The Natural History of the Anteriorly Dislocated Total Hip Arthroplasty

Abstract

Dislocation with instability is one of the most frequent causes of early failure and subsequent revision following primary total hip arthroplasty. However, anterior hip dislocation has been shown to be a relatively infrequent event and there are little data on outcomes of patients with these types of dislocation. The purpose of the current study was to assess the functional outcomes and survival of the prosthetic hip in patients who have sustained an anterior dislocation and to compare these results with a similar cohort of patients who have sustained a posterior dislocation. The charts and radiographs of patients sustaining an anterior dislocation following primary total hip arthroplasty were reviewed at an average of 7 years after the index procedure. Redislocation rate, revision status, and function as assessed by the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) were examined. These were compared with an age- and gender-matched cohort of patients who had sustained a posterior dislocation. Patients sustaining an anterior dislocation were found to have a mean acetabular anteversion of 36 degrees, compared with 25.6 degrees in patients who had sustained a posterior dislocation. However, this did not result in any difference in revision rate or WOMAC score at the time of follow-up. The current evidence shows us that a single-posterior dislocation does not preclude a satisfactory long-term outcome. Based on their data, the authors feel it would be appropriate to counsel patients that a single-anterior dislocation also does not preclude a satisfactory outcome.

Keywords

total hip arthroplasty - dislocation - anterior - history

• References

• 1 Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg 2004; 12 (05) 314-321
• 2 Mahoney CR, Heitenberger S, Sanchez P, Schaefer SH, Sculco TP, Westrich GH. Ultimate outcome in immediate postoperative total hip arthroplasty instability. J Arthroplasty 2007; 22 (01) 79-82
• 3 Li E, Meding JB, Ritter MA, Keating EM, Faris PM. The natural history of a posteriorly dislocated total hip replacement. J Arthroplasty 1999; 14 (08) 964-968
• 4 Forsythe ME, Whitehouse SL, Dick J, Crawford RW. Functional outcomes after nonrecurrent dislocation of primary total hip arthroplasty. J Arthroplasty 2007; 22 (02) 227-230
• 5 Kotwal RS, Ganapathi M, John A, Maheson M, Jones SA. Outcome of treatment for dislocation after primary total hip replacement. J Bone Joint Surg Br 2009; 91 (03) 321-326
• 6 Joshi A, Lee CM, Markovic L, Vlatis G, Murphy JC. Prognosis of dislocation after total hip arthroplasty. J Arthroplasty 1998; 13 (01) 17-21
• 7 Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60 (02) 217-220
• 8 Tp Ng, Yau WP, Tang WM, Chiu KY. Anterior dislocation following primary total hip replacement by the posterior approach - aetiology and treatment. Hong Kong J Orthop Surg 2003; 7: 14-18
• 9 Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am 1982; 64 (09) 1295-1306
• 10 Coventry MB. Late dislocations in patients with Charnley total hip arthroplasty. J Bone Joint Surg Am 1985; 67 (06) 832-841
• 11 McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 2001; 45 (05) 453-461
• 12 Tian Y, Xu Y, Fu Q. Comparison of anterior and posterior dislocation after total hip arthroplasty through the posterior approach. Austin J Orthopade & Rheumatol 2016; 3 (04) 1040
• 13 Berry DJ. Unstable total hip arthroplasty: detailed overview. Instr Course Lect 2001; 50: 265-274
• 14 Berry DJ, von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 2004; 86 (01) 9-14