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Related Experiment Video

Updated: May 10, 2026

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Dislocation Risk in Modern Total Hip Arthroplasty: Comparing Surgical Approaches With and Without Enabling

Aymen Alqazzaz1, Angela T Chen2, Weston E Smith2

  • 1Department of Orthopaedic Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.

The Journal of Arthroplasty
|May 8, 2026
PubMed
Summary

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Total hip arthroplasty (THA) complication rates were low across different surgical approaches and technologies. While direct anterior navigation showed a trend toward fewer dislocations, no significant differences were found between groups.

Area of Science:

  • Orthopedic Surgery
  • Arthroplasty Research
  • Surgical Technology

Background:

  • Dislocation is a frequent complication after total hip arthroplasty (THA).
  • The combined influence of surgical approach and enabling technologies on THA dislocation risk is not well understood.
  • This study investigates dislocation, periprosthetic fracture, and revision rates across different THA approaches and technology utilizations.

Purpose of the Study:

  • To compare complication rates, specifically dislocation, periprosthetic fracture, and revision, among distinct total hip arthroplasty (THA) cohorts.
  • To evaluate the impact of surgical approach (posterior vs. direct anterior) and technology (conventional, navigation, robotic) on THA outcomes.
  • To identify factors influencing dislocation risk in primary THA.

Main Methods:

Keywords:
computer navigationdirect anterior approachdislocationposterior approachrobotic-assisted surgerytotal hip arthroplasty

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  • Retrospective cohort study of 3,243 primary THAs performed between May 2013 and December 2023.
  • Patients were stratified into four groups: posterior approach-conventional, direct anterior approach-conventional fluoroscopy, direct anterior approach-navigation, and posterior approach-robotic.
  • Multivariable logistic regression analysis was employed to adjust for baseline differences, with a mean follow-up of 1.4 years.

Main Results:

  • Overall complication rates were low: dislocation (1.0%), periprosthetic fracture (2.2%), and revision (3.2%).
  • Dislocation rates varied numerically across cohorts (PA-conventional 1.2%, DA-fluoroscopy 0.7%, DA-navigation 0.3%, PA-robotic 2.7%), but differences were not statistically significant (P = 0.09).
  • Active tobacco use was a significant predictor of increased dislocation risk (OR 6.31, P < 0.001).

Conclusions:

  • Various surgical approaches and technology platforms yield excellent early outcomes with low complication rates in experienced surgeons' hands.
  • While direct anterior navigation showed a numerically lower dislocation rate (0.3%), this difference did not reach statistical significance.
  • Larger, prospective studies are necessary to definitively ascertain the clinical benefits of enabling technologies in THA.