Dislocation following total hip arthroplasty. Management by special brace in selected patients

Dislocation after total hip arthroplasty (THA) occurs in 1%-3% of the cases reported in the literature. Recurrent dislocations due to malpositioned components should be treated by revision arthroplasty. Dislocated hips that have optimally positioned components but weak abductors can be treated by a special brace that prevents extremes of flexion, adduction, and rotation. Two hundred and eighty-nine total hip arthroplasties were performed from 1975 to 1981. Nine patients, all of whom had optimal position of components and the brace treatment, had dislocations. In one patient who had a spastic muscle disorder the brace was used as prophylaxis. The short chair-back brace has a lateral joint with thigh cuff. The joint can be locked at a particular position to give the desired movement of the hip joint. The brace, applied after the second dislocation, is worn for six to nine months. Excellent results were obtained in nine patients. One patient is still using the brace. The brace is light and can be worn under normal clothing; ordinary activities are easily performed by patients wearing the brace. Patients should be trained to avoid positions and activities that predispose to dislocation.