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


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.


Hip Arthroplasty Dislocation Complications 



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.


  1. 1.
    Wishart N, Beaumont R, Young E, Mccormack V, Swanson M (2014) National joint registry 11th annual reportGoogle Scholar
  2. 2.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedGoogle Scholar
  3. 3.
    Eftekhar N (1976) Dislocation and instability complicating low friction arthroplasty of the hip joint. Clin Orthop Relat Res 121:120–125Google Scholar
  4. 4.
    Woo RY (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg Am 64:1295–1306CrossRefPubMedGoogle Scholar
  5. 5.
    Kwon MS et al (2006) Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res 447:34–38CrossRefPubMedGoogle Scholar
  6. 6.
    Fender D, Harper WM, Gregg PJ (1999) Outcome of Charnley total hip replacement across a single health region in England. The results at five years from a regional hip register. JBJS (Br) 81-B:577–581CrossRefGoogle Scholar
  7. 7.
    Jameson SS, Lees D, James P, Meek RMD (2011) Lower rates of dislocation with increased femoral head size after primary total hip replacement. J. Bone Joint Surg. Br. 93-B:876–880CrossRefGoogle Scholar
  8. 8.
    Chairman MP, Beaumont R, Young E, Forsyth O, Swanson M (20136) 10th annual reportGoogle Scholar
  9. 9.
    Sanchez-Sotelo J, Haidukewych GJ (2006) B. C. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 88-A:290–294CrossRefGoogle Scholar
  10. 10.
    Byström S, Espehaug B, Furnes O, Havelin LI (2003) Femoral head size is a risk factor for total hip luxation. Acta Orthop Scand 74:514–524CrossRefPubMedGoogle Scholar
  11. 11.
    Eklund A, Rydell N, Nilsson O (1992) Total hip arthroplasty in patients 80 years of age and older. Clin Orthop Relat Res 281:101–106Google Scholar
  12. 12.
    Sadr Azodi O et al (2008) High body mass index is associated with increased risk of implant dislocation following primary total hip replacement: 2106 patients followed for up to 8 years. Acta Orthop 79:141–147CrossRefPubMedGoogle Scholar
  13. 13.
    Kim Y, Morshed S, Joseph T, Bozic K, Ries MD (2006) Clinical impact of obesity on stability following revision total hip arthroplasty. Clin Orthop Relat Res 453:142–146CrossRefPubMedGoogle Scholar
  14. 14.
    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 87:2456–2463CrossRefPubMedGoogle Scholar
  15. 15.
    Ravi B et al (2014) Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study. BMJ 348:g3284CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
  17. 17.
    Gossec L et al (2011) The role of pain and functional impairment in the decision to recommend total joint replacement in hip and knee osteoarthritis: an international cross-sectional study of 1909 patients. Report of the OARSI-OMERACT Task Force on total joint replacement. Osteoarthr Cartil 19:147–154CrossRefPubMedGoogle Scholar
  18. 18.
    McCalden RW, Charron KD, MacDonald SJ, Bourne RB, Naudie DD (2011) Does morbid obesity affect the outcome of total hip replacement?: an analysis of 3290 THRs. JBJS (Br) 93-B:321–325Google Scholar
  19. 19.
    Andrew JG et al (2008) Obesity in total hip replacement. J Bone Joint Surg Br 90:424–429CrossRefPubMedGoogle Scholar
  20. 20.
    Foresight. (2007) Tackling Obesities: Future Choices 2nd Edition–Modelling future trends in obesity and their impact on healthGoogle Scholar
  21. 21.
    Rajgopal R et al (2013) Outcomes and complications of total hip replacement in super-obese patients. BJJ-B 95:758–763CrossRefGoogle Scholar
  22. 22.
    Sadr Azodi O, Bellocco R, Eriksson K, Adami J (2006) The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg. Br 88:1316–1320CrossRefPubMedGoogle Scholar
  23. 23.
    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 78:206–209CrossRefPubMedGoogle Scholar
  24. 24.
    Meek RMD, Allan DB, McPhillips G, Kerr L, Howie CR (2006) Epidemiology of dislocation after total hip arthroplasty. Clin Orthop Relat Res 447:9–18CrossRefPubMedGoogle Scholar
  25. 25.
    Conroy JL et al (2008) Risk factors for revision for early dislocation in total hip arthroplasty. J Arthroplast 23:867–872CrossRefGoogle Scholar
  26. 26.
    Woolson ST (1999) R. Z. Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplast 14:662–668CrossRefGoogle Scholar
  27. 27.
    Paterno SA, Lachiewicz PF, Kelley SS (1997) The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. JBJS (Am) 79-A:1202–1210CrossRefGoogle Scholar
  28. 28.
    NSS Information and Intelligence. Scottish arthroplasty report, biennial report (2014) Accessed online 2017
  29. 29.
    Robertson O, Dunbar M, Knutson J, Lewold S, Lidgren L (1999) Validation of the Swedish knee arthroplasty register. Acta Orthop Scand 70(5):467–472CrossRefGoogle Scholar
  30. 30.
    Zhu M, Ravi S, Frampton C, Luey C, Yound S (2016) New Zealand Joint Registry data underestimates the rate of prosthetic joint infection. Acta Orthop 87(4):346–350CrossRefPubMedPubMedCentralGoogle Scholar

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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