Instability (INS)/Dislocation (DISL)

  • Eustathios Kenanidis
  • Eleftherios TsiridisEmail author
  • Nathanael Heckmann
  • Braden McKnight
  • Lawrence D. Dorr
  • Emmanuel Gibon
  • Stuart B. Goodman


  1. (a)
    • The incidence ranges from 0.2 to 7% for primary and 5 to 25% for revision THA [1–3].

    • INS is the third reason of revision THA following loosening and infection but the first reason of early revision. Greater than 50% of DISLs occur within three months postoperatively [4, 5].

    • The risk of recurrence following the first episode is estimated up to 33% [4].

  2. (b)
    Types [4–7]
    1. 1.
      Early dislocation [6, 7]
      • It occurs during the first 3–6 postoperative months.

      • It is the most common type (5070%).

      • The inadequate healing and other preoperative risk factors are the main reasons.

      • It has a better prognosis with a lower rate of recurrence.

      • Usually nonoperative treatment.

    2. 2.
      Intermediate [6]
      • It occurs between the six months and five years postoperatively.

      • The older age, muscular laxity, and cognitive impairment are the main reasons.

    3. 3.
      Late dislocation [6, 7]
      • It occurs more than five years postoperatively.

      • It usually has a multifactorial etiology.

      • It has a higher rate of recurrence.

      • Frequently involves operative treatment.

  3. (c)
    Risk Factors
    1. 1.
      Patient’s [5]
      1. (a)
        Neuromuscular and cognitive disorders [5, 8]
        • Muscular dystrophy, dementia, alcoholism, Parkinson, MS, etc.

        • Muscle weakness, imbalance, and inability to comply with activity restriction

      2. (b)
        Age [9, 10]
        • It is not definitely considered an independent risk factor [5].

        • Muscle weakness, frailty, propensity to fall, and lack of adherence to the postoperative protocol that follows the older age are the main reasons.

      3. (c)

        Posttraumatic/prior hip surgery and history of fracture

      4. (d)

        Other underlying diseases (osteonecrosis, inflammatory arthritis, DDH) [11]

      5. (e)

        Patient noncompliance with activity restrictions

    2. 2.
      Surgical (not only one cause but usually multifactorial) [5]
      1. (a)
        Surgical approach
        • Although the posterior approach was considered an independent risk factor of dislocation at the past [11], the meticulous repair of the soft tissue and the use of large heads lessened the risk [10]. A meta-analysis [12] found that the dislocation rates of posterior approach with and without repair were 0.49 and 4.46%, respectively, and 8.21 times the greater relative risk for the posterior approach without soft tissue repair than with soft tissue repair [12]. Goldstein [13] et al. and Pellici [14] et al. reported decrease of dislocation rate with posterior capsule repair from 4.8 to 0.7% in 1515 patients and from 4.1 to 0%, respectively.

        • A recent meta-analysis [15] involving 13,203 primary THAs found dislocation rates of 1.27% for trans-trochanteric, 3.23% for posterior (2.03% with capsular repair), 2.18% for anterolateral, and 0.55% for the direct lateral approach. There were however only four prospective studies that did not have sufficient power to reach statistical significance [15].

      2. (b)
        Soft tissue tensioning/condition of soft tissues [4, 5]
        • Meticulous reconstruction of posterior joint capsule and short external rotators lessened the dislocation risk [14].

        • Non-healing of the soft tissue following revision THA increases the risk.

        • Trochanteric nonunion increases sixfold the risk of dislocation.

        • Abductor deficiency [16].

      3. (c)
        Restoration of offset [3, 4]
        • Less offset limits the soft tissue tensioning and increases dislocation risk.

      4. (d)

        Restoration of leg length [17]

      5. (e)
        Component positioning [18]
        • It is the most common cause of instability [5, 19].

        • Cup safe zone of abduction is 40 ± 10 and anteversion is 15–20 ± 5–10. It is also affected by the orientation of the pelvis and body position [4, 5, 20, 21].

        • Risk factors are low-volume surgeons, obesity, and minimal approaches [17, 19].

