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Risk Factors for Dislocation After Revision Total Hip Arthroplasty

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

Abstract

Background

Despite dislocation being the most frequent complication after revision THA, risk factors for its occurrence are not completely understood.

Questions/purposes

We therefore (1) determined the overall risk of dislocation after revision THA in a large series of revision THAs using contemporary revision techniques, (2) identified patient-related risk factors predicting dislocation, and (3) identified surgical variables predicting dislocation.

Methods

We performed 1211 revision THAs between June 2004 and October 2010 in 576 women and 415 men who had a mean age of 64.7 years (range, 25–95 years) at time of surgery. Forty-six (4%) were lost to followup and 13 died (1%), leaving 1152 hips followed for a minimum of 90 days (mean, 2 years; range, 90 days to 7.1 years). Multivariate logistic regression was performed to identify risk factors for dislocation. The model was also tested on patients followed for a minimum 1 year to assess any difference in longer followup.

Results

One hundred thirteen patients dislocated over the followup period (9.8%). Factors that were different between patients who dislocated and those who remained stable included a history of at least one previous dislocation (odds ratio [OR] = 2.673), abductor deficiency (OR = 2.672), and Paprosky acetabulum class (OR = 1.522). Use of a constrained liner (OR = 0.503) and increased femoral head size (OR = 0.942) were protective against dislocation, while with longer followup a constrained liner was no longer significant.

Conclusions

Dislocation remains a common problem after revision THA. Identifying these risk factors can assist in patient education and surgical planning. Recognition of these risk factors in both patient type and surgical strategy is important for the surgeon performing revision THA and for minimizing these risks.

Level of Evidence

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

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Acknowledgments

The authors thank Vamsi Kancherla, MD, for his invaluable help with this research.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Nathan G. Wetters BS.

Additional information

The institution of one or more of the authors (SMS, WGP, CJDV) has received, during the study period, funding from Zimmer Inc (Warsaw, IN, USA), Smith & Nephew Inc (Memphis, TN, USA), and Stryker Orthopaedics (Mahwah, NJ, USA).

One of the authors (TGM) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of less than $10,000, from Zimmer Inc. One of the authors (SMS) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of $10,000 to $100,000, from Smith & Nephew. One of the authors (WGP) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of $100,001 to $1,000,000, from Zimmer Inc; and an amount of $10,000 to $100,000, from Biomet Inc (Warsaw, IN, USA). One of the authors (CJDV) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of $10,000 to $100,000, from Biomet; an amount of $10,000 to $100,000, from Smith & Nephew; and an amount of less than $10,000, from Convatec (Skillman, NJ, USA). Each remaining author (NGW, MM) certifies that he or she, or a member of his or her immediate family, has 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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution 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.

This work was performed at Rush University Medical Center, Chicago, IL, USA.

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Wetters, N.G., Murray, T.G., Moric, M. et al. Risk Factors for Dislocation After Revision Total Hip Arthroplasty. Clin Orthop Relat Res 471, 410–416 (2013). https://doi.org/10.1007/s11999-012-2561-7

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  • DOI: https://doi.org/10.1007/s11999-012-2561-7

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