Total Hip Replacement Dislocation
Original Editor - User Name
Top Contributors - Lucinda hampton and Kim Jackson
Introduction[edit | edit source]
Total hip replacement (THR) dislocation is a complication of THR usually occurring due to patient noncomplicance with post-operative precautions, implant malposition, or soft-tissue deficiency. This type of dislocation normally caused by minimal trauma, usually falls or turning, moving into the contra-indicated positions, and putting stress on the capsule that was cut to do the replacement surgery.[1][2]
Diagnosis is with plain x-rays of the hip. CT of the pelvis assists with assessing for implant malpositioning.
Treatment is closed reduction of the hip. Surgical management with possible revision THA is advisable for irreducible dislocations, recurrent instability, and implant malposition.[2]
Roughly 66% of cases are successfully treated; one third of cases will require surgical treatment (including revision arthroplasty with use of constrained liners, elevated rim liners or dual mobility implants or trochanteric advancement)[3].
Epidemiology[edit | edit source]
Incidence: 1-3% with 70% occur within first month and 75-90% being posterior dislocations.[2]
Risk Factors[edit | edit source]
Following a THR the normal hip anatomy and support structures is altered. This violation may cause a decrease in the amount of inherent/anatomic force that assists in maintaining the femoral head within the acetabulum. Consequently the amount of energy necessary for a dislocation to occur is reduced. Significant risk factors mechanically predisposing individuals with THRs to dislocation include:
- Surgical approach used, for example, anterior or posterior
- King of prosthesis (hemi or total arthroplasty)
- Previous hip surgery
- Female
- Malposition of the prosthesis during surgery
- Drug/alcohol abuse
- Neuromuscular disease for example Parkinson, Demetia. [4]
- Polyethylene wear, a common cause of late instability occurring >5 years after surgery.[2]
Presentation[edit | edit source]
Typically the dislocation include falls, bending down to tie one's shoes, sitting on a low/short chair then trying to stand, or sitting, standing, or lying down with crossed legs.[4]
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References[edit | edit source]
- ↑ Radiopedia Hip dislocation Availablehttps://radiopaedia.org/articles/hip-dislocation (accessed 7.1.2023)
- ↑ 2.0 2.1 2.2 2.3 Orthobullets THA Dislocation Available:https:https://www.orthobullets.com/recon/5012/tha-dislocation (accessed 7.1.2023)
- ↑ Lu Y, Xiao H, Xue F. Causes of and treatment options for dislocation following total hip arthroplasty. Experimental and Therapeutic Medicine. 2019 Sep 1;18(3):1715-22.Available:https://pubmed.ncbi.nlm.nih.gov/31410129/ (accessed 7.1.2023)
- ↑ 4.0 4.1 Masiewicz S, Mabrouk A, Johnson DE. Posterior hip dislocation.Available:https://www.ncbi.nlm.nih.gov/books/NBK459319/ (accessed 7.1.2023)