        • Femoral stem false positioning (inadequate offset, length, and/or version on the femoral side) is another reason.

        • Uncombined version of cup and stem and the effect of pelvic tilt [22].

        • X-rays more suitable for inclination than anteversion measurement. Different CT protocols have been proposed but they lack standardization [4].

        • Femoral anteversion is easier to measure on CT by evaluating the angle between the femoral neck and the axis of posterior condyles [22], which proved that this value differs from surgeon thought by 16.8° as a mean [22].

      6. (f)
        • Usually femoral neck comes into contact during ROM with liner or cement, osteophyte, or heterotopic ossification creating torque and dislocation.

        • Medial placement of femoral component and cup is another reason.

        • Increased head/neck ratio decreases possibility.

      7. (g)
        Head size [18]
        • Larger head advantages: increased head/neck ratio, avoidance of a skirted component, and increased jump distance because the head sits deeper in the shell and allows greater range of subluxation before dislocation occurs [5, 16, 23, 24].

      8. (h)
        Liner profile
        • Neutral liners increased risk than posteriorly elevated (however posteriorly elevated increase time of neck impingement and liner wear so not uniformly recommended).

        • Oblique and lateralized.

      9. (i)
        Surgeon experience
        • Higher dislocation rate was reported among surgeons who perform < 30 THAs yearly choice of implant [5].

  • Treatment
    • Primary THA: first dislocation
      • Patient assessment [5, 10]
        1. 1.

          History (of dislocation and surgical note)

        2. 2.

          Physical examination (LLD, ROM, neurovascular integrity)

        3. 3.

          Infection exclusion (CRP, ESR, aspiration, culture)

        4. 4.

          Imaging (AP X-rays, CT) to detect cup orientation, eccentric wear, the possibility of liner dissociation, osteophytes, bone quality and integrity, femoral offset, subsidence, angulation, anteversion (difficult) component geometry (including head-to-neck ratio), osteolysis, and component loosening

        5. 5.

          Time of dislocation is crucial for the reason/weeks or months think soft tissue tension (including muscle weakness and inadequate capsular healing and scarring), component malposition, infection, or patient noncompliance. Late dislocations (> 1 year) think stretching of the soft tissues or polyethylene wear

        6. 6.

          Direction of dislocation evaluated from X-rays and from the direction of relocation

    • Closed reduction: spica
      • With sedation to prevent damage to implant.

      • In case of well-positioned and stable implant postreduction [3].

      • 6–12 weeks spica (their use based on small series [3]).

      • Their use is extremely patient dependent [25]/even the most compliant have difficulties/probably in noncompliant patient can be considered [3, 25].

      • Almost two-thirds have effective treatment in this way.

    • Indications for operative management
      1. 1.

        Recurrent dislocation >2 times

      2. 2.

        Chronic dislocation

      3. 3.

        Irreducible dislocation

      4. 4.

        Soft tissue tension

      5. 5.


      6. 6.

        Malposition of components (one of the primary causes)

  • Recurrent dislocation
    • Identify the cause to have better chance of successful management [26].

    • Assess the patient using the previously mentioned steps for primary DISL.

    • Revision seems to be more effective for component malpositioning, infection, and abductor insufficiency.

    • However, none of the available surgical procedures can uniformly solve the problem of instability [6].

    • In case of multifactorial cause, the treatment is less obvious.


