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Updated: Jun 20, 2026
Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
The unstable total hip replacement
F D'Angelo1, L Murena, G Zatti
1Department of Orthopedics and Traumatology, University of Insubria, Varese - Italy. fabio.dangelo@uninsubria.it
Insights
Preventing total hip arthroplasty dislocation is key. Surgeons should consider patient and surgical risk factors, restoring leg length and offset, and using larger femoral heads for high-risk patients.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Total hip arthroplasty dislocation is a common complication with a persistent 3.2% rate.
- Despite advancements, the overall dislocation rate in hip replacement has not decreased.
Purpose of the Study:
- To review recent literature on total hip arthroplasty dislocation.
- To identify key risk factors and standardize treatment protocols for prosthetic hip dislocation.
Main Methods:
- Literature search of Medline database (1980-2007).
- Keywords: "hip dislocation", "hip instability".
- Inclusion criteria: English publications, clinical trials, and review papers.
Main Results:
- Dislocation risk is highest in the early months post-surgery but can occur years later.
- Identified risk factors include surgical approach, head diameter, impingement, component malposition, and abductor muscle insufficiency.
- Various treatment options exist, including bracing, component reorientation, and surgical interventions.
Conclusions:
- Preventing dislocation is the primary goal.
- Surgeons must assess patient and surgical risks, optimize leg length and femoral offset, and consider specific techniques for high-risk individuals.
- Patient education and postoperative care are crucial for managing dislocation risk.
Background:
Dislocation is one of the most common complications of total hip arthroplasty with a reported dislocation rate of 3.2%. Despite increased experience with hip replacement, the overall rate has not yet changed. The aim of this paper is to review the most recent literature published on this topic and indexed in Medline, in order to clarify the main risk factors, and to standardize a treatment protocol of such an important complication of prosthetic surgery.
Materials And Methods:
Medline database was searched using key words: "hip dislocation", "hip instability" from 1980-2007. Studies were eligible for review and included if they met the following criteria: (1) publication in English, (2) clinical trials (3) review papers.
Results:
The risk of first-time dislocation as a function of time after the surgery is not well understood. Most, but not all, series have demonstrated that the risk of dislocation is highest during the first few months after hip arthroplasty; however, first-time late dislocation can also occur many years after the procedure. Several risk factors were described, including the surgical approach, the diameter of the head, impingement, component malposition, insufficient abductor musculature. In addition, there are also many treatment options, such as long-term bracing after closed reduction, component reorientation, capsulorraphy, trochanteric advancement, increasing offset, exchange of the modular head and the polyethylene liner, insertion of constrained liner.
Conclusion:
Preventing hip dislocation is obviously the best strategy. Surgeons must take into account patient and surgical risk factors. For patients at high risk for dislocation the surgeon should accurately restore leg length and femoral offset; the use of larger femoral heads, posterior transosseous repair of the capsulotendinous envelope if posterior approach is chosen or the use of a lateral approach should be considered. Proper patient education and postoperative care are very important.
