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Dislocation following total hip replacement

M A Ali Khan, P H Brakenbury, I S Reynolds

The Journal of Bone and Joint Surgery. British Volume

|January 1, 1981

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Total hip replacement dislocation occurs in 2.1% of cases. Surgical errors, particularly acetabular cup placement, are common causes, necessitating mechanical correction for successful treatment.

Area of Science:

Orthopedic Surgery
Biomedical Engineering

Background:

Total hip replacement (THR) is a common procedure to alleviate hip pain and improve function.
Dislocation remains a significant complication following THR, impacting patient outcomes and healthcare costs.

Purpose of the Study:

To analyze the incidence, risk factors, and treatment outcomes of dislocation after total hip replacement.
To identify common surgical errors contributing to THR dislocations and evaluate their impact on stability.

Main Methods:

Retrospective analysis of 142 dislocations from a multicentre study involving 6774 total hip replacements.
Categorization of dislocations based on timing (early/late), recurrence (single/recurrent), and patient-specific risk factors.
Evaluation of treatment strategies, including manipulation and open reduction, and their success rates.

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Main Results:

The overall incidence of dislocation was 2.1%.
Patients with neuromuscular disorders, confusion, or undergoing revision surgery were at higher risk.
Incorrect acetabular cup placement (too vertical or anteverted) was the most frequent surgical error, found in nearly half of the cases.
Femoral component malposition was a less common error.
Overall, 78.2% of patients achieved stability, with 62% of single dislocations resolving after one manipulation.
Thirty-four percent of patients required open surgery for stability.

Conclusions:

Surgical technique, particularly accurate acetabular component positioning, is crucial in preventing total hip replacement dislocations.
Addressing mechanical faults during revision surgery is essential for achieving long-term stability.
While non-operative management can be successful for some dislocations, surgical correction of malpositioning is often required.