  1. 1.
    Langlais FL, Ropars M, Gaucher F, Musset TH, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res. 2008;466:389–95.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Berend KR, Sporer SM, Sierra RJ, Glassman AH, Morris MJ. Achieving stability and lower-limb length in total hip arthroplasty. J Bone Joint Surg Am. 2010;92:2737–52.PubMedGoogle Scholar
  3. 3.
    Patel PD, Potts A, Froimson MI. The dislocating hip arthroplasty. Prevention and treatment. J Arthroplast. 2007;22(4 Suppl):1.Google Scholar
  4. 4.
    Charissoux J-L, Asloum Y, Marcheix P-S. Surgical management of recurrent dislocation after total hip arthroplasty. Orthop Traumatol Surg Res. 2014;100:S25–34.CrossRefPubMedGoogle Scholar
  5. 5.
    Cui Q. Instability after total hip arthroplasty. World J Orthop. 2012;3(8):122–30.CrossRefGoogle Scholar
  6. 6.
    Parvizi J, Picinic E, Sharkey PF. Revision total hip arthroplasty for instability: surgical techniques and principles. J Bone Joint Surg Am. 2008;90(5):1134–42.PubMedGoogle Scholar
  7. 7.
    Pulido L, Restrepo C, Parvizi J. Late instability following total hip arthroplasty. Clin Med Res. 2007;5(2):139–42.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty. A multivariate analysis. J Arthroplast. 2002;17:282–8.CrossRefGoogle Scholar
  9. 9.
    Berry DJ, Von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am. 2004;86:9–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Yun AG, Padgett D, Pellicci P, Dorr LD. Constrained acetabular liners: mechanisms of failure. J Arthroplast. 2005;20:536–41.CrossRefGoogle Scholar
  11. 11.
    Hailer NP, Weiss RJ, Stark A, Kδrrholm J. Dual-mobility cups for revision due to instability are associated with a low rate of re-revisions due to dislocation 228 patients from the Swedish Hip Arthroplasty Register. Acta Orthop. 2012;83(6):566–71.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res. 2006;447:34–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Goldstein WM, Gleason TF, Kopplin M, Branson JJ. Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorrhaphy. J Bone Joint Surg Am. 2001;83(Suppl 2):2–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res. 1998;355:224–8.CrossRefGoogle Scholar
  15. 15.
    Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;405:46.CrossRefGoogle Scholar
  16. 16.
    Wetters NG, Murray TG, Moric M, Sporer SM, Paprosky WG, Della Valle CJ. Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res. 2013;471:410–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Callaghan JJ, Heithoff BE, Goetz DD, et al. Prevention of dislocation after hip arthroplasty: lessons from long-term followup. Clin Orthop. 2001;393:157–62.CrossRefGoogle Scholar
  18. 18.
    Barrack RL. Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg. 2003;11:89–99.CrossRefPubMedGoogle Scholar
  19. 19.
    Werner BC, Brown TE. Instability after total hip arthroplasty. World J Orthop. 2012;3(8):122–30.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B. Reducing the risk of dislocation after total hip arthroplasty the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005;87:762–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Dorr LD, Malik A, Dastane M, Wan Z. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res. 2009;467:119–27.CrossRefPubMedGoogle Scholar
  23. 23.
    Triclot P, Gouin F, Richter D, Musset T, Bonnan J, Ollivier H, et al. Update‘big-head’: the solution to the problem of hip implant dislocation? Orthop Traumatol Surg Res. 2011;97S:S120–7.Google Scholar
  24. 24.
    Howie DW, Holubowycz OT, Midelton R. Large femoral heads decrease the inci-dence of dislocation after total hip arthroplasty. A randomised controlled trial. J Bone Joint Surg Am. 2012;94:1095–102.CrossRefPubMedGoogle Scholar
