Dislocating a hip after total hip replacement can be a traumatic experience
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Osteoarthritis of the hip is a degenerative joint disease that, besides being painful, also has a negative impact on mobility. An affected joint can be surgically replaced with an artificial prosthesis to alleviate pain and enhance mobility and quality of life. However, when the replacement hip is forced from its normal position-a so-called dislocation-these patients frequently experience injuries, undermining their trust in the artificial joint. Depending on the trauma that caused the dislocation, it may even be necessary to replace the prosthesis. In their current review article published in Deutsches Ärzteblatt International (Dtsch Arztebl Int 2014; 111: 884-90), Jens Dargel et al. point out that the prevention of dislocation plays an important role and describe the risks that need to be addressed.
Approximately 1 in 50 patients who undergo total hip replacement for the first time will experience a dislocation. Among patients with total hip replacements that required revision and implant exchange surgeries, this rate can be as high as 1 in 4 patients (up to 28%). Here the risks include advanced age and concomitant neurological conditions.
Moreover, patients should make sure to avoid certain movements, such as bending too far forward, as these can increase the risk for dislocation of the implant. Further risks arise at the time the surgery is performed: incorrect positioning of the implant, inadequate soft-tissue tension and inadequate experience of the surgeon all add to the risk for dislocation. The authors recommend using a standardized approach for the management of dislocation following total hip replacement, based on a diagnostic and therapeutic algorithm.
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SUMMARY
Background: Hip replacement ranks among the more successful operations on
the musculoskeletal system, but it can have serious complications. A common
one is dislocation of the total hip endoprosthesis, an event that arises in about
2% of patients within 1 year of the operation. Physicians should be aware of
how this problem can be prevented and, if necessary, treated, so that the
degree of trauma due to hip dislocation after hip replacement surgery can be
kept to a minimum.
Methods: The authors searched Medline selectively for pertinent publications
and analyzed the annual reports of international endoprosthesis registries.
Results: The rate of dislocation of primary hip replacements ranges from 0.2%
to 10% per year, while that of artificial hip joints that have already been surgi-
cally revised can be as high as 28%, depending on the patient population, the
follow-up interval, and the type of prosthesis. Patient-specific risk factors for
displacement of a hip endoprosthesis include advanced age, accompanying
neurologic disease, and impaired compliance. Patients should scrupulously
avoid hip movements such as bending far forward from a standing position, or
internal rotation of the flexed hip. Operation-specific risk factors include
suboptimal implant position, insufficient soft-tissue tension, and inadequate
experience of the surgeon. Conservative treatment is justified the first time
dislocation occurs without any identifiable cause. If a mechanical cause of
instability is found, then operative revision should be performed as recom-
mended in a standardized treatment algorithm, because, otherwise, dislocation
is likely to recur.
Conclusions: The dislocation of a total hip endoprosthesis is an emotionally
traumatizing event that should be prevented if possible. Preoperative risk
assessment should be performed and the operation should be performed with
optimal technique, including the best possible physical configuration of implant
components, soft-tissue balance, and an adequately experienced orthopedic
surgeon.
Jens Dargel
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Deutsches Aerzteblatt International
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Deutsches Ärzteblatt International
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