[Dislocation of total hip prostheses; risk factors and treatment]

Primary hip prostheses dislocate in 0.4 to 8.7% of the cases. Revision hip prostheses dislocate in 5 to 20% of the cases. High age, female sex, co-morbidity and alcoholism increase the risk of dislocation. The surgical approach of the hip and the experience of the surgeon are important factors in the operation technique. The anterior approach causes the least dislocations, but a disadvantage of this approach is that patients are more likely to walk with a limp afterwards. The selected implant also influences the dislocation risk. The smaller the head, the narrower the neck must be. Furthermore, the femur must not come to be too close to the pelvis. If necessary, a cup can be used with a raised anterior edge. Treatment of a primary dislocation is usually conservative and is based on providing the patient with guidelines. An abduction brace can be prescribed if a patient is not able or willing to comply with these rules. If dislocation is a recurring problem, revision of the prosthesis is often the only solution.