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Published on: February 27, 2018
Dislocation after revision of hemiarthroplasty to total hip replacement
L Miranda V Champion1, Scarlett A McNally
1Department of Orthopaedics, Eastbourne District General Hospital, Kings Drive, BN21 2UD, Eastbourne, UK.
Insights
Revision of hip hemiarthroplasty to total hip arthroplasty resulted in a high 50% dislocation rate. Patient factors and surgical techniques are crucial for preventing post-revision hip instability.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Biomedical Engineering
Background:
- Hemiarthroplasty is a common procedure for subcapital hip fractures.
- Revision to total hip arthroplasty may be necessary due to complications.
- Instability and acetabular erosion are common indications for revision surgery.
Purpose of the Study:
- To evaluate the outcomes of revising hemiarthroplasty to total hip arthroplasty.
- To identify risk factors associated with post-revision instability.
- To discuss preventative strategies for improving outcomes.
Main Methods:
- A retrospective review of nine patients who underwent revision from hemiarthroplasty to total hip arthroplasty over three years.
- Analysis of indications for revision, including instability, loosening, and acetabular erosion.
- Assessment of post-revision dislocation and subluxation rates.
Main Results:
- Four out of nine revised hips (44.4%) dislocated post-operatively.
- One patient experienced recurrent subluxation, leading to a total instability rate of 50%.
- Identified contributing factors included previous strokes, advanced age, poor compliance, and a non-contracted hip capsule.
Conclusions:
- The 50% dislocation rate following hemiarthroplasty revision is significantly higher than previously reported.
- Specific patient populations require tailored management strategies.
- Preserving the hip capsule and considering prophylactic bracing are recommended preventative measures.
Abstract:
Over a 3-year period, nine hemiarthroplasties were revised to total hip arthroplasty. The hemiarthroplasties were all performed for an original diagnosis of subcapital fracture, and the revisions were for a variety of indications including instability, loosening and acetabular erosion. Four of the revised prostheses subsequently dislocated, and one has recurrent subluxation. This dislocation rate of 50% is higher than previously reported. Factors contributing to this are discussed. These include: previous strokes, advanced age, difficulty complying with instructions, and a hip capsule not contracted by osteoarthritis. Preventative factors are discussed. It is imperative to treat this group of patients differently from those having other hip arthroplasties, and to consider prophylactic bracing post-operatively. The capsule or pseudo-capsule should be preserved wherever possible.
