The dislocating hip: what to do, what to do.

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Dislocation is a significant complication following total hip arthroplasty (THA), affecting 1-3% of primary and 7-10% of revision procedures.
• A majority of dislocations (60%) occur within the initial 5 weeks post-surgery.
• While closed reduction is successful in 67% of cases, recurrent instability poses a challenge, with revision surgery for instability achieving only ~61% success.

Purpose of the Study:

• To review and discuss the efficacy of various surgical interventions for managing recurrent hip instability after THA.
• To present a treatment algorithm to guide clinical decision-making in these complex cases.

Main Methods:

• Review of existing literature on surgical techniques for THA instability.
• Discussion of outcomes for procedures such as trochanteric advancement, modular component exchange, jumbo femoral heads, bipolar/tripolar arthroplasty, and constrained acetabular components.
• Development of a treatment algorithm based on current evidence.

Main Results:

• Various surgical techniques demonstrate success in managing recurrent THA instability.
• Specific interventions like trochanteric advancement and the use of constrained acetabular components are noted for addressing instability.
• The article synthesizes results to inform treatment selection.

Conclusions:

• Recurrent instability after total hip arthroplasty requires tailored surgical management.
• A structured treatment algorithm can aid surgeons in selecting the most appropriate intervention for hip instability.
• Optimizing surgical technique and component selection is crucial for improving outcomes in revision THA.