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Prior Instability is Strongly Associated With Dislocation After Isolated Head and Liner Exchange
Elyse J Berlinberg1, Mackenzie A Roof1, Ittai Shichman1
1New York University Langone Health, Department of Orthopaedic Surgery, New York, New York.
The Journal of Arthroplasty
|July 5, 2022
Summary
Patients with a history of hip instability undergoing head and liner exchange face significantly higher risks of postoperative dislocation. This finding is crucial for managing revision total hip arthroplasty patients and preventing instability after hip surgery.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Biomedical Engineering
Background:
- Isolated head and liner exchange is a viable option for revision total hip arthroplasty (THA) when components are well-fixed.
- However, limited component revision may increase the risk of postoperative instability, despite efforts to optimize femoral offset and soft tissue tension.
Purpose of the Study:
- To assess the risk factors for postoperative dislocation after isolated head and liner exchange in THA.
- To identify patient characteristics and surgical factors associated with instability following this revision procedure.
Main Methods:
- A retrospective analysis of 209 patients undergoing head and liner exchange between 2011 and 2019 was performed.
- Postoperative cup positioning was evaluated using the Lewinnek safe zone on radiographs.
- Patient demographics, indications for surgery, and dislocation events were recorded and analyzed.
Main Results:
- Twenty-eight hips (13%) experienced dislocation within two years post-surgery.
- A history of dislocation was the strongest predictor, increasing the odds of re-dislocation by 5.67 times (P < .001).
- Increased age and body mass index were also associated with higher dislocation risk.
Conclusions:
- Patients with prior instability have a significantly elevated risk (7-fold odds) of dislocation after isolated head and liner exchange.
- This increased risk persists even when accounting for various surgical and patient factors.
- Preoperative instability is a critical factor to consider in the management of revision THA.
