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Dislocation: incidence after THR

Josephine

NURSE DIRECTOR EMERITUS
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Dislocation Following Total Hip Replacement: The Avon Orthopaedic Centre Experience
by Ashley W Blom, Mark Rogers, Adrian H Taylor, Giles Pattison, Sarah Whitehouse, and Gordon C Bannister
LINK

The aim of this study was to determine the incidence and outcome of dislocation after total hip arthroplasty at our unit.
Of the 1567 primary total hip arthroplasties,
555 were performed through a posterior approach,
120 through an Omega approach and
892 through a modified Hardinge approach.

The dislocation rates by approach were
23 out of 555 (4.1%) for the posterior approach,
0 out of 120 (0%) for the Omega approach and
30 out of 892 (3.4%) for the modified Hardinge approach.


(NB note that the 0 dislocations from the Omega approach is probably due to there being so small a number included in the study. Both Omega and Hardinge are varieties of lateral approaches)

See also THR approaches or incisions
 
OP
OP
Josephine

Josephine

NURSE DIRECTOR EMERITUS
Nurse Director
Joined
Jun 8, 2007
Messages
84,940
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Dislocation following THR. Dr William Barret
LINK

The dislocation rate in the first six months following a hip replacement decreased over time. The dislocation rate in 1997 was 4.1%, this decreased to 2.9% in 2006. This decrease is due in part to the use of larger heads in total hip replacement, which improve stability and decreased the risk of dislocation. It was also found that surgeons with lower volume of total hip replacement had an increased risk of their patients dislocating their hip. Patients who had associated medical problems had an increased risk of dislocation.

Strategies to decrease dislocation following total hip replacement include
~ maximizing the patient’s health
~ going to a hospital that does a high volume of total hip replacements
~ utilizing a surgeon who likewise performs a significant number of joint replacements per year.

Variations in dislocation rate, based on approach, have also been noted with a lower dislocation rate with an anterior approach.



Another article The unstable total hip replacement Indian J Orthop. 2008 Jul-Sep; 42(3): 252–259.

The definition of THA dislocation is complete loss of contact between the femoral head and acetabular component that requires intervention for reduction. Subluxation is usually considered a transient and incomplete loss of contact that self-reduces. Dislocation may occur early or late. Early dislocation occurs in the first three months postoperatively and has a lower rate of recurrence with better prognosis.6 Late dislocation can occur after several years of implantation and could be considered as a distinct pathologic entity with multifactorial etiology including polyethylene wear, soft-tissue laxity, neurological decline and eventually trauma.7 Dislocation can be single or recurrent: more than two dislocations are defined as recurrent.

Body weight doesn't seem to be a risk factor for dislocation.
On the other hand, a tall patient may be at risk because of the longer lever arm of the legs that generates a relative ease of translation of femoral head
Surgical approach is probably one of the most controversial factors that influence hip stability after THA. Woo and Morrey reported a dislocation rate of 5.8% for the posterior approach and only 2.3% for anterolateral approach
As a consequence many authors suggested that a meticulous posterior capsular repair could decrease the dislocation rates to comparable levels to other approaches.
Component orientation is a very important factor affecting the stability of an implant


 

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