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

Faldini, Cesare; Stefanini, Niccolò; Fenga, Domenico; Neonakis, E M; Perna, Fabrizio; Mazzotti, Antonio; Pilla, Francesco; Triantafyllopoulos, Ioannis Κ.; Traina, Francesco

doi:10.1186/s10195-018-0510-2

Cited by 45 publications

(64 citation statements)

References 48 publications

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“…This is in contrast to the findings of Wang who found that 22‐mm and 28‐mm femoral heads were both risk factors for dislocation in DDH patients. The small femoral head diameter has been widely accepted as a risk factor for dislocation after THA because of increased component impingement and decreased “jump distance”. In THA of Crowe type IV hips, the general consensus is that placement of acetabular component in the true acetabulum instead of a high placement can provide better hip function and longer prosthetic durability.…”

Section: Discussionmentioning

confidence: 70%

“…Although much effort has been devoted to its prevention, the incidence of dislocation after primary THA still ranges from 1.4% to 5.0%. The risk factors for postoperative dislocation identified include patient factors (including advanced age, abductor muscle weakness, preoperative diagnosis, and so on) and surgical factors (including small femoral head size, component malposition and low soft tissue tension, and so on). Besides, the surgeon experience can influence the postoperative dislocation rate.…”

Section: Introductionmentioning

confidence: 99%

“…Combined anteversion technique, combining the anteversion of acetabular and femoral component within safe zone of 25 degrees to 50 degrees, has been suggested in recent years. The large femoral head diameter has been widely accepted as a protective factor for dislocation after THA because of reduced component impingement and increased “jump distance”. Abductor muscle plays an important part in maintaining the stability of the hip.…”

Section: Introductionmentioning

confidence: 99%

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Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Ding

Zeng

Mou

et al. 2020

Orthopaedic Surgery

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Objective: To investigate whether the risk of dislocation after total hip arthroplasty (THA) in patients with Crowe type IV developmental dysplasia of the hip (DDH) is high and to further identify the risk factors for postoperative dislocation in these patients.Methods: This retrospective cohort study reviewed Crowe type IV DDH patients undergoing THA between January 2009 and December 2017 in our institution. Each Crowe type IV DDH patient was matched with three Crowe type I, II, or III DDH patients according to gender, side and date of operation. The primary outcome of this study was postoperative dislocation after THA. Occurrence, rate, classification, treatment and outcome of dislocation were documented in detail for all patients. The dislocation rates were compared between Crowe type IV DDH patients and Crowe type I, II, or III DDH patients. Demographic data, implant factors, and surgical factors were compared between the dislocation and no dislocation groups. Multiple logistic regression analysis was used to determine the independent risk factors for dislocation in Crowe type IV hips.Results: A total of 131 Crowe type IV hips were followed up for a mean of 76.5 AE 28.1 months. Three hundred and ninety-three Crowe type I, II and III hips, including 261 type I hips, 94 type II hips, and 38 type III hips, were identified as controls and followed up for a mean of 76.4 AE 28.2 months. No significant difference was observed in follow-up time between two groups (P = 0.804). One or more dislocations occurred in 22 of the 524 dysplasia hips (4.20%). Of the 22 dislocated hips, 20 hips (90.9%) were successfully managed with non-operative treatment. Two patients (9.1%, one Crowe type I and one Crowe type IV) experienced recurrent dislocation and required revision surgery. Crowe type IV hips had a significantly higher postoperative dislocation rate than type I, II, and III hips (11.45% vs 1.78%, P < 0.001). The use of a 22-mm femoral head (odds ratio [OR] = 23.55, 95% confidence interval [CI] = 1.901-291.788, P = 0.014), older age (OR = 1.128, 95% CI = 1.037-1.275, P = 0.031), and absence of false acetabulum (OR = 12.425, 95% CI = 1.982-77.879, P = 0.007) were identified as independent risk factors for dislocation in Crowe type IV hips.Conclusions: Crowe type IV DDH patients were at a high risk of dislocation after THA, and using large femoral heads and improving abductor muscle strength may help decrease the rate of postoperative dislocation in such patients.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Ding

