Dislocation following total hip replacement

Brooks, Peter J.

doi:10.1302/0301-620x.95b11.32645

Cited by 132 publications

(94 citation statements)

References 3 publications

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“…Instability is one of the most common complications after primary THA, occurring in 0.3% to 10% of cases [9,25]. Prior studies distinguish between patient-related factors such as abductor weakness or neurologic deficits and technique-related risk factors [9,32,39].…”

Section: Discussionmentioning

confidence: 99%

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Abdel

Roth

Jennings

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40°± 10°a nd 15°± 10°, respectively, represent a ''safe zone'' as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate. Questions/purposes We sought to determine if these classic radiographic targets for cup inclination and anteversion accurately predicted a safe zone limiting dislocation in a contemporary THA practice.Methods From a cohort of 9784 primary THAs performed between 2003 and 2012 at one institution, we retrospectively identified 206 THAs (2%) that subsequently dislocated. Radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. Mean followup was 27 months (range, 0-133 months). Results The majority (58% [120 of 206]) of dislocated THAs had a socket within the Lewinnek safe zone. Mean cup inclination was 44°± 8°with 84% within the safe zone for inclination. Mean anteversion was 15°± 9°with 69% within the safe zone for anteversion. Sixty-five percent of dislocated THAs that were performed through a posterior approach had an acetabular component within the combined acetabular safe zones, whereas this was true for only 33% performed through an anterolateral approach. An acetabular component performed through a posterior approach was three times as likely to be within the combined acetabular safe zones (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) than after an anterolateral approach (OR, 0.4; 95% CI, 0.2-0.7; p \ 0.0001). In contrast, acetabular components performed through a posterior approach (OR, 1.6; 95% CI, 1.2-1.9) had an increased risk of dislocation compared with those performed through an anterolateral approach (OR, 0.8; 95% CI, 0.7-0.

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Section: Discussionmentioning

confidence: 99%

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Abdel

Roth

Jennings

et al. 2016

Clinical Orthopaedics &Amp; Related Research

500

301

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“…Most dislocations are thought to occur secondary to mechanical impingement [25] and much literature discusses dislocation secondary to femoral-neck-on-liner impingement with impingement damage shown on retrieval studies [14,27,28]. Elevated lip liners were first used by Charnley in the early 1970s to prevent posterior hip dislocation and more recently have been shown to increase stability [10,9,26]. Our results show that an inferior placement of the elevated lip liner allows increased effective coronal (abduction) as well as sagittal plane range of motion for the femoral component (Figure 4a, Figure 4b, Table 2, Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…It was first used by Charnley to decrease posterior dislocations of the femoral head component [9]. Improved stability was first shown by Cobb et al [10] in a retrospective study of elevated-rim liners in THA.…”

Section: Introductionmentioning

confidence: 99%

“…They showed that the most common site for impingement was posterior, however, impingement could occur at any location from excessive joint motion. Currently, the postero-superior positioning of the lip liner has been shown to provide additional stability [15], however, a common direction of dislocation is posterior when the hip is flexed and internally rotated [10,16], i.e., posteroinferiorly. Anterior direction of dislocation has also been reported.…”

Section: Introductionmentioning

confidence: 99%

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Elevated Lip Liner Positions Improving Stability in Total Hip Arthroplasty – An Experimental Study

et al. 2018

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Background: The use of elevated lip polyethylene liners with the acetabular component is relatively common in Total Hip Arthroplasty (THA). Elevated lip liners increase stability of the THA by increasing the jump distance in one direction. However, the elevated lip, conversely, also reduces the primary arc in the opposite direction and leads to early impingement of the neck on the elevated lip, potentially causing instability.The aim of the present study is to determine the total range of motion of the femoral head component within the acetabular component with the elevated lip liner in different orientations within the acetabular cup.Methods: We introduce a novel experimental (ex-vivo) framework for studying the effects lip liner orientation on the range of motion of the femoral component. For constant acetabular cup orientation, the elevated lip liner was positioned superiorly and inferiorly. The femoral component range of motion in the coronal, sagittal and axial plane was measured. To avoid any confounding influences of out of plane motion, the femoral component was constrained to move in the tested plane.Results: This experimental set up introduces a rigorous framework in which to test the effects of elevated lip liner orientations on the range of motion of the femoral head component in abduction, adduction, flexion, extension and rotation. The movements of this experimental set-up are directly informative of patient's maximum potential postoperative range of motion. Initial results show that an in-

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“…The posterior approach (PA) has been associated with postoperative dislocations (Edmunds and Boscainos 2011, Brooks 2013), mainly owing to the small femoral heads used to prevent wear (Bystrom et al 2003). However, the introduction of highly cross-linked polyethylene into the articulation has reduced wear independently of head diameter (Bragdon et al 2007), leading to increased use of larger head diameters (Lombardi et al 2011).…”

mentioning

confidence: 99%

Muscular strength after total hip arthroplasty

et al. 2015

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Background and purposeMinimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches.Patients and methodsIn a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up.ResultsDifferences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups.InterpretationThe posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery.

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Dislocation following total hip replacement

Cited by 132 publications

References 3 publications

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Elevated Lip Liner Positions Improving Stability in Total Hip Arthroplasty – An Experimental Study

Muscular strength after total hip arthroplasty

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