Unstable total hip replacement: why? Clinical and radiological aspects

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering

Background:

• Total hip arthroplasty (THA) dislocation is the leading cause of revision surgery in the US.
• THA dislocation incurs significant economic costs due to readmissions and revisions.

Purpose of the Study:

• To identify clinical and radiological factors associated with unstable total hip replacements.
• To analyze patient-related, implant-related, and surgeon-related factors contributing to THA instability.

Main Methods:

• Conducted a literature search on PubMed to identify strategies for defining THA instability.
• Categorized identified characteristics into patient, implant, and surgeon experience factors.

Main Results:

• Patient factors include age, inflammatory disease, prior surgery, diagnosis, comorbidities, ASA score, spino-pelvic abnormalities, and neurological disability.
• Implant factors include surgical approach, component malposition, femoral head size, and use of dual-mobility or constrained components.
• Gender, simultaneous bilateral THA, and postoperative precautions do not impact dislocation rates; surgeon experience does.

Conclusions:

• THA dislocation is a significant complication arising from patient and/or surgical factors.
• Thorough patient and radiographic evaluation is crucial to determine instability causes.
• Adjusting reconstruction strategies based on identified factors is imperative to mitigate dislocation risk.