To evaluate risk factors for early dislocation after primary total hip arthroplasty (THA).
Methods.
Records of 175 cases with dislocation during hospitalisation after THA and 651 controls without dislocation were reviewed. Cases and controls were matched for age, gender, body mass index classification, primary diagnosis, cup design, hospital, and year of intervention. Version and inclination of the acetabular component and version of the femoral component were assessed intra- and post-operatively. Various risk factors were analysed, including surgical approach, cup positioning, combined cup and stem positioning, and femoral head size.
Results.
The posterior approach was 6 fold more prone to dislocation (odds ratio [OR]=6.3, p<0.018) than the anterolateral or straight lateral approach. With regard to combined cup and stem positioning, the acceptable position was at significantly higher risk of dislocation than the ideal position (OR=2.59, p=0.033). Larger femoral head sizes were associated with significantly lower risk of dislocation (OR=0.84, p=0.02).
Conclusion.
Surgical approach, combined cup and stem positioning, and femoral head size were significant risk factors for dislocation during hospitalisation.
KluessDMartinHMittelmeierWSchmitzKPBaderR. Influence of femoral head size on impingement, dislocation and stress distribution in total hip replacement. Med Eng Phys2007;29:465–71.
2.
BerryDJvon KnochMSchleckCDHarmsenWS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am2004;86:9–14.
3.
LewinnekGELewisJLTarrRCompereCLZimmermanJR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am1978;60:217–20.
4.
ElkeR. What modifies the stability of an artificial joint? [in German]. Praxis (Bern 1994)1998;87:459–60.
5.
HedlundhUFredinH. Patient characteristics in dislocations after primary total hip arthroplasty. 60 patients compared with a control group. Acta Orthop Scand1995;66:225–8.
6.
HedlundhUHybbinetteCHFredinH. Influence of surgical approach on dislocations after Charnley hip arthroplasty. J Arthroplasty1995;10:609–14.
7.
HedlundhUAhnfeltLFredinH. Incidence of dislocation after hip arthroplasty. Comparison of different registration methods in 408 cases. Acta Orthop Scand1992;63:403–6.
8.
HedlundhUAhnfeltLHybbinetteCHWallinderLWeckstromJFredinH. Dislocations and the femoral head size in primary total hip arthroplasty. Clin Orthop Relat Res1996;333:226–33.
9.
WoolsonSTRahimtoolaZO. Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplasty1999;14:662–8.
10.
SoongMRubashHEMacaulayW. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg2004;12:314–21.
11.
JollesBMZanggerPLeyvrazPF. Factors predisposing to dislocation after primary total hip arthroplasty: A multivariate analysis. J Arthroplasty2002;17:282–8.
12.
KhanMA AliBrakenburyPHReynoldsIS. Dislocation following total hip replacement. J Bone Joint Surg Br1981;63:214–8.
13.
BarrackRL. Dislocation after total hip arthroplasty: Implant design and orientation. J Am Acad Orthop Surg2003;11:89–99.
14.
NadzadiMEPedersenDRYackHJCallaghanJJBrownTD. Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation. J Biomech2003;36:577–91.
15.
MaruyamaMFeinbergJRCapelloWND'AntonioJA. The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: Anteversion angle and implant positioning. Clin Orthop Relat Res2001;393:52–65.
16.
GrossmannPBraunMBeckerW. Dislocation following total hip endoprosthesis. Association with surgical approach and other factors [in German]. Z Orthop Ihre Grenzgeb1994;132:521–6.
17.
KerschbaumerFKerschbaumerGDeghaniF. Is a dorsal access associated with an elevated luxation rate following total hip replacement? [in German]. Orthopade2007;36:928–34.
18.
HummelMTMalkaniALYakkantiMRBakerDL. Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplasty2009;24(6 Suppl):S73–6.
19.
KonanSRheeSJHaddadFS. Total hip arthroplasty for displaced fracture of the femoral neck using size 32 mm femoral head and soft tissue repair after a posterior approach. Hip Int2009;19:30–5.
20.
StahelinTViennePHerscheO. Failure of reinserted short external rotator muscles after total hip arthroplasty. J Arthroplasty2002;17:604–7.
21.
PfirrmannCWNotzliHPDoraCHodlerJZanettiM. Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology2005;235:969–76.
22.
SierraRJRaposoJMTrousdaleRTCabanelaME. Dislocation of primary THA done through a posterolateral approach in the elderly. Clin Orthop Relat Res2005;441:262–7.
23.
AlbertonGMHighWAMorreyBF. Dislocation after revision total hip arthroplasty: An analysis of risk factors and treatment options. J Bone Joint Surg Am2002;84:1788–92.
24.
LachiewiczPFSoileauEEllisJ. Modular revision for recurrent dislocation of primary or revision total hip arthroplasty. J Arthroplasty2004;19:424–9.
25.
BiedermannRToninAKrismerMRachbauerFEiblGStocklB. Reducing the risk of dislocation after total hip arthroplasty: The effect of orientation of the acetabular component. J Bone Joint Surg Br2005;87:762–9.
26.
GiureaAZehetgruberHFunovicsPGramppSKaramatLGottsauner-WolfF. Risk factors for dislocation of a cementless total hip endoprosthesis—a statistical analysis [in German]. Z Orthop Ihre Grenzgeb2001;139:194–9.
27.
van StralenGMStrubenPJvan LoonCJ. The incidence of dislocation after primary total hip arthroplasty using posterior approach with posterior soft-tissue repair. Arch Orthop Trauma Surg2003;123:219–22.
28.
BurroughsBRHallstromBGolladayGJHoeffelDHarrisWH. Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes. J Arthroplasty2005;20:11–9.
29.
YuanLShihC. Dislocation after total hip arthroplasty. Arch Orthop Trauma Surg1999;119:263–6.
30.
BaderRSteinhauserEGradingerRWillmannGMittelmeierW. Computer-based motion simulation of total hip prostheses with ceramic-on-ceramic wear couple. Analysis of implant design and orientation as influence parameters [in German]. Z Orthop Ihre Grenzgeb2002;140:310–6.
31.
ClaytonMLThirupathiRG. Dislocation following total hip arthroplasty. Management by special brace in selected patients. Clin Orthop Relat Res1983;177:154–9.
