title: Acetabular Component Position and the Risk of Dislocation Following Primary and Revision Total Hip Arthroplasty: A Matched Cohort Analysis.
abstract: Recently, the importance of acetabular component positioning in the Lewinnek "safe zone" in preventing prosthetic dislocation following total hip arthroplasty (THA) has been questioned. The purpose of this study was to determine the proportion of acetabular components within the Lewinnek safe zone between primary and revision THAs that have sustained a dislocation vs matched controls without a dislocation event.
  
  
  
  This was a retrospective, institutional review board-approved investigation of THAs performed at our institution or referred to our institution between 1997 and 2013. Ninety-six primary THAs and 60 revision THAs that sustained a dislocation were included and matched 1:1 based on age, gender, and body mass index with nondislocated controls. Acetabular component inclination and anteversion were performed using Martell Hip Analysis Suite and compared between the 2 cohorts for both primary and revision THAs.
  
  
  
  The proportion of acetabular components within the safe zone for both inclination and anteversion was 23 of 96 (24%) in primary THA dislocators vs 48 of 96 (50%, P < .001) in controls. The proportion of acetabular components within the safe zone for both inclination and anteversion was 28 of 60 (47%) in revision THA dislocators vs 40 of 60 (66%, P = .03) in controls.
  
  
  
  Patients sustaining a dislocation following a primary or revision THA had acetabular components less frequently positioned within the safe zone compared to control patients. This study suggests acetabular component positioning remains an important variable in decreasing the risk of dislocation following primary and revision THA.
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Anita
authors.initials: A
authors.lastname: Sadhu
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Denis
authors.initials: D
authors.lastname: Nam
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Coobs
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Barrack
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nunley
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Barrack
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D005260:Female; D006617:Hip Dislocation / Q000209:etiology*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D004204:Joint Dislocations; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
keywords: acetabular positioning; dislocation; safe zone; stability; total hip arthroplasty