Abstract
Dislocation of total hip arthroplasty (THA) is a severe and challenging complication. Orthopaedic surgeons should therefore know the risk factors for instability and follow the principles of correct implant positioning, proper soft tissue treatment as well as appropriate patient information.
If dislocation occurs, all potential reasons for the instability must be analyzed by appropriate clinical examination and imaging. Therapeutic alternatives depend on the type of dislocation, the temporal pattern, and the aetiology. Anterior dislocations – especially in the early post-operative period – can respond to conservative measures, if there is no gross malpositioning of components or severe soft tissue damage. Posterior dislocations as well as late dislocations, however, show a tendency to recur more often. Several options of surgical therapy are available (i.e. partial exchange of femoral head and/or acetabular liner or revision arthroplasty with complete exchange of stem and/or cup). It is difficult to establish clear treatment algorithms as there is not enough evidence from the literature. However, a reasonable outcome can be achieved if the therapeutic strategy addresses the underlying pathology.
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References
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Alberton GM, High WA, Morrey BF (2002) Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am 84-A(10):1788–1792
Baldwin KF, Dorr LD (2001) The unstable total hip arthroplasty: the role of postoperative bracing. Instr Course Lect 50:289–293
Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91(1):128–133
Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau H (2011) The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 469(2):319–329
Carter AH, Sheehan EC, Mortazavi SM, Purtill JJ, Sharkey PF, Parvizi J (2011) Revision for recurrent instability what are the predictors of failure? J Arthroplasty 26:46–52
Cobb TK, Morrey BF, Ilstrup DM (1996) The elevated-rim acetabular liner in total hip arthroplasty: relationship to postoperative dislocation. J Bone Joint Surg Am 78(1):80–86
Dorr LD, Wan Z (1998) Causes of and treatment protocol for instability of total hip replacement. Clin Orthop Relat Res 355:144–151
Dorr LD, Wolf AW, Chandler R, Conaty JP (1983) Classification and treatment of dislocations of total hip arthroplasty. Clin Orthop Relat Res 173:151–158
Hamilton WG, McAuley JP (2004) Evaluation of the unstable total hip arthroplasty. Instr Course Lect 53:87–92
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(2):206–209
Hernigou P, Filippini P, Flouzat-Lachaniette CH, Batista SU, Poignard A (2010) Constrained liner in neurologic or cognitively impaired patients undergoing primary THA. Clin Orthop Relat Res 468(12):3255–3262
Honl M, Schwieger K, Salineros M, Jacobs J, Morlock M, Wimmer M (2006) Orientation of the acetabular component. A comparison of five navigation systems with conventional surgical technique. J Bone Joint Surg Br 88(10):1401–1405
Jolles BM and Bogoch ER (2006) Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis Cochrane Database Syst Rev 3:CD003828
Kessler O, Patil S, Wirth S, Mayr E, Colwell CW Jr, D’Lima DD (2008) Bony impingement affects range of motion after total hip arthroplasty: a subject-specific approach. J Orthop Res 26(4):443–452
Khan RJ, Carey Smith RL, Alakeson R, Fick DP, Wood D (2006) Operative and non-operative treatment options for dislocation of the hip following total hip arthroplasty Cochrane Database Syst Rev 4:CD005320
Khan RJ, Fick D, Alakeson R, Haebich S, de Cruz M, Nivbrant B, Wood D (2006) A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br 88(7):870–876
Kluess D, Martin H, Mittelmeier W, Schmitz KP, Bader R (2007) Influence of femoral head size on impingement, dislocation and stress distribution in total hip replacement. Med Eng Phys 29(4):465–471
Kotwal RS, Ganapathi M, John A, Maheson M, Jones SA (2009) Outcome of treatment for dislocation after primary total hip replacement. J Bone Joint Surg Br 91(3):321–326
Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ (2006) Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res 447:34–38
Lachiewicz PF, Soileau ES (2006) Polyethylene liner exchange of the Harris-Galante porous I and II acetabular components without cement: results and complications. J Arthroplasty 21(7):992–997
Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O (2008) Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res 466(2):389–395
Leiber-Wackenheim F, Brunschweiler B, Ehlinger M, Gabrion A, Mertl P (2011) 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 97(1):8–13
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220
Matsushita A, Nakashima Y, Jingushi S, Yamamoto T, Kuraoka A, Iwamoto Y (2009) Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplasty 24(4):646–651
McConway J, O’Brien S, Doran E, Archbold P, Beverland D (2007) 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 89(12):1581–1585
Parvizi J, Sharkey PF, Bissett GA, Rothman RH, Hozack WJ (2003) Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am 85-A(12):2310–2317
Patel AB, Wagle RR, Usrey MM, Thompson MT, Incavo SJ, Noble PC (2010) Guidelines for implant placement to minimize impingement during activities of daily living after total hip arthroplasty. J Arthroplasty 25(8):1275–1281
Philippot R, Adam P, Reckhaus M, Delangle F, Verdot FX, Curvale G, Farizon F (2009) Prevention of dislocation in total hip revision surgery using a dual mobility design. Orthop Traumatol Surg Res 95(6):407–413
Sikes CV, Lai LP, Schreiber M, Mont MA, Jinnah RH, Seyler TM (2008) Instability after total hip arthroplasty: treatment with large femoral heads vs constrained liners. J Arthroplasty 23(7):59–63
Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22(4):815–821
Williams JT Jr, Ragland PS, Clarke S (2007) Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop 31(3):273–277
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Günther, KP., Kirschner, S., Stiehler, M., Hartmann, A. (2012). Instability Following Total Hip Arthroplasty . In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 12. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27293-6_12
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