  25. 25.
    Dewal H, Maurer SL, Tsai P, et al. Efficacy of abduction bracing in the management of total hip arthroplasty dislocation. J Arthroplast. 2004;19:733.CrossRefGoogle Scholar
  26. 26.
    Salassa T, Hoeffel D, Mehle S, Tatman P, Gioe TJ. Efficacy of revision surgery for the dislocating total hip arthroplasty: report from a large community registry. Clin Orthop Relat Res. 2014;472(3):962–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Puri L, Lapinski B, Wixson RL, Lynch J, Hendrix R, Stulberg SD. Computed tomographic follow-up evaluation of operative intervention for periacetabular lysis. J Arthroplast. 2006;21(6 Suppl 2):78–82.CrossRefGoogle Scholar
  28. 28.
    Parvizi J, Kim KI, Goldberg G, et al. Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning. Clin Orthop Relat Res. 2006;447:60.CrossRefPubMedGoogle Scholar
  29. 29.
    Morrey BF. Difficult complications after hip joint replacement. dislocation. ClinOrthop Relat Res. 1997;344:179–87.Google Scholar
  30. 30.
    Lombardi AV, Berend KR. Isolated acetabular liner exchange. J Am Acad Orthop Surg. 2008;16:243–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Biviji AA, Ezzet KA, Pulido P, Colwell CW. Modular femoral head and liner exchange for the unstable total hip arthroplasty. J Arthroplast. 2009;24:625–30.CrossRefGoogle Scholar
  32. 32.
    Toomey SD, Hopper RH, 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;83:1529–33.CrossRefPubMedGoogle Scholar
  33. 33.
    Earll MD, Fehring TK, Griffin WL, Mason JB, McCoy T, Odum S. Success rate of modular component exchange for the treatment of an unstable total hip arthroplasty. J Arthroplast. 2002;17:864–9.CrossRefGoogle Scholar
  34. 34.
    Carter AH, Sheehan EC, Mortazavi SM, Purtill JJ, Sharkey PF, Parvizi J. Revision for recurrent instability: what are the predictors of failure? J Arthroplast. 2011;26(6 Suppl):46–52.CrossRefGoogle Scholar
  35. 35.
    Lachiewicz PF, Soileau E, Ellis J. Modular revision for recurrent dislocation of primary or revision total hip arthroplasty. J Arthroplast. 2004;19(4):424–9.CrossRefGoogle Scholar
  36. 36.
    Garbuz DS, Masri BA, Duncan CP, Greidanus NV, Bohm ER, Petrak MJ, et al. Dislocation in revision THA. Do large heads (36 and 40 mm) result inreduced dislocation rates in a randomised clinical trial? Clin Orthop Relat Res. 2012;470:351–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Kung PL, Ries MD. Effect of femoral head size and abductors on dislocation after revision THA. Clin Orthop Relat Res. 2007;465:170–4.PubMedGoogle Scholar
  38. 38.
    Hummel MT, Malkani AL, Yakkanti MR. Baker DL Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplast. 2009;24(6 Suppl):73–6.CrossRefGoogle Scholar
  39. 39.
    Van Sikes C, Lai LP, Schreiber M, Mont MA, Jinnah RH, Seyler TM. Instability after total hip arthroplasty treatment with large femoral heads vs constrained liners. J Arthroplast. 2008;23(7 Suppl):59–63.CrossRefGoogle Scholar
  40. 40.
    Amstutz HC, Le Duff MJ, Beaulé PE. Prevention and treatment of dislocation after total hip replacement using large diameter balls. Clin Orthop Relat Res. 2004;429:108–16.CrossRefGoogle Scholar
  41. 41.
    Beaulé 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;84:256–63.CrossRefPubMedGoogle Scholar
  42. 42.
    Jo S, Jimenez Almonte JH, Sierra RJ. The cumulative risk of re-dislocation after revision THA performed for instability increases close to 35% at 15 years. J Arthroplast. 2015;30(7):1177–82.CrossRefGoogle Scholar
  43. 43.
