A critical analysis of radiographic factors in patients who develop dislocation after elective primary total hip arthroplasty.
OBJECTIVE
In order to diminish total hip arthroplasty (THA) dislocation rate, surgeons strive to achieve adequate component orientation, offset and limb length. In addition, dislocation rate can theoretically be reduced by increasing head diameter and by choosing implants with favorable head-to-neck and cup-to head ratios. We assessed nine radiographic and implant-related parameters associated with an increased risk of dislocation in patients who sustained a dislocation and in those with a stable arthroplasty.


METHODS
A total of 1,487 consecutive elective primary THAs performed by a single surgeon, using a posterolateral approach were reviewed at an average follow-up of 18 months (range, 1-112). Fixation was hybrid in 85 % of hips and non-cemented in 15 %. Thirty-eight patients (38 hips, 2.5 %) sustained at least one dislocation. Thirty-seven patients with good quality, standardized anteroposterior radiographs were selected as a "study group". The study group was matched-paired (1:3) with patients who had a stable arthroplasty based on gender, age, BMI, diagnosis and follow-up. Variables compared between the groups included: head size, cup size, head-to-neck ratio, cup-to-head ratio, leg-length discrepancy, offset, cup inclination, cup version and cup orientation based on the safe zone defined by Lewinnek et al.


RESULTS
None of the nine parameters showed a statistically significant difference between the groups.


CONCLUSIONS
In this study, 90 % of patients who developed a dislocation had properly positioned acetabular components. In addition, the vast majority of patients in the study group had adequate restoration of limb length and offset. The results of our study may be useful for the orthopedic surgeons who discuss instability following THA surgery, particularly in patients with radiographically sound reconstructions.
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Marion
M
Opperer
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Yuo-yu
YY
Lee
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Francisco
F
Nally
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Alvaro
A
Blanes Perez
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Kaveh
K
Goudarz-Mehdikhani
Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. gonzaleza@hss.edu.
Alejandro
A
Gonzalez Della Valle
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
Dislocation; Radiographic analysis; Total hip replacement