Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty

Abstract

Background and purposeRecurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA).Patients and methodsWe analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons.ResultsPosterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5–0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5).InterpretationCompared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation.

Patient Characteristics Influence Revision Rate of Total Hip Arthroplasty: American Society of Anesthesiologists Score and Body Mass Index Were the Strongest Predictors for Short-Term Revision After Primary Total Hip Arthroplasty

“…1). This was similar to previous studies using LROI data [4,8,9,14]. Smoking status, BMI, and Charnley score were registered since 2014 in the LROI.…”

“…For example, the diagnosis is a non-modifiable risk factor which could be taken into account during preoperative planning. In order to reduce the risk for dislocation in patients with an acute femoral neck fracture and late posttraumatic pathology, the use of a larger (eg, 36 vs 32 mm) femoral head component or a change in surgical approach could be considered, to reduce the risk for revision due to recurrent dislocation [8]. For obese patients, strategies to minimize infection should be optimized, for instance, the dose of perioperative cefazolin should be adjusted to 3 g instead of 2 g in case of BMI >40 or perhaps >35 [18].…”

“…For obese patients, strategies to minimize infection should be optimized, for instance, the dose of perioperative cefazolin should be adjusted to 3 g instead of 2 g in case of BMI >40 or perhaps >35 [18]. Furthermore, for ASA III-IV patients, one might consider a cemented prosthesis, in order to reduce the risk of periprosthetic fracture [8].…”

How to prevent dislocation after revision total hip arthroplasty: a systematic review of the risk factors and a focus on treatment options

“…A surgical approach is a significant surgical choice both for primary [24, 25] and revision [26–28] procedures, and should be based on several factors, such as previous approach, soft tissue and bone condition, and surgeon experience.…”

Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty

“…This indicates that the contribution of the capsule to the mechanics of the joint may be more extensive than passive stabilization alone, particularly as no significant difference has been noted between the biomechanical properties of the capsular ligaments [22]. This is despite research indicating that the posterior approach to the capsule is at greater risk of postoperative dislocation when repaired or excised [24,25]. Although the risk may be higher due to excising the capsule in the most common dislocating direction, which is a result of injury mechanisms and differences in bony or muscular architectural support to the joint.…”