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Dislocation After Total Hip Arthroplasty: Implant Design and Orientation

Dr. Barrack is Professor of Orthopaedic Surgery and Director, Adult Reconstructive Surgery, Tulane University School of Medicine, New Orleans, LA.

Reprint requests: Dr. Barrack, 1430 Tulane Avenue, New Orleans, LA 70112.

Implant design and positioning are important factors in maintaining stability and minimizing dislocation after total hip arthroplasty. Although the advent of modular femoral stems and acetabular implants increased the number of head, neck, and liner designs, the features of recent designs can cause intra-articular prosthetic impingement within the arc of motion required for normal daily activities and thus lead to limited motion, increased wear, osteolysis, and subluxation or dislocation. Minimizing impingement involves avoiding skirted heads, matching a 22-mm head with an appropriate acetabular implant, maximizing the head-to-neck ratio, and, when possible, using a chamfered acetabular liner and a trapezoidal, rather than circular, neck cross-section. Computer modeling studies indicate the optimal cup position is 45° to 55° abduction. Angles <55° require anteversion of 10° to 20° of both the stem and cup to minimize the risk of impingement and dislocation.

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				A. Malik, A. Maheshwari, and L. D. Dorr Impingement with Total Hip Replacement J. Bone Joint Surg. Am., August 1, 2007; 89(8): 1832 - 1842. [Abstract] [Full Text] [PDF]

				A. G. Della Valle, D. E. Padgett, and E. A. Salvati Preoperative Planning for Primary Total Hip Arthroplasty J. Am. Acad. Ortho. Surg., November 1, 2005; 13(7): 455 - 462. [Abstract] [Full Text] [PDF]