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J Am Acad Orthop Surg, Vol 12, No 5, September/October 2004, 314-321.
© 2004 the American Academy of Orthopaedic Surgeons
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Dislocation After Total Hip Arthroplasty

Maximillian Soong, MD, Harry E. Rubash, MD and William Macaulay, MD

Dr. Soong is Resident, Harvard Combined Orthopaedic Residency Program, Boston, MA. Dr. Rubash is Chairman, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston. Dr. Macaulay is Director, Center for Hip and Knee Replacement, Columbia University, New York, NY.

Reprint requests: Dr. Macaulay, Columbia University, PH 11th Floor, Rm 1146, 622 West 168th Street, New York, NY 10032.

Dislocation is one of the most common complications after total hip arthroplasty (THA). Risk factors include neuromuscular and cognitive disorders, patient non-compliance, and previous hip surgery. Surgical considerations that must be addressed include approach, soft-tissue tension, component positioning, impingement, head size, acetabular liner profile, and surgeon experience. Recent improvements in posterior soft-tissue repair after primary THA have shown a reduced incidence of dislocation. When dislocation occurs, a thorough history, physical examination, and radiographic assessment help in choosing the proper intervention. Closed reduction usually is possible, and nonsurgical management frequently succeeds in preventing recurrence. When these measures fail, first-line revision options should target the underlying etiology. This most often involves tensioning or augmentation of soft tissues, as in capsulorrhaphy or trochanteric advancement; correction of malpositioned components; or improving the head-to-neck ratio. If instability persists, or if a primary THA repeatedly dislocates without a clear cause, a constrained cup or bipolar femoral prosthesis may be as effective as a salvage procedure.




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J. Parvizi, E. Picinic, and P. F. Sharkey
Revision Total Hip Arthroplasty for Instability: Surgical Techniques and Principles
J. Bone Joint Surg. Am., May 1, 2008; 90(5): 1134 - 1142.
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