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Did the dislocation risk after primary total hip arthroplasty decrease over time? A meta-analysis across six decades.

J H J van Erp1,2,3, M F T Hüsken4,5, M D Filipe6

  • 1Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands. jverp@diakhuis.nl.

Archives of Orthopaedic and Trauma Surgery
|November 10, 2022
PubMed
Summary

The risk of dislocation after total hip arthroplasty (THA) has significantly decreased over recent decades, now standing at 0.7%. This meta-analysis highlights that real-world data from large registries may better reflect actual dislocation rates.

Keywords:
DislocationInstabiltyRCTRegistryTHATotal hip artroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biostatistics
  • Medical Device Research

Background:

  • Dislocation remains a significant complication following total hip arthroplasty (THA).
  • Continuous optimization efforts aim to reduce THA dislocation incidence.
  • This meta-analysis investigates the historical trends and publication bias of dislocation risk in THA.

Approach:

  • A systematic literature search was conducted across MEDLINE, Cochrane, and Embase databases (1962-2020).
  • Included studies reported dislocation risk and follow-up length, excluding those solely reporting revision rates.
  • Data quality was assessed, and dislocation rates were analyzed concerning time frame, study design, sample size, and follow-up duration.

Key Points:

  • 174 studies with moderate quality were analyzed, reporting 85,209 dislocations in 5,030,293 THAs (overall risk 1.7%).
  • Dislocation risk per decade decreased from 3.7% (1960s-1970s) to 0.7% (2010s-2020s).
  • No significant correlation was found between dislocation risk and follow-up duration or sample size, but registry studies reported higher risks.

Conclusions:

  • The incidence of dislocation after THA has demonstrably decreased over time.
  • Registry studies indicate a potentially higher real-world dislocation risk than selective cohorts or RCTs.
  • Findings suggest that large-scale cohort and registry data provide a more accurate reflection of actual THA dislocation rates.