Instability Prevention and Treatment in Total Hip Replacement

Bruno Alves Rudelli; Fabio Seiji Mazzi Yamaguchi; Marco Rudelli; Lucas Torres Oliveira; Helder de Souza Miyahara; Henrique Melo de Campos Gurgel

doi:10.1055/s-0045-1810122

Revista Brasileira de Ortopedia, Table of Contents

CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(05): s00451810122
DOI: 10.1055/s-0045-1810122

Update Article

Instability Prevention and Treatment in Total Hip Replacement

Prevenção e tratamento da instabilidade na artroplastia total do quadril

Authors

Bruno Alves Rudelli

¹Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
Fabio Seiji Mazzi Yamaguchi

¹Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
Marco Rudelli

²Department of Orthopedics and Traumatology, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
Lucas Torres Oliveira

¹Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
Helder de Souza Miyahara

¹Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil
Henrique Melo de Campos Gurgel

¹Institute of Orthopedics and Traumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), São Paulo, SP, Brazil

Abstract

Instability is a challenging complication and a significant revision cause in hip replacement surgery. The incidence of dislocation ranges from 0.5 to 10% in primary prostheses and can reach up to 30% in revision surgeries. The literature describes several risk factors, including surgeon-, patient-, and implant-related factors. Knowledge of these factors is essential to preventing and managing instability cases. Preventive treatment involves preoperative planning, adequate component positioning, normal hip biomechanics reestablishment, risk factor identification, and proper implant selection. Approximately two thirds of dislocation episodes are treatable with non-surgical treatment with closed reduction, education, and muscle strengthening. One third of the cases develop recurrent dislocations and require surgical intervention. Revision surgery should target the cause of instability. When necessary, consider special implants, such as dual-mobility acetabular components, polyethylene-based lipped acetabular liners, constrained acetabular inserts, or large-diameter prosthetic heads. Technological advances in robotic surgery and the understanding of the biomechanics of spinopelvic swing-related dislocation are promising current topics that may improve the prevention and treatment of instability.

Resumo

A instabilidade é uma complicação desafiadora e uma das principais causas de revisão na cirurgia de prótese de quadril. A incidência da luxação varia de 0,5 a 10% nas próteses primárias e pode chegar a 30% nas cirurgias de revisão. Existem diversos fatores de risco descritos na literatura, sendo que podemos dividi-los em dependentes do cirurgião, dependentes do paciente e dependentes do implante. O conhecimento pleno desses fatores é fundamental para a prevenção e manejo da instabilidade. O tratamento preventivo envolve planejamento pré-operatório, posicionamento adequado dos componentes, restabelecimento da biomecânica normal do quadril, identificação de fatores de risco e escolha adequada do implante. Aproximadamente dois terços dos episódios de luxação podem ser tratados não cirurgicamente com redução fechada, orientações e fortalecimento muscular. Um terço evoluiu para luxações recorrentes e necessita de intervenção cirúrgica. A cirurgia de revisão deve ser direcionada diretamente para a causa da instabilidade. Quando necessário, considerar a utilização de implantes especiais como acetábulos de dupla mobilidade, insertos de polietileno com rebordo elevado, acetábulos constritos ou cabeças de grande diâmetro. Avanços tecnológicos na área da cirurgia robótica e na compreensão da biomecânica da luxação relacionada ao balanço espinopélvico são temas atuais promissores que devem impactar em melhorias na prevenção e no tratamento da instabilidade.

Keywords

arthroplasty, replacement, hip - joint dislocations/prevention & control - joint instability - postoperative complications

Palavras-chave

artroplastia de quadril - complicações pós-operatórias - instabilidade articular - luxações articulares/prevenção & controle

Bibliographical Record
Bruno Alves Rudelli, Fabio Seiji Mazzi Yamaguchi, Marco Rudelli, Lucas Torres Oliveira, Helder de Souza Miyahara, Henrique Melo de Campos Gurgel. Instability Prevention and Treatment in Total Hip Replacement. Rev Bras Ortop (Sao Paulo) 2025; 60: s00451810122.
DOI: 10.1055/s-0045-1810122

Full Text

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