreased to 2.3% when operated on by a high-volume surgeon. These risk factors could be used to identify patients at high risk of dislocation, and modification of these factors, such as weight loss to achieve a BMI of ≤ 35 or referral to a high-volume surgeon, may decrease the risk of dislocation and the resulting secondary morbidity.

Keywords

Hip Arthroplasty Dislocation Complications 

Notes

Acknowledgements

The authors would like to thank specialist arthroplasty nurses Mrs A. Simpson, L. McComiskie and S. Wilson for maintaining the arthroplasty database.

Compliance with ethical standards

Conflict of interest

Dr. Annan has nothing to disclose. Dr. Clement has nothing to disclose. Dr. MacPherson has nothing to disclose. Dr. Dunstan has nothing to disclose. Dr. Ballantyne has nothing to disclose. Dr. Brenkel reports other from DePuy Orthopaedics, Inc. during the conduct of the study. A salary was previously provided by DePuy Orthopaedics, Inc. for a research nurse to collect and maintain a database from which this study draws its data. This relationship ended prior to the completion of the submitted work.

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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryVictoria HospitalKirkcaldy, FifeUK
  2. 2.Royal Infirmary of EdinburghEdinburghUK

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