    Yoshimoto K, Nakashima Y, Aota S, Kaneuji A, Fukui K, Hirakawa K, Nakura N, Kinoshita K, Naito M, Iwamoto Y. Re-dislocation after revision total hip arthroplasty for recurrent dislocation: a multicentre study. Int Orthop. 2017;41(2):253–8.CrossRefPubMedGoogle Scholar
  44. 44.
    McConway J, O’Brien S, Doran E, Archbold P, Beverland D. The use of a posterior lip augmentation device for a revision of recurrent dislocation after primary cemented Charnley/Charnley Elite total hip replacement. Results at a mean follow-up of six years and nine months. J Bone Joint Surg Br. 2007;89:1581–5.CrossRefPubMedGoogle Scholar
  45. 45.
    Charlwood AP, Thompson NW, Thompson NS, Beverland DE, Nixon JR. Recurrent hip arthroplasty dislocation: good outcome after cup augmentation in 20 patients followed for 2 years. Acta Orthop Scand. 2002;73(5):502–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Charlwood P, Thompson NW, Brown JG, Nixon JR. The Belfast Posterior Lip Augmentation Device (PLAD) in the management of recurrent posterior dislocation following primary total hip arthroplasty. J Bone Joint Surg Br. 2001;84-B(Suppl II):154.Google Scholar
  47. 47.
    Gie GA, Scott TD, Ling RS. Cup augmentation for recurrent hip replacement dislocation. J Bone Joint Surg Br. 1989;71-B:338.Google Scholar
  48. 48.
    Campbell D, Muthusamy K, Sturdee S, Finlayson D, Stone M. The posterior lip augmentation device for recurrent dislocation. J Bone Joint Surg [Br] 2001;84-B(Suppl II):154.Google Scholar
  49. 49.
    Williamson JB, Galasko CSB, Rowley DI. Failure of acetabular augmentation for recurrent dislocation after hip arthroplasty: report of 3 cases. Acta Orthop Scand 1989;60:676–7.CrossRefPubMedGoogle Scholar
  50. 50.
    Schmidl S, Jakobs O, Guenther D, Lausmann C, Schoof B, Beckmann J, Gehrke T, Gebauer M. Effective prevention of recurrent dislocation following primary cemented Endo-MarkIII/SP2 total hip arthroplasty using a posterior lip augmentation device. Arch Orthop Trauma Surg. 2016;136(4):579–83.CrossRefPubMedGoogle Scholar
  51. 51.
    Gholve PA, Lovell ME, Naqui SZ. Minimal surgical approach for recurrent hip dislocation using the posterior lip augmentation device for the Charnley hip arthroplasty. J Arthroplast. 2006;21(6):865–8.CrossRefGoogle Scholar
  52. 52.
    Lombardi AV Jr. Constrained liners in revision: total hip arthroplasty an overuse syndrome: in opposition. J Arthroplast. 2006;21(4 Suppl 1):126–30.CrossRefGoogle Scholar
  53. 53.
    Williams JT Jr, Ragland PS, Clarke S. Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop. 2007;31:273.CrossRefPubMedGoogle Scholar
  54. 54.
    Callaghan JJ, Parvizi J, Novak CC, et al. A constrained liner cemented into a secure cementless acetabular shell. J Bone Joint Surg Am. 2004;86:2206.CrossRefPubMedGoogle Scholar
  55. 55.
    Cooke CC, Hozack W, Lavernia C, Sharkey P, Shastri S, Rothman RH. Early failure mechanisms of constrained tripolar acetabular sockets used in revision total hip arthroplasty. J Arthroplast. 2003;18:827–33.CrossRefGoogle Scholar
  56. 56.
    Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res. 2012;470:1907–16.CrossRefPubMedGoogle Scholar
  57. 57.
    Della Valle CJ, Chang D, Sporer S, Berger RA, Rosenberg AG, Paprosky WG. High failure rate of a constrained acetabular liner in revision total hip arthroplasty. J Arthroplast. 2005;20(7 Suppl 3):103–7.CrossRefGoogle Scholar
  58. 58.
    Clavé A, Maurer D, Tristan L, Dubrana F, Lefèvre C, Pandit H. Midterm survivorship of the Lefèvre constrained liner: a consecutive multisurgeon series of 166 cases. J Arthroplast. 2016;31(9):1970–8.CrossRefGoogle Scholar
  59. 59.
    Chalmers BP, Arsoy D, Sierra RJ, Lewallen DG, Trousdale RT. High failure rate of modular exchange with a specific design of a constrained liner in high-risk patients undergoing revision total hip arthroplasty. J Arthroplast. 2016;31(9):1963–9.CrossRefGoogle Scholar
