Skip to main content
Log in

Dislocation and its recurrence after revision total hip arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Dislocation is a leading cause of failure after revision total hip arthroplasty (THA). This study was conducted to examine the risk factors for dislocation as well as their recurrence after revision THA.

Methods

We retrospectively reviewed 178 revision THAs in 162 patients between 1998 and 2013. The mean patient age was 65.2 years at operation and the mean follow-up period was 6.7 years. Multivariate logistic regression was performed to identify risk factors for dislocation, and further comparison was made between patients with single and recurrent dislocations.

Results

Sixteen hips in 15 patients (9.0 %) dislocated at a mean of 9.1 months (range, 0–83 months) after revision THA. Multivariate analysis identified advanced age (odds ratio [OR] = 2.94/10 years) and osteonecrosis of the femoral head (OR = 7.71) as the independent risk factors for any dislocations. Risk factors for recurrent dislocations, which were observed in eight hips (50 %), were later dislocations (≥4 months) and lower BMI.

Conclusion

Dislocation is a serious problem after revision THA with multiple risk factors. Although our findings were limited to revision THAs done through posterolateral approach, recognition of these factors is helpful in patient education and surgical planning.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. Vicar AJ, Coleman CR (1984) A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty. Clin Orthop Relat Res 188:152–159

    PubMed  Google Scholar 

  3. Berry DJ, von Knoch M, Schleck CD, Harmsen WS (2004) The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 86-A:9–14

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  5. 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. J Bone Joint Surg Am 79:1202–1210

    CAS  PubMed  Google Scholar 

  6. Retpen JB, Varmarken JE, Sturup J, Olsen C, Solund K, Jensen JS (1989) Clinical results after revision and primary total hip arthroplasty. J Arthroplasty 4:297–302

    Article  CAS  PubMed  Google Scholar 

  7. 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:1788–1792

    PubMed  Google Scholar 

  8. Kosashvili Y, Drexler M, Backstein D, Safir O, Lakstein D, Safir A, Chakravertty R, Dwyer T, Gross A (2014) Dislocation after the first and multiple revision total hip arthroplasty: comparison between acetabulum-only, femur-only and both component revision hip arthroplasty. Can J Surg 57:E15–E18

    Article  PubMed  PubMed Central  Google Scholar 

  9. Nakashima Y, Hirata M, Akiyama M, Itokawa T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Iwamoto Y (2014) Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty. Int Orthop 38:27–32

    Article  PubMed  Google Scholar 

  10. Garbuz DS, Masri BA, Duncan CP, Greidanus NV, Bohm ER, Petrak MJ, Della Valle CJ, Gross AE (2012) The Frank Stinchfield Award. Dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial? Clin Orthop Relat Res 470:351–356

    Article  PubMed  Google Scholar 

  11. Wetters NG, Murray TG, Moric M, Sporer SM, Paprosky WG, Della Valle CJ (2013) Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res 471:410–416

    Article  PubMed  Google Scholar 

  12. Cogan A, Klouche S, Mamoudy P, Sariali E (2011) Total hip arthroplasty dislocation rate following isolated cup revision using Hueter’s direct anterior approach on a fracture table. Orthop Traumatol Surg Res 97:501–505

    Article  CAS  PubMed  Google Scholar 

  13. Itokawa T, Nakashima Y, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y (2013) Late dislocation is associated with recurrence after total hip arthroplasty. Int Orthop 37:1457–1463

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pellicci PM, Bostrom M, Poss R (1998) Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res 355:224–228

    Article  PubMed  Google Scholar 

  15. Nakashima Y, Sato T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Akiyama M, Hirata M, Hara D, Iwamoto Y (2013) Results at a minimum of 10 years of follow-up for AMS and PerFix HA-coated cementless total hip arthroplasty: impact of cross-linked polyethylene on implant longevity. J Orthop Sci 18:962–968

