Skip to main content
Log in

Is an Algorithmic Approach to the Treatment of Recurrent Dislocation After THA Effective?

  • Symposium: Papers Presented at the Annual Meetings of The Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The indications for surgical techniques for treatment of recurrent hip dislocation after THA differ, and their rates of achievement of stability may not be similar.

Questions/purposes

We (1) describe our indications for different approaches for recurrent dislocation, (2) outline an algorithmic approach to the management of recurrently dislocating hips after THA, and (3) determine the overall rate of restoration of stability via this algorithmic approach and for each of four procedures with our indications.

Patients and Methods

We retrospectively reviewed 66 patients (69 hips) with revision THA for symptomatic recurrent dislocation from 1993 to 2008. We determined the rate of achievement of stability for the overall patient population and with each revision technique. Minimum followup was 2.8 years (mean, 7.8 years; range, 2.8–12.7 years).

Results

Fifty-one of the 69 hips (74%) had no further dislocations while nine (13%) required two revisions and nine (13%) required three or more revisions. Ultimately, all of the 69 hips (100%) were stable at followup. Use of a large (36-mm-diameter) head, constrained cup, trochanteric advancement, correction of malposition, and a combination of techniques was effective in achieving stability in 67%, 68%, 86%, 91%, and 90% of cases, respectively.

Conclusions

Separating the treatment of patients based primarily on the presence or absence of (1) component malposition, (2) an intact abductor mechanism, and (3) implants accommodating a large-diameter femoral head, we were able to achieve hip stability with one operation in 74% of cases.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1A–D
Fig. 2A–B
Fig. 3A–B
Fig. 4A–B
Fig. 5

Similar content being viewed by others

References

  1. Alberton GM, High WA, Morrey BF. Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am. 2002;84:1788–1792.

    PubMed  Google Scholar 

  2. Bartz RL, Nobel PC, Kadakia NR, Tullos HS. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg Am. 2000;82:1300–1307.

    PubMed  CAS  Google Scholar 

  3. Beaule PE, Schmalzried TP, Udomkiat P, Amstutz HC. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J Bone Joint Surg Am. 2002;84:256–263.

    PubMed  Google Scholar 

  4. Bystrom S, Espehaug B, Furnes O, Havelin LI. 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. 2003;74:514–524.

    Article  PubMed  Google Scholar 

  5. D’Angelo F, Murena L, Zatti G, Cherubino P. The unstable total hip replacement. Indian J Orthop. 2008;42:252–259.

    Article  PubMed  Google Scholar 

  6. Dorr LD, Wolf AW, Chandler R, Conaty JP. Classification and treatment of dislocations of total hip arthroplasty. Clin Orthop Relat Res. 1983;173:151–158.

    PubMed  Google Scholar 

  7. Ekelund A. Trochanteric osteotomy for recurrent dislocation of total hip arthroplasty. J Arthroplasty. 1993;8:629–632.

    Article  PubMed  CAS  Google Scholar 

  8. Etienne A, Cupic Z, Charnley J. Postoperative dislocation after Charnley low-friction arthroplasty. Clin Orthop Relat Res. 1978;132:19–23.

    PubMed  Google Scholar 

  9. Fackler CD, Poss R. Dislocation in total hip arthroplasties. Clin Orthop Relat Res. 1980;151:169–178.

    PubMed  Google Scholar 

  10. Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component: a retrospective analysis of fifty-six cases. J Bone Joint Surg Am. 1998;80:502–509.

    PubMed  CAS  Google Scholar 

  11. Grigoris P, Grecula MJ, Amstutz HC. Tripolar hip replacement for recurrent prosthetic dislocation. Clin Orthop Relat Res. 1994;304:148–155.

    PubMed  Google Scholar 

  12. Huffman GR, Ries MD. Combined vertical and horizontal cable fixation of an extended trochanteric osteotomy site. J Bone Joint Surg Am. 2003;85:273–277.

    Article  PubMed  Google Scholar 

  13. Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty. 2002;17:282–288.

    Article  PubMed  CAS  Google Scholar 

  14. Joshi A, Lee CM, Markovic L, Vlatis G, Murphy JC. Prognosis of dislocation after total hip arthroplasty. J Arthroplasty. 1998;13:17–21.

