Instability following total hip arthroplasty

Dislocation is the second most common complication of total hip arthroplasty. Most dislocations occur early in the postoperative period and are caused by patient factors, surgical factors, or a combination of both. Patient factors that predispose to postoperative dislocation include previous surgery and neurologic impairment. Surgical factors include surgical approach, component orientation, and prosthetic and/or bony impingement. Evaluation of patients undergoing total hip arthroplasty requires a thorough history and physical examination, as well as a detailed radiographic assessment. Closed treatment of instability is successful in two thirds of cases; the remainder require surgical management. Surgical techniques used to treat or minimize risk of further dislocation include revision arthroplasty, trochanteric advancement, use of elevated rim liners, and use of constrained liners.