Skip to main content
SpringerLink
Log in

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.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2A–B

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. Biviji AA, Ezzet KA, Pulido P, Colwell CW Jr. Modular femoral head and liner exchange for the unstable total hip arthroplasty. J Arthroplasty. 2009;24:625–630.

    Article  PubMed  Google Scholar 

  3. Carter AH, Sheehan EC, Mortazavi SM, Purtill JJ, Sharkey PF, Parvizi J. Revision for recurrent instability: what are the predictors of failure? J Arthroplasty. 2011;26(6 suppl):46–52.

    Article  PubMed  Google Scholar 

  4. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Della Valle CJ, Paprosky WG. The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res. 2004;420:55–62.

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  8. Garbuz DS, Masri BA, Duncan CP, Greidanus NV, Bohm ER, Petrak MJ, Della Valle CJ, Gross AE. 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. 2012;470:351–356.

    Article  PubMed  Google Scholar 

  9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    PubMed  CAS  Google Scholar 

  10. Kaplan SJ, Thomas WH, Poss R. Trochanteric advancement for recurrent dislocation after total hip arthroplasty. J Arthroplasty. 1987;2:119–124.

    Article  PubMed  CAS  Google Scholar 

  11. Kavanagh BF, Ilstrup DM, Fitzgerald RH. Revision total hip arthroplasty. J Bone Joint Surg Am. 1985;67:517–526.

    PubMed  CAS  Google Scholar 

  12. 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 

  13. 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 

  14. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.

    Article  PubMed  Google Scholar 

  15. Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. J Bone Joint Surg Am. 2003;85:27–32.

    PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  17. Murray TG, Wetters NG, Moric M, Sporer SM, Paprosky WG, Della Valle CJ. The Use of Abduction Bracing for Early Postoperative Dislocation Prevention Following Revision Total Hip Arthroplasty. J Arthroplasty. 2012 May 17 [Epub ahead of print].

  18. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow-up evaluation. J Arthroplasty. 1994;9:33–44.

    Article  PubMed  CAS  Google Scholar 

  19. Saadat E, Diekmann G, Takemoto S, Ries MD. Is an algorithmic approach to the treatment of recurrent dislocation after THA effective? Clin Orthop Relat Res. 2012;470:482–489.

    Article  PubMed  Google Scholar 

  20. Sah AP, Estok DM 2nd. Dislocation rate after conversion from hip hemiarthroplasty to total hip arthroplasty. J Bone Joint Surg Am. 2008;90:506–516.

    Article  PubMed  Google Scholar 

  21. Springer BD, Fehring TK, Griffin WL, Odum SM, Masonis JL. Why revision total hip arthroplasty fails. Clin Orthop Relat Res. 2009;467:166–173.

    Article  PubMed  Google Scholar 

  22. 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 

  23. Weiss RJ, Beckman MO, Enocson A, Schmalholz A, Stark A. Minimum 5-year follow-up of a cementless, modular, tapered stem in hip revision arthroplasty. J Arthroplasty. 2011;26:16–23.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA

    Nathan G. Wetters BS, Mario Moric MS, Scott M. Sporer MD, Wayne G. Paprosky MD & Craig J. Della Valle MD

  2. Department of Orthopaedics, Cleveland Clinic, Cleveland, OH, USA

    Trevor G. Murray MD

Authors
  1. Nathan G. Wetters BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trevor G. Murray MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario Moric MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scott M. Sporer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wayne G. Paprosky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Craig J. Della Valle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

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

Keywords

Search

Navigation