  60. 60.
    Mäkinen TJ, Fichman SG, Rahman WA, Amenabar T, Safir O, Gross AE, Kuzyk PR. The focally constrained liner is a reasonable option for revision of unstable total hip arthroplasty. Int Orthop. 2016;40(11):2239–45.CrossRefPubMedGoogle Scholar
  61. 61.
    Khoury JI, Malkani AL, Adler EM, Markel DC. Constrained acetabular liners cemented into cages during total hip revision arthroplasty. J Arthroplast. 2010;25(6):901–5.CrossRefGoogle Scholar
  62. 62.
    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;85:2179–83.CrossRefPubMedGoogle Scholar
  63. 63.
    Anderson MJ, Murray WR, Skinner HB. Constrained acetabular components. J Arthroplast. 1994;9:17–23.CrossRefGoogle Scholar
  64. 64.
    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;80:502–9.CrossRefPubMedGoogle Scholar
  65. 65.
    Goetz DD, Bremner BR, Callaghan JJ, et al. Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component. A concise follow-up of a previous report. J Bone Joint Surg Am. 2004;86:2419.CrossRefPubMedGoogle Scholar
  66. 66.
    Berend KR, Lombardi AV Jr, Mallory TH, et al. The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures. J Arthroplast. 2005;20:93.CrossRefGoogle Scholar
  67. 67.
    Shapiro GS, Weiland DE, Markel DC, Padgett DE, Sculco TP, Pellicci PM. The use of a constrained acetabular component for recurrent dislocation. J Arthroplast. 2003;18:250–8.CrossRefGoogle Scholar
  68. 68.
    Karvonen M, Karvonen H, Seppänen M, Liukas A, Koivisto M, Mäkelä KT. Freedom constrained liner for the treatment and prevention of dislocation in total hip arthroplasty. Scand J Surg. 2017;106Google Scholar
  69. 69.
    Stanton DA, Bruce WJ, Goldberg JA, Walsh W. Salvaging unstable or recurrent dislocating total hip arthroplasty with the constrained acetabular component. J Orthop Surg. 2002;10(2):165–9.CrossRefGoogle Scholar
  70. 70.
    Andersen AV, Kjersgaard AG, Solgaard S. Trilogy-constrained acetabular component for recurrent dislocation. ISRN Orthop. 2013;2013:629201.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Levine BR, Della Valle CJ, Deirmengian CA, Breien KM, Weeden SH, Sporer SM, Paprosky WG. The use of a tripolar articulation in revision total hip arthroplasty: a minimum of 24 months’ follow-up. J Arthroplast. 2008;23(8):1182–8.CrossRefGoogle Scholar
  72. 72.
    Knudsen R, Ovesen O, Kjaersgaard-Andersen P, Overgaard S. Constrained liners for recurrent dislocations in total hip arthroplasty. Hip Int. 2007;17(2):78–81.CrossRefPubMedGoogle Scholar
  73. 73.
    Rady AE, Asal MK, Bassiony AA. The use of a constrained cementless acetabular component for instability in total hip replacement. Hip Int. 2010;20:434–9.CrossRefPubMedGoogle Scholar
  74. 74.
    Zywiel MG, Mustafa LH, Bonutti PM, Mont MA. Are abductor muscle quality and previous revision surgery predictors of constrained liner failure in hip arthroplasty? Int Orthop. 2011;35(6):797–802. doi: 10.1007/s00264-010-0962-3.CrossRefPubMedGoogle Scholar
  75. 75.
    Farizon F, de Lavison R, Azoulai JJ, Bousquet G. Results with a Cementless alumina-coated cup with dual mobility: a twelve-year follow-up study. Int Orthop. 1998;22(4):219–24.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Lachiewicz PF, Watters TS. The use of dual-mobility components in total hip arthroplasty. J Am Acad Orthop Surg. 2012;20:481–6.CrossRefPubMedGoogle Scholar
  77. 77.
    Ko LM, Hozack WJ. The dual mobility cup: what problems does it solve? Bone Joint J. 2016;98(1 Suppl A):60–3.CrossRefPubMedGoogle Scholar
  78. 78.
