Revision for recurrent dislocation of total hip replacement.

Area of Science:

• Orthopedic Surgery
• Arthroplasty Research
• Biomechanical Engineering

Background:

• Dislocation is a frequent complication of total hip arthroplasty (THA), with incidence rates ranging from 0.5% to 9.2%.
• Limited understanding exists regarding the effectiveness of various treatment strategies for THA dislocations.
• Recurrent dislocations necessitate revision surgery, impacting patient outcomes and healthcare resources.

Purpose of the Study:

• To determine the optimal surgical strategy for managing recurrent dislocations following total hip arthroplasty (THA).
• To evaluate the influence of the initial surgical approach (transgluteal vs. posterior) on revision outcomes.
• To assess the impact of dislocation direction (anterior vs. posterior) on the success of operative management.

Main Methods:

• A retrospective review of 70 patients undergoing revision surgery for recurrent THA dislocation.
• Categorization of patients based on the primary surgical approach: 38 transgluteal (Hardinge) and 32 posterior.
• Data collection included the initial surgical approach, direction of dislocation, and the revision strategy employed.

Main Results:

• Overall stability was achieved in 75% of primary THA dislocations and 50% of revision THA dislocations.
• Anterior dislocations were more common after the transgluteal approach (77%), while posterior dislocations predominated after the posterior approach (88%).
• Cup augmentation demonstrated the highest success rate, achieving stability in 90% of cases.

Conclusions:

• Revision surgery for instability after primary THA has a higher success rate (75%) compared to revision THA (50%).
• Posterior dislocations are more successfully treated than anterior dislocations, despite a potentially higher initial risk.
• The effectiveness of revision for THA instability is contingent upon the initial surgical approach and the specific direction of dislocation.