    Article  PubMed  CAS  Google Scholar 

  15. Kelley SS, Lachiewicz PF, Hickman JM, Paterno SM. Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res. 1998;355:163–170.

    Article  PubMed  Google Scholar 

  16. Khatod M, Barber T, Paxton E, Namba R, Fithian D. An analysis of the risk of hip dislocation with a contemporary total joint registry. Clin Orthop Relat Res. 2006;447:19–23.

    Article  PubMed  Google Scholar 

  17. Kim Y, Morshed S, Joseph T, Bozic K, Ries MD. Clinical impact of obesity on stability following revision total hip arthroplasty. Clin Orthop Relat Res. 2006;453:142–146.

    Article  PubMed  Google Scholar 

  18. Kung PL, Ries MD. Effect of femoral head size and abductors on dislocation after revision THA. Clin Orthop Relat Res. 2007;465:170–174.

    PubMed  Google Scholar 

  19. Lindberg HO, Carlsson AS, Gentz CF, Pettersson H. Recurrent and non-recurrent dislocation following total hip arthroplasty. Acta Orthop Scand. 1982;53:947–952.

    Article  PubMed  CAS  Google Scholar 

  20. McCollum DE, Gray WJ. Dislocation after total hip arthroplasty: causes and prevention. Clin Orthop Relat Res. 1990;261:159–170.

    PubMed  Google Scholar 

  21. Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am. 1992;23:237–248.

    PubMed  CAS  Google Scholar 

  22. Padgett DE, Warashina H. The unstable total hip replacement. Clin Orthop Relat Res. 2004;420:72–79.

    Article  PubMed  Google Scholar 

  23. Parvizi J, Morrey BF. Bipolar hip arthroplasty as a salvage treatment for instability of the hip. J Bone Joint Surg Am. 2000;82:1132–1139.

    PubMed  Google Scholar 

  24. Paterno SA, Lachiewicz PF, Kelley SS. The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Joint Surg Am. 1997;79:1202–1210.

    PubMed  CAS  Google Scholar 

  25. Ries MD, Wiedel JD. Bipolar hip arthroplasty for recurrent dislocation after total hip arthroplasty: a report of three cases. Clin Orthop Relat Res. 1992;278:121–127.

    PubMed  Google Scholar 

  26. Ritter MA. Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res. 1976;121:92–94.

    PubMed  Google Scholar 

  27. Shrader MW, Parvizi J, Lewallen DG. The use of a constrained acetabular component to treat instability after total hip arthroplasty. J Bone Joint Surg Am. 2003;85:2179–2183.

    PubMed  Google Scholar 

  28. Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg. 2004;12:314–321.

    PubMed  Google Scholar 

  29. Toomey SD, Hopper RH Jr, McAuley JP, Engh CA. Modular component exchange for treatment of recurrent dislocation of a total hip replacement in selected patients. J Bone Joint Surg Am. 2001;83:1529–1533.

    PubMed  Google Scholar 

  30. Turner RS. Postoperative total hip prosthetic femoral head dislocations: incidence, etiologic factors, and management. Clin Orthop Relat Res. 1994;301:196–204.

    PubMed  Google Scholar 

  31. Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–1306.

    PubMed  CAS  Google Scholar 

  32. Woolson ST, Rahimtoola ZO. Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplasty. 1999;14:662–668.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Elizabeth Schamber for help with data collection.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael D. Ries MD.

Additional information

Ehsan Saadat, Glenn Diekmann, and Steven Takemoto have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Michael D. Ries is a consultant with intellectual property (royalty income) from Smith and Nephew, Inc (Memphis, TN, USA) and products from Stryker Orthopaedics (Mahwah, NJ, USA).

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained if required.

This work was performed at the University of California, San Francisco, Medical Center.

About this article

Cite this article

Saadat, E., Diekmann, G., Takemoto, S. et al. Is an Algorithmic Approach to the Treatment of Recurrent Dislocation After THA Effective?. Clin Orthop Relat Res 470, 482–489 (2012). https://doi.org/10.1007/s11999-011-2101-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-2101-x

Keywords

Navigation