    Guyen O, Chen QS, Bejui-Hugues J, Berry DJ, An KN. Unconstrained tripolar hip implants: effect on hip stability. Clin Orthop Relat Res. 2007;455:202–8.CrossRefPubMedGoogle Scholar
  79. 79.
    Fabry C, Langlois J, Hamadouche M, Bader R. Intra-prosthetic dislocation of dual-mobility cups after total hip arthroplasty: potential causes from a clinical and biomechanical perspective. Int Orthop. 2016;40(5):901–6.CrossRefPubMedGoogle Scholar
  80. 80.
    Guyen O, Pibarot V, Vaz G, Chevillotte C, Béjui-Hugues J. Use of a dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res. 2009;467(2):465–72.CrossRefPubMedGoogle Scholar
  81. 81.
    Mertl P, Combes A, Leiber-Wackenheim F, Fessy MH, Girard J, Migaud H. Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years. HSSJ. 2012;8:251–6.CrossRefGoogle Scholar
  82. 82.
    Philippot R, Adam P, Reckhaus M, et al. Prevention of dislocation in total hip revision surgery using a dual mobility design. Orthop Traumatol Surg Res. 2009;95(6):407–13.CrossRefPubMedGoogle Scholar
  83. 83.
    Leiber-Wackenheim F, Brunschweiler B, Ehlinger M, Gabrion A, Mertl P. Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: A 59 cases series with a mean 8 years follow-up. Orthop Traumatol Surg Res. 2011;97(1):8–13.CrossRefPubMedGoogle Scholar
  84. 84.
    Simian E, Chatellard R, Druon J, Berhouet J, Rosset P. Dual mobility cup in revision total hip arthroplasty: dislocation rate and survival after 5 years. Orthop Traumatol Surg Res. 2015;101(5):577–81.CrossRefPubMedGoogle Scholar
  85. 85.
    Wegrzyn J, Tebaa E, Jacquel A, Carret JP, Béjui-Hugues J, Pibarot V. Can dual mobility cups prevent dislocation in all situations after revision total hip arthroplasty? J Arthroplast. 2015;30(4):631–40.CrossRefGoogle Scholar
  86. 86.
    Saragaglia D, Ruatti S, Refaie R. Relevance of a press-fit dual mobility cup to deal with recurrent dislocation of conventional total hip arthroplasty: a 29-case series. Eur J Orthop Surg Traumatol. 2013;23(4):431–6.CrossRefPubMedGoogle Scholar
  87. 87.
    Civinini R, Carulli C, Matassi F, Nistri L, Innocenti M. A dual-mobility cup reduces risk of dislocation in isolated acetabular revisions. Clin Orthop Relat Res. 2012;470(12):3542–8.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Jakobsen T, Kappel A, Hansen F, Krarup N. The dislocating hip replacement – revision with a dual mobility cup in 56 consecutive patients. Open Orthop J. 2014;8:268–71.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Plummer DR, Christy JM, Sporer SM, Paprosky WG, Della Valle CJ. Dual-mobility articulations for patients at high risk for dislocation. J Arthroplast. 2016;31:131.CrossRefGoogle Scholar
  90. 90.
    van Heumen M, Heesterbeek PJ, Swierstra BA, Van Hellemondt GG, Goosen JH. Dual mobility acetabular component in revision total hip arthroplasty for persistent dislocation: no dislocations in 50 hips after 1-5 years. J Orthop Traumatol. 2015;16(1):15–20.CrossRefPubMedGoogle Scholar
  91. 91.
    Hamadouche M, Biau DJ, Huten D, Musset T, Gaucher F. The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res. 2010;468(12):3248–54.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Van Warmerdam JM, McGann WA, Donnelly JR, Kim J, Welch RB. Achilles allograft reconstruction for recurrent dislocation in total hip arthroplasty. J Arthroplast. 2011;26:941–8.CrossRefGoogle Scholar
  93. 93.
    Strømsøe K, Eikvar K. Fascia lata plasty in recurrent posterior dislocation after total hip arthroplasty. Arch Orthop Trauma Surg. 1995;114:292–4.CrossRefPubMedGoogle Scholar
  94. 94.
    Lavigne MJ, Sanchez AA, Coutts RD. Recurrent dislocation after total hip arthroplasty: treatment with an Achilles tendon allograft. J Arthroplast. 2001;16:13–8.CrossRefGoogle Scholar
