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Evaluation of Dislocation Risk Factors With Total Hip Arthroplasty in Developmental Hip Dysplasia Patients: A
Cem Yetkin1, Timur Yildirim2, Yakup Alpay3
1Department of Orthopedics, Çan State Hospital, Çanakkale, Turkey.
Insights
Previous hip surgery and diabetes mellitus increase dislocation risk after total hip arthroplasty for developmental dysplasia of the hip (DDH). Accurate implant positioning and larger femoral heads are crucial for prevention.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Developmental dysplasia of the hip (DDH) is a common condition requiring total hip arthroplasty (THA).
- Dislocation is a significant complication following THA in DDH patients, impacting outcomes.
Purpose of the Study:
- To identify risk factors associated with hip dislocation after THA in patients with DDH.
- To inform strategies for preventing dislocation in this patient population.
Main Methods:
- Retrospective review of 40 patients with dislocation post-THA for DDH, compared to 400 controls.
- Analysis of patient, surgical, and implant-related factors using multivariate logistic regression.
Main Results:
- Diabetes mellitus (DM) and prior hip surgery for DDH were significant risk factors for dislocation.
- Subtrochanteric shortening osteotomy, acetabular inclination/anteversion, femoral head size, and postoperative infection were associated with dislocation.
- Key predictors included previous hip surgery (OR 6.76), high hip center (OR 2.90), DM (OR 2.68), and acetabular inclination (OR 2.62).
Conclusions:
- Patients with DM and a history of hip surgery require counseling on elevated dislocation risks.
- Restoring the native hip center, utilizing larger femoral head sizes, and precise acetabular component positioning are vital for preventing dislocation.
Background:
This study aimed to investigate the risk factors for dislocation in patients diagnosed with developmental dysplasia of the hip (DDH) who underwent total hip arthroplasty.
Methods:
We retrospectively reviewed 40 patients who developed dislocation and compared them with 400 patients in the control group without hip instability. Patients-, surgery-, and implant-related factors were investigated. Risk factors were evaluated using multivariate logistic regression.
Results:
The mean follow-up period was 32.3 months. The mean time to dislocation was 4.4 months. There were 7 men (17.5%) and 33 women (82.5%) in the dislocation group and 83 men (20.7%) and 317 women (79.3%) in the control group (P = .627). Diabetes mellitus (DM; P = .032) and history of previous hip surgery for DDH were associated with dislocation (P < .001). The subtrochanteric shortening osteotomy (P = .001), acetabular inclination (P = .037), acetabular anteversion (P < .001), femoral head size (P < .001), and postoperative infection (P = .003) were associated with dislocation. Major predictors of hip dislocation after total hip arthroplasty in patients with DDH were previous hip surgery (odds ratio [OR], 6.76; 95% confidence interval [CI], 1.86-24.6; P = .004), high hip center (OR, 2.90; 95% CI, 1.31-6.38; P = .008), DM (OR, 2.68; 95% CI, 1.06-6.80; P = .037), and acetabular inclination (OR, 2.62; 95% CI, 1.09-6.26; P = .03).
Conclusion:
Patients with DM and previous hip surgery should be informed about increased dislocation rates. Using a larger head diameter and restoration of the true hip rotation center are essential to prevent hip dislocation in these patients. Furthermore, accurate positioning of the acetabular inclination and anteversion are also important.
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