Prevention and Management of Instability After Total Hip Arthroplasty: Current Concepts

Abstract

Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures, and has been shown to be exceedingly effective in improving function and decreasing pain. Dislocation is one of the most common and most devastating complications after THA, with reported rates of 0.3% to 10% after primary THA and up to 28% after revision THA. Risk factors for dislocation include previous hip surgery, neuromuscular and cognitive disorders, patient noncompliance, and THA for femoral neck fracture. Surgical risk factors for instability after THA include the surgical approach, postoperative soft-tissue tension, component positioning, impingement, head size, liner profile, and surgeon experience. Appropriate management includes a detailed patient history, physical examination, and radiographic evaluation to determine the proper intervention. Most dislocations after THA are solitary events that can be managed with closed reduction and nonsurgical treatment; however, some patients eventually require revision to address recurrent instability. Revision for instability should involve a thorough assessment of the underlying etiology for dislocation, and revision should directly target the underlying problem. THA revision for instability can be a frustrating endeavor for both the patient and the surgeon, and the patient should be counseled thoroughly prior to any revision operation.

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