  95. 95.
    McGann WA, Welch RB. Treatment of the unstable total hip arthroplasty using modularity, soft tissue, and allograft reconstruction. J Arthroplast. 2001;16:19–23.CrossRefGoogle Scholar
  96. 96.
    Barbosa JK, Khan AM, Andrew JG. Treatment of recurrent dislocation of total hip arthroplasty using a ligament prosthesis. J Arthroplast. 2004;19:318–21.CrossRefGoogle Scholar
  97. 97.
    Ekelund A. Trochanteric osteotomy for recurrent dislocation of total hip arthroplasty. J Arthroplast. 1993;8:629–32.CrossRefGoogle Scholar
  98. 98.
    Kaplan SJ, Thomas WH, Poss R. Trochanteric advancement for recurrent dislocation after total hip arthroplasty. J Arthroplast. 1987;2:119–24.CrossRefGoogle Scholar
  99. 99.
    Lazennec J-Y, Boyer P, Gorin M, Catonné Y, Rousseau MA. Acetabular anteversion with CT in supine, simulated standing, and sitting positions in a THA patient population. Clin Orthop Relat Res. 2011;469(4):1103–9. doi: 10.1007/s11999-010-1732-7.CrossRefPubMedGoogle Scholar
  100. 100.
    Kanawade V, Dorr LD, Wan Z. Predictability of acetabular component angular change with postural shift from standing to sitting position. J Bone Joint Surg Am. 2014;96(12):978–86. doi: 10.2106/JBJS.M.00765.CrossRefPubMedGoogle Scholar
  101. 101.
    Radcliff KE, Kepler CK, Hellman M, et al. Does spinal alignment influence acetabular orientation: a study of spino-pelvic variables and sagittal acetabular version. Orthop Surg. 2014;6(1):15–22. doi: 10.1111/os.12090.CrossRefPubMedGoogle Scholar
  102. 102.
    Inaba Y, Dorr LD, Wan Z, Sirianni L, Boutary M. Operative and patient care techniques for posterior mini-incision total hip arthroplasty. Clin Orthop Relat Res. 2005;441:104–14.CrossRefPubMedGoogle Scholar
  103. 103.
    Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993;14(3):231–42.CrossRefPubMedGoogle Scholar
  104. 104.
    Karachalios T, Hartofilakidis G, Zacharakis N, Tsekoura M. A 12- to 18-year radiographic follow-up study of Charnley low-friction arthroplasty. The role of the center of rotation. Clin Orthop Relat Res. 1993;296:140–7.Google Scholar
  105. 105.
    Dastane M, Dorr LD, Tarwala R, Wan Z. Hip offset in total hip arthroplasty: quantitative measurement with navigation. Clin Orthop Relat Res. 2011;469(2):429–36.CrossRefPubMedGoogle Scholar
  106. 106.
    Insull PJ, Cobbett H, Frampton CM, Munro JT. The use of a lipped acetabular liner decreases the rate of revision for instability after total hip replacement: a study using data from the New Zealand Joint Registry. Bone Joint J. 2014;96-B:884–8.CrossRefPubMedGoogle Scholar
  107. 107.
    Epinette J-A, Béracassat R, Tracol P, Pagazani G, Vandenbussche E. Are modern dual mobility cups a valuable option in reducing instability after primary hip arthroplasty, even in younger patients? J Arthroplasty. 2014;29:1323–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Eustathios Kenanidis
    • 1
  • Eleftherios Tsiridis
    • 2
    Email author
  • Nathanael Heckmann
    • 3
  • Braden McKnight
    • 3
  • Lawrence D. Dorr
    • 4
  • Emmanuel Gibon
    • 5
  • Stuart B. Goodman
    • 6
  1. 1.Academic Orthopaedic UnitAristotle University Medical SchoolThessalonikiGreece
  2. 2.Academic Orthopaedic UnitPapageorgiou General Hospital, Aristotle University Medical SchoolThessalonikiGreece
  3. 3.Department of Orthopaedic SurgeryKeck School of Medicine of USCLos AngelesUSA
  4. 4.USCLos AngelesUSA
  5. 5.Department of Orthopaedic SurgeryStanford UniversityStanfordUSA
  6. 6.Department of Orthopaedic Surgery and (by Courtesy) BioengineeringStanford University Medical Center Outpatient CenterRedwood CityUSA

Personalised recommendations