Zeng

Mou

et al. 2020

Orthopaedic Surgery

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“…To cope with a limited ROM after a THA, prosthesis designs with larger diameter head bearings have been introduced to provide stability, a larger ROM, a smaller risk of dislocation, and to possibly prevent StL impingement. These claims have been supported in the literature [8][9][10][11][12], although concerns are still reported [13][14][15].…”

Section: Introductionmentioning

confidence: 92%

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

et al. 2020

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After a total hip arthroplasty, a limited range of motion and lower-limb disability continue to be observed, with these being mainly associated with the implant design and the head-to-neck ratio. Larger diameters of the head bearings were assumed to provide better stability, a larger range of motion, and smaller risks of dislocation and stem-to-liner impingement. However, these claims have never been demonstrated in real patients. The specific aim of this study was to assess, via multi-instrumental analysis, whether the range of motion of a replaced hip is limited by the stem-to-liner contact in patients with large femoral head diameters. Twenty-three patients with a total hip arthroplasty were evaluated at their one-year follow-ups using clinical and instrumental examinations. A combined three-dimensional gait analysis of the full body and videofluoroscopy analysis of the replaced hip were performed during the execution of standard, i.e., daily living, and more demanding motor tasks. The latter were meant to reach the extreme range of motion at the replaced hip site, thus revealing possible stem-to-liner contact. An original technique based on imaging and computer-aided design (CAD) models of the prosthesis components was developed to calculate the stem-to-liner distance. Excellent clinical scores were observed in the study. The gait analysis showed that the range of motion of the replaced hip in the sagittal plane, averaged over all patients, ranged from 28° to 78° in standard activities. In more demanding tasks, single peaks were as high as 110°, 39°, and 60° in the sagittal, frontal, and transverse anatomical planes, respectively. In all motor tasks, the stem-to-liner distances ranged from 8.7 to 13.0 mm on average, with one outlier minimum distance being 2.2 mm. This study shows that, even in demanding motor tasks and with an extreme range of motion, the hip joint replaced with large femoral head diameters did not experience impingement between the prosthesis components.

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“…In primary and revision total hip arthroplasty (THA), appropriate implant size and placement is important to prevent complications such as dislocation [1] [2] [3], wear of the polyethylene liner, and loosening of the components [4][5] [6]. Lewinnek et al proposed a "safe zone" of cup alignment, and Widmer et al proposed an optimal combination of cup alignment and stem anteversion to minimize the risk of impingement [7].…”

Section: Introductionmentioning

confidence: 99%

Interobserver and Intraobserver Repeatability and Reliability of Three-Dimensional Postoperative Evaluation Software in Total Hip Arthroplasty

Konno¹,

Hagiwara²,

Nakamura³

et al. 2020

Preprint

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Background: We investigated the reliability of measurement of the alignment and position of the prosthetic components after total hip arthroplasty (THA) using three-dimensional computed tomography (CT)-based postoperative evaluation software.Methods: We evaluated the postoperative CT data from 20 hips in 20 patients, using postoperative evaluation software. The alignment and three-dimensional positioning of the cup and stem were assessed by eight orthopedic surgeons for repeatability (intraobserver reliability) and reproducibility (interobserver reliability) of postoperative evaluation software using intra-class correlation coefficients (ICC). The radiographic inclination (RI) and radiographic anteversion (RA) of the cup, and anteversion, varus-valgus angle and flexion-extension angles of the stem were measured for alignment. The implant positioning was measured along three axes, X-axis (transverse), Y-axis (sagittal), and Z-axis (longitudinal).Results: The intra- and inter-observer ICC of alignment measurement were very good for both cup and stem (0.86–1.00). The intra-observer and inter-observer ICC of cup positioning were very good in X-axis and Y-axis (0.91–0.94) and good in Z-axis (0.68–0.80). The intra-observer and inter-observer ICC of implant positioning were very good for the stem (0.98–0.99) for all axes.Conclusion: CT-based postoperative evaluation software was able to evaluate the position of total hip implants with high reproducibility.

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

Cited by 45 publications

References 48 publications

Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

Interobserver and Intraobserver Repeatability and Reliability of Three-Dimensional Postoperative Evaluation Software in Total Hip Arthroplasty

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