    Article  CAS  PubMed  Google Scholar 

  16. Nakashima Y, Mashima N, Imai H, Mitsugi N, Taki N, Mochida Y, Owan I, Arakaki K, Yamamoto T, Mawatari T, Motomura G, Ohishi M, Doi T, Kanazawa M, Iwamoto Y (2013) Clinical and radiographic evaluation of total hip arthroplasties using porous tantalum modular acetabular components: 5-year follow-up of clinical trial. Mod Rheumatol 23:112–118

    Article  CAS  PubMed  Google Scholar 

  17. Ejsted R, Olsen NJ (1987) Revision of failed total hip arthroplasty. J Bone Joint Surg (Br) 69:57–60

    CAS  Google Scholar 

  18. Barrack RL, Butler RA, Laster DR, Andrews P (2001) Stem design and dislocation after revision total hip arthroplasty: clinical results and computer modeling. J Arthroplasty 16:8–12

    Article  CAS  PubMed  Google Scholar 

  19. Espehaug B, Havelin LI, Engesaeter LB, Langeland N, Vollset SE (1997) Patientrelated risk factors for early revision of total hip replacements. A population register-based case-control study of 674 revised hips. Acta Orthop Scand 68:207–215

    Article  CAS  PubMed  Google Scholar 

  20. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M (2001) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on Sarcopenia in older people. European working group on Sarcopenia in older people. Age Ageing 39:412–423

    Article  Google Scholar 

  21. Bergh C, Fenstad AM, Furnes O, Garellick G, Havelin LI, Overgaard S, Pedersen AB, Mäkelä KT, Pulkkinen P, Mohaddes M, Kärrholm J (2014) Increased risk of revision in patients with non-traumatic femoral head necrosis. Acta Orthop 85:11–17

    Article  PubMed  PubMed Central  Google Scholar 

  22. West LJ, Maxwell DS, Noble EP, Solomon DH (1984) Alcoholism. Ann Intern Med 100:405–416

    Article  CAS  PubMed  Google Scholar 

  23. Caton JH, Prudhon JL, Ferreira A, Aslanian T, Verdier R (2014) A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess whether a dual mobility cup has a decreased dislocation risk. Int Orthop 38:1125–1129

    Article  PubMed  PubMed Central  Google Scholar 

  24. Meek RM, Allan DB, McPhillips G, Kerr L, Howie CR (2008) Late dislocation after total hip arthroplasty. Clin Med Res 6:17–23

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. von Knoch M, Berry DJ, Harmsen WS, Morrey BF (2002) Late dislocation after total hip arthroplasty. J Bone Joint Surg Am 84-A:1949–1953

    Google Scholar 

  26. Wallner O, Stark A, Muren O, Eisler T, Sköldenberg O (2015) Unstable hip arthroplasties. A prospective cohort study on seventy dislocating hips followed up for four years. Int Orthop 39:1037–1044

    Article  PubMed  Google Scholar 

  27. Ali Khan MA, Brakenbury PH, Reynolds IS (1981) Dislocation following total hip replacement. J Bone Joint Surg (Br) 63-B:214–218

    CAS  Google Scholar 

  28. Cebatorius A, Robertsson O, Stucinskas J, Smailys A, Leonas L, Tarasevicius S (2015) Choice of approach, but not femoral head size, affects revision rate due to dislocations in THA after femoral neck fracture: results from the Lithuanian arthroplasty register. Int Orthop 39:1073–1076

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (No. 15 K10450). We thank Junji Kishimoto, a statistician from the Digital Medicine Initiative, Kyushu University, for his valuable comments and suggestions with regards to the statistical analysis. The authors certify that they have no commercial associations that might pose a conflict of interest in connection with the submitted article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yasuharu Nakashima.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshimoto, K., Nakashima, Y., Yamamoto, T. et al. Dislocation and its recurrence after revision total hip arthroplasty. International Orthopaedics (SICOT) 40, 1625–1630 (2016). https://doi.org/10.1007/s00264-015-3020-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-3020-3

Keywords

Navigation