The functional and financial impact of isolated and recurrent dislocation after total hip arthroplasty.

The aims of this study were to determine the functional impact and financial burden of isolated and recurrent dislocation after total hip arthroplasty (THA). Our secondary goal was to determine whether there was a difference between patients who were treated non-operatively and those who were treated operatively. We retrospectively reviewed 71 patients who had suffered dislocation of a primary THA. Their mean age was 67 years (41 to 92) and the mean follow-up was 3.8 years (2.1 to 8.2). Because patients with recurrent dislocation were three times more likely to undergo operative treatment (p < 0.0001), they ultimately had a significantly higher mean Harris Hip Score (HHS) (p = 0.0001), lower mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (p = 0.001) and a higher mean SF-12 score (p < 0.0001) than patients with a single dislocation. Likewise, those who underwent operative treatment had a higher mean HHS (p < 0.0001), lower mean WOMAC score (p < 0.0001) and a higher mean SF-12 score (p < 0.0001) than those who were treated non-operatively. Recurrent dislocation and operative treatment increased costs by 300% (£11 456; p < 0.0001) and 40% (£5217; p < 0.0001), respectively. The operative treatment of recurrent dislocation results in significantly better function than non-operative management. Moreover, the increase in costs for operative treatment is modest compared with that of non-operative measures.

Operative and non-operative treatment options for dislocation of the hip following total hip arthroplasty.

BACKGROUND: Dislocation following hip replacement is associated with significant morbidity and functional cost. The cause is usually multifactorial. A variety of treatment options are available which can broadly be classified into operative and non-operative. OBJECTIVES: To determine the best methods of treatment of recurrent dislocation following total hip replacement. SEARCH STRATEGY: The following databases were searched until August 2006: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Health Technology Assessment database (HTA), Database of Abstracts of Reviews of Effectiveness (DARE), International Standard Randomised Controlled Trial Number Register (ISRCTN), and MetaRegister of Controlled Trials (mRCT). SELECTION CRITERIA: Randomised and quasi-randomised trials comparing operative and non-operative treatments for recurrent dislocation following total hip replacement. DATA COLLECTION AND ANALYSIS: Two independent reviewers applied the inclusion criteria to identified studies. MAIN RESULTS: Searches identified 269 studies. None fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: The authors invite researchers to perform RCTs comparing different treatment options for recurrent dislocation of the hip. The heterogeneity of the population and variety of underlying causes would favour a multi-centre study to achieve an adequate sample size.

Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management.

Twenty-five dislocations occurred after 561 total hip arthroplasties performed by the author from 1971 to 1992. Acetabular shell and liner loosening must be differentiated from true dislocations. The dislocation rate of 5.49% in female patients was higher than the 2.8% rate in male patients. The 4.76% rate after 84 total hip revisions was slightly higher than the 3.98% rate after 477 primary replacements. No dislocations occurred using the anterolateral approach for 53 patients. Dislocation rates varied using different prosthetic systems for 508 patients who had the posterolateral approach used. Femoral prostheses with larger neck diameters were more prone to dislocation. These differences were not statistically significant with the sample sizes used, according to the chi square test for equality of proportions. Fluoroscopy aided reduction of one multiplanar recurrent case. Single hip spica abduction casts with and without knee hinges used for three to four months, along with abduction isometric exercises, led to stability in six recurrent cases.

Hip dislocations in myelodysplasia: a functional assessment.

We reviewed the records of 281 patients with myelodysplasia to ascertain the effect of hip dislocation on their ability to walk. There was no difference in the prevalence of myelodysplasia by gender. When adjusted for neurologic level and patient age, no statistical differences were found in the methods of locomotion between patients with hip dislocations and those without. Data (from this report and other published investigations) show that treatment for hip dislocation in myelodysplasia is unnecessary and fraught with many complications.