Dislocation After Total Hip Arthroplasty: A Randomized Clinical Trial of a Posterior Approach and a Modified Lateral Approach

Ji, Hyung-Min; Kim, Ki-Choul; Lee, Yong Seuk; Ha, Yong‐Chan; Koo, Kyung‐Hoi

doi:10.1016/j.arth.2011.06.007

Cited by 82 publications

(60 citation statements)

References 26 publications

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“…Additionally, there is an increased prevalence of osteoporosis in patients with RA (44), which may increase the risk of fractures and dislocations. There may also be a systematic difference in surgical approach between types of arthritis that accounts for our results (45)(46)(47). Finally, increased susceptibility to dislocation in patients with RA may result from poorer soft tissue quality than that in patients with OA (48), resulting in suboptimal hip abductor strength and soft tissue laxity postoperatively (49).…”

Section: Discussionmentioning

confidence: 90%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

169

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Objective. Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.Methods. In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2-year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).Results. We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex-standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex-standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio [HR] 1.91, P ‫؍‬ 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P ‫؍‬ 0.03) relative to recipients with OA.Conclusion. Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.

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Section: Discussionmentioning

confidence: 90%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

169

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“…However, the proposed enhanced risk of dislocation associated with posterior approaches has been questioned. A randomized trial comparing a lateral approach and a posterior approach combined with repair of posterior capsule and external rotators found a higher dislocation rate in the group with THAs inserted using a lateral approach (Ji et al 2012). …”

Section: Discussionmentioning

confidence: 99%

“…Various diagnoses such as femoral neck fracture (Conroy et al 2008), the posterior approach to the joint, and small femoral head size of the prosthesis are parameters that have been identified as risk factors for dislocation (Furnes et al 2001, Bystrom et al 2003, Berry et al 2005, Lachiewicz and Soileau 2006, Enocson et al 2009b, Sariali et al 2009, Ji et al 2012). …”

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confidence: 99%

The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis

Hailer¹,

Weiss²,

Stark³

et al. 2012

Acta Orthopaedica

231

168

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Background and purpose The effects of patient-related and technical factors on the risk of revision due to dislocation after primary total hip arthroplasty (THA) are only partly understood. We hypothesized that increasing the femoral head size can reduce this risk, that the lateral surgical approach is associated with a lower risk than the posterior and minimally invasive approaches, and that gender and diagnosis influence the risk of revision due to dislocation.Patients and methods Data on 78,098 THAs in 61,743 patients performed between 2005 and 2010 were extracted from the Swedish Hip Arthroplasty Register. Inclusion criteria were a head size of 22, 28, 32, or 36 mm, or the use of a dual-mobility cup. The covariates age, sex, primary diagnosis, type of surgical approach, and head size were entered into Cox proportional hazards models in order to calculate the adjusted relative risk (RR) of revision due to dislocation, with 95% confidence intervals (CI).Results After a mean follow-up of 2.7 (0–6) years, 399 hips (0.5%) had been revised due to dislocation. The use of 22-mm femoral heads resulted in a higher risk of revision than the use of 28-mm heads (RR = 2.0, CI: 1.2–3.3). Only 1 of 287 dual-mobility cups had been revised due to dislocation. Compared with the direct lateral approach, minimally invasive approaches were associated with a higher risk of revision due to dislocation (RR = 4.2, CI: 2.3–7.7), as were posterior approaches (RR = 1.3, CI: 1.1–1.7). An increased risk of revision due to dislocation was found for the diagnoses femoral neck fracture (RR = 3.9, CI: 3.1–5.0) and osteonecrosis of the femoral head (RR = 3.7, CI: 2.5–5.5), whereas women were at lower risk than men (RR = 0.8, CI: 0.7–1.0). Restriction of the analysis to the first 6 months after the index procedure gave similar risk estimates.Interpretation Patients with femoral neck fracture or osteonecrosis of the femoral head are at higher risk of dislocation. Use of the minimally invasive and posterior approaches also increases this risk, and we raise the question of whether patients belonging to risk groups should be operated using lateral approaches. The use of femoral head diameters above 28 mm or of dual-mobility cups reduced this risk in a clinically relevant manner, but this observation was not statistically significant.

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“…Twenty-eight millimeter heads were used in seven hips and 32 mm were used in three hips. For the posterior approach, the posterior capsular flap and the external rotator tendons were repaired using the technique described by Ji et al [19]. After removal of the drain 2 or 3 days postoperatively, the patients were encouraged to walk with toe-touch weightbearing using two crutches for 6 weeks and then were allowed weightbearing as tolerated.…”

Section: Methodsmentioning

confidence: 99%

Total Hip Arthroplasty Performed in Patients with Residual Poliomyelitis: Does it Work?

Yoon

Lee

Yoo

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Patients with residual poliomyelitis can have advanced degenerative arthritis of the hip in the paralytic limb or the nonparalytic contralateral limb. Although THA is a treatment option for some of these patients, there are few studies regarding THA in this patient population. Questions/purposes We therefore reviewed a group of patients with residual poliomyelitis who underwent cementless THA on either their paralytic limb or nonparalytic limb to assess (1) Harris hip scores, (2) radiographic results, including implant loosening, (3) complications, including dislocation, and (4) limb length discrepancy after recovery from surgery. Methods

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Dislocation After Total Hip Arthroplasty: A Randomized Clinical Trial of a Posterior Approach and a Modified Lateral Approach

Cited by 82 publications

References 26 publications

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis

Total Hip Arthroplasty Performed in Patients with Residual Poliomyelitis: Does it Work?

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