Outcome of revision surgery in recurrent dislocation of primary total hip arthroplasty

Abstract

Background:

The cause of recurrent dislocation following primary total hip arthroplasty (THA) is multifactorial. A re-dislocation rate of up-to 34% following revision is reported. The aim of this study was to determine the re-dislocation rates following revision for recurrent THR dislocation.

Methodology:

Patients who underwent revision for recurrent dislocation between January 2008 and January 2015 were identified. We identified the date and type of primary implant, overall number and reasons for dislocation, revision implant details and complication data.

Results:

Over an 8-year period, 24 patients underwent revision. The median age was 77 (68–85) years, median time to first dislocation was 78 (23–160) months and median number of dislocations was 3 (2–4) with a mean follow-up of 18 months. Socket Mal-Orientation (10) and Abductor deficiency (5) were the main causes of recurrent dislocation. 21 patients (88%) underwent revision of both components, 1 patient underwent isolated cup revision and 2 patients had revision of acetabular component with insertion of a BioBall. There were no dislocations within 90 days of revision surgery. 4 patients had late dislocations (3 recurrent, 1 isolated). There was no significant increase risk of dislocation after revision surgery in the neck of femur group (p = 0.467).

Conclusions:

We report favourable outcomes for revision of both components for recurrent dislocation with no dislocations within 90 days. The overall late dislocation rate was 16.7%, however, these patients have settled following closed reduction. Due to its multifactorial aetiology, both component revision can be considered in this patient population.

Keywords

Both components recurrent dislocation revision

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References

Charissoux

Asloum

Marcheix

PS.

Surgical management of recurrent dislocation after total hip arthroplasty. Orthop Traumatol Surg Res 2014; 100(Suppl. 1): S25–S34.

López-López

Humphriss

Beswick

, et al. Choice of implant combinations in total hip replacement: systematic review and network meta-analysis. BMJ 2017; 359: j4651.

Kotwal

Ganapathi

John

, et al. Outcome of treatment for dislocation after primary total hip replacement. J Bone Joint Surg Br 2009; 91: 321–326.

Zijlstra

De Hartog

Van Steenbergen

, et al. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty. Acta Orthop 2017; 88: 395–401.

Yuan

Shih

Dislocation after total hip arthroplasty. Arch Orthop Trauma Surg 1999; 119: 263–266.

Malik

Jain

Scharschmidt

, et al. Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty 2018; 33: 3329–3342.

D‘Angelo

Murena

Zatti

, et al. The unstable total hip replacement. Indian J Orthop 2008; 42: 252–259.

Fraser

Wroblewski

BM.

Revision of the Charnley low-friction arthroplasty for recurrent or irreducible dislocation. J Bone Joint Surg Br 1981; 63: 552–555.

McConway

O’Brien

Doran

, et al. The use of a posterior lip augmentation device for a revision of recurrent dislocation after primary cemented Charnley/Charnley Elite total hip replacement: results at a mean follow-up of six years and nine months. J Bone Joint Surg Br 2007; 89: 1581–1585.

10.

Lachiewicz

Soileau

Ellis

Modular revision for recurrent dislocation of primary or revision total hip arthroplasty. J Arthroplasty 2004; 19: 424–429.

11.

Bremner

Goetz

Callaghan

, et al. Use of constrained acetabular components for hip instability: an average 10 year follow-up study. J Arthroplasty 2003; 18(Suppl. 1): 131–137.

12.

Simian

Chatellard

Druon

, et al. Dual mobility cup in revision total hip arthroplasty: dislocation rate and survival after 5 years. Orthop Traumatol Surg Res 2015; 101: 577–581.

13.

Mertl

Combes

Leiber-Wackenheim

, et al. Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years. HSS J 2012; 8: 251–256.

14.

Rogers

Blom

Barnett

, et al. Revision for recurrent dislocation of total hip replacement. Hip Int 2009; 19: 109–113.

15.

Stedman

Lim

Husain

, et al. Single-component revisions are associated with dislocation after revision total hip arthroplasty at intermediate-term follow-up. Hip Int 2016; 26: 233–236.

16.

Yoshimoto

Nakashima

Aota

, et al. Re-dislocation after revision total hip arthroplasty for recurrent dislocation: a multicentre study. Int Orthop 2017; 41: 253–258.

17.

Mahoney

Pellicci

Complications in primary total hip arthroplasty: avoidance and management of dislocations. Instr Course Lect 2003; 52: 247–255.

18.

Joshi

Lee

Markovic

, et al. Prognosis of dislocation after total hip arthroplasty. J Arthroplasty 1998; 13: 17–21.

19.

Meding

Ritter

, et al. The natural history of a posteriorly dislocated total hip replacement. J Arthroplasty 1999; 14: 964–968.

20.

Woo

Morrey

BF.

Dislocations after total hip arthroplasty. J Bone Joint Surg Am 1982; 64: 1295–1306.

21.

Enocson

Minde

Svensson

Socket wall addition device in the treatment of recurrent hip prosthesis dislocation: good outcome in 12 patients followed for 4.5 (1-9) years. Acta Orthop 2006; 77: 87–91.

22.

Wroblewski

Siney

Fleming

PA.

The angle-bore acetabular component and dislocation after revision of a failed total hip replacement. J Bone Joint Surg Br 2006; 88: 184–187.

23.

Earll

Fehring

Griddin

, et al. Success rate of modular component exchange for the treatment of an unstable total hip arthroplasty. J Arthroplasty 2002; 17: 864–869.

24.

Novoa

Citak

Zahar

, et al. The Merete BioBall system in hip revision surgery: a systematic review. Orthop Traumatol Surg Res 2018; 104: 1171–1178.

25.

Dabis

Shaw

Hutt

, et al. Clinical outcomes and dislocation rates after hip reconstruction using the BioBall system. Orthop Proceedings 2018; 99B: 22.

26.

Rajaee

Campbell

Mirocha

, et al. Increasing burden of total hip arthroplasty revisions in patients between 45 and 64 years of age. J Bone Joint Surg Am 2018; 100: 449–458.

27.

Barratt

Turner

Hutchings

, et al. Mixed methods evaluation of the getting it right first time programme - improvements to NHS orthopaedic care in England: study protocol. BMC Health Serv Res 2017; 17: 71.