Dislocation following total hip arthroplasty: A series of 6 cases and literature review
Keywords:dislocation, total hip, risk factor
Despite being one of the most successful operative procedures in the field of orthopaedic, total hip arthroplasty (THA) could lead to devastating complications, one of which is dislocation. Such condition is one of the most common causes of both patient and surgeon dissatisfaction, and impairs the quality of life. To our knowledge, there are no studies regarding factors associated with dislocation following THA in our country.
We conducted a cross-sectional study by reviewing medical records of patients who underwent primary and revision THA at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, during the period between January 2017 and December 2018. Those who were diagnosed with dislocation following the surgery were included. Individuals who had previous THA in other hospitals, and those who had neoplasms, were excluded. We recorded the underlying disease, THA approach, implants used, component placements, type of dislocation, reduction performed, the interval between the procedure and dislocation, adherence to hip precaution and whether revision was needed.
A total of 68 patients (73 hips) had undergone THA in our center. Five hips were excluded, as four of them had undergone THA in other centers, and one had history of malignancy. Thus, the final hips reviewed in this study were 68 (42, 13, and 13 had primary, primary difficult, and revision THA, respectively). None of those who had undergone primary THA developed dislocation; whereas, four (30.7%) and two (15.4%) subjects who had undergone primary difficult and revision THA, respectively, had dislocation.
We observed higher rates of dislocation compared to previous findings, which probably occurred because our center was a national referral hospital, which treated more complex cases. We found two patients who did not adhere to hip precaution, two patients with septic loosening and multiple prior surgeries. We recommended the use of hip precaution, particularly in patients who underwent primary difficult THA. This study confirms findings from previous reports, which states that two-stage revisions for infection and history of previous surgery predisposes to dislocation. We found that non-compliance to hip precaution also contributes to dislocation.
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