Dislocation after Total hip arthroplasty: A collective review

Abstract

Background: Total hip arthroplasty (THA) has proven to be a highly effective surgical procedure in improving patients’ quality of life. However, postoperative dislocation remains a concerning complication, affecting patient outcomes and increasing healthcare costs. Primary THA dislocation rates range between 1.0% - 2.0%, while revision THA carries a significantly higher risk, ranging from 5.0% - 30.0%. Understanding the causes, preventive measures, and management strategies for hip dislocation is crucial for optimizing surgical success and patient recovery.

Objective: To analyze the factors contributing to hip dislocation after THA, explore diagnostic methods, and review treatment strategies to improve surgical outcomes and reduce recurrence rates.

Methods: This literature review systematically compiles data on patient evaluations, including history-taking, physical examination, and radiographic assessments. It also classifies hip dislocation types, discusses associated risk factors, and outlines management strategies. Factors influencing dislocation risk—including confirmed contributors, potential associations, and disproven variables—are examined. Additionally, treatment approaches for recurrent dislocations and specialized prosthetic options designed for cases with unresolved instability are explored.

Results: Studies indicate various factors contribute to hip dislocation after THA, including spinopelvic alignment, prior hip surgery, revision surgery, surgical approach, soft tissue tension, implant positioning, neuromuscular conditions, head to neck ration, diagnosis of the index surgery and demographic data. Risk mitigation strategies include careful preoperative planning, appropriate implant selection, and rehabilitation protocols tailored to individual patient conditions. Evidence suggests that constrained liners and dual-mobility bearings significantly improve stability in high-risk cases, yet each option presents unique advantages and challenges requiring careful consideration.

Conclusion: Hip dislocation remains a significant concern following THA, particularly in revision procedures. A comprehensive approach involving thorough patient assessment, individualized surgical planning, and evidence-based treatment strategies is essential for reducing dislocation rates and optimizing patient outcomes. Future research should focus on developing patient-specific implants and surgical techniques to further enhance hip stability and long-term success.