Total hip arthroplasty instability in Italy

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Hip dislocation is a frequent complication following total hip arthroplasty (THA).
• Incidence ranges from 0.3% to 10% in primary THA and up to 28% in revision THA.
• Dislocations are categorized as early, intermediate, or late, with non-operative treatment successful in about two-thirds of cases.

Purpose of the Study:

• To outline an evaluation and treatment strategy for hip dislocations after THA.
• To identify factors contributing to THA dislocation and discuss management options.
• To emphasize the importance of prevention in managing recurrent hip dislocations.

Main Methods:

• Thorough evaluation to identify causes of dislocation.
• Closed reduction of the dislocated implant.
• Computed tomography (CT) scan post-reduction to assess surgical options.
• Review of surgical techniques and implant choices for recurrent dislocations.

Main Results:

• Non-operative treatment is effective for approximately two-thirds of hip dislocations.
• Surgical interventions for recurrent dislocations include revision arthroplasty, modular component exchange, dual-mobility cups, larger femoral heads, constrained cups, impingement elimination, and soft tissue procedures.
• Accurate diagnosis and appropriate management are crucial to avoid further dislocations.

Conclusions:

• Preventing recurrent hip dislocation after THA is paramount to minimize further surgical interventions.
• A systematic approach, including thorough evaluation and tailored treatment strategies, is essential.
• While treatment algorithms exist, prevention remains the most effective goal.