Transient subluxation of the femoral head after total hip replacement

Abstract

Dislocation is a common and well-studied complication after total hip replacement. However, subluxation, which we define as a clinically recognised episode of incomplete movement of the femoral head outside the acetabulum with spontaneous reduction, has not been studied previously. Out of a total of 2521 hip replacements performed over 12 years by one surgeon, 30 patients experienced subluxations which occurred in 31 arthroplasties. Data were collected prospectively with a minimum follow-up of two years. Subluxation occurred significantly more frequently after revision than after primary hip replacement, and resolved in 19 of 31 cases (61.3%). In six of the 31 hips (19.4%) the patient subsequently dislocated the affected hip, and in six hips (19.4%) intermittent subluxation continued. Four patients had a revision operation for instability, three for recurrent dislocation and one for recurrent subluxation. Clinical and radiological comparisons with a matched group of stable total hips showed no correlation with demographic or radiological parameters. Patients with subluxing hips reported significantly more concern that their hip would dislocate, more often changed their behaviour to prevent instability and had lower postoperative Harris hip scores than patients with stable replacements.

Patient Satisfaction Reporting After Total Hip Arthroplasty: A Systematic Review

“…The most common method for assessing satisfaction was the 10-point visual analog scale for satisfaction (7 studies, 29.2%). [20][21][22][23][24][25][26] Other methods included an ordinal scale (eg, very satisfied, satisfied, neutral, dissatisfied) (6 studies, 25.0%) [27][28][29][30][31][32] ; willingness to undergo surgery again (5 studies, 20.8%) 30,[32][33][34][35] ; and a binary scale (yes/ no for satisfied) (3 studies, 12.5%) (Table). [36][37][38] For the 3 studies reporting a binary (yes/no) result for patient satisfaction, all showed greater than 80% overall satisfaction.…”

“…Most of the studies examined satisfaction with the outcome of arthroplasty surgery (18 studies, 75.0%) 20,[22][23][24][25][26][27][28][29][30]32,[35][36][37][38][39][40][41] ; 2 studies (8.3%) examined satisfaction with cosmesis after THA 33,42 ; 3 studies (12.5%) considered satisfaction with the process of care 21,34,43 ; and 1 study evaluated satisfaction with physical therapy after THA. 31 Two studies (8.3%) measured satisfaction at multiple time points, 21,33 and the rest reported satisfaction only at 1 specific follow-up visit or at the final follow-up visit.…”

“…42 Postoperative clinical factors that influenced satisfaction included leg length equality, hip stability, and decreased pain levels. 22,41 Only 1 study measured patient expectations preoperatively and found that patients whose expectations were met were more satisfied postoperatively. 32…”

Incidence, risk factors and prognosis of transient pseudosubluxation after total hip arthroplasty

“…To the best of our knowledge, two retrospective studies have described this phenomenon. 1,2 However, the incidence and progression rate to further dislocation were quite different between these two studies. In the first study of 13 cases, the incidence was 3% (5/178) and pseudosubluxation did not appear as a risk factor for postoperative dislocation.…”

Anterior Subluxation after Total Hip Replacement Confirmed by Radiographs: Report of Two Cases

“…In rare cases, instability presents as transient subluxation [1–3]. A patient reports a sound or click and often has a sense of giving way or apprehension.…”