Skip to main content

Advertisement

SpringerLink
Log in

Total hip arthroplasty instability in Italy

  • Review Article
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Hip dislocation is a major and common complication of total hip arthroplasty (THA), which appears with an incidence between 0.3% and 10% in primary total hip arthroplasties and up to 28% in revision THA. The hip dislocations can be classified into three groups: early, intermediate and late. Approximately two-thirds of cases can be treated successfully with a non-operative approach. The rest require further surgical intervention. The prerequisite to developing an appropriate treatment strategy is a thorough evaluation to identify the causes of the dislocation. In addition, many factors that contribute to THA dislocation are related to the surgical technique, mainly including component orientation, femoral head diameter, restoration of femoral offset and leg length, cam impingement and condition of the soft tissues. The diagnosis of a dislocated hip is relatively easy because the clinical situation is very typical. Having identified a dislocated hip, the first step is to perform a closed reduction of the implant. After reduction you must perform a computed tomography scan to evaluate the surgical options for treatment of recurrent dislocation that include: revision arthroplasty, modular components exchange, dual-mobility cups, large femoral heads, constrained cups, elimination of impingement and soft tissue procedures. The objective is to avoid further dislocation, a devastating event which is increasing the number of operations on the hip. To obtain this goal is useful to follow an algorithm of treatment, but the best treatment remains prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Chang RW, Pellisier JM, Hazen GB (1996) A cost effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA 275:858–865

    Article  CAS  PubMed  Google Scholar 

  2. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemilogy of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91:128–133

    Article  PubMed  Google Scholar 

  3. Sanchez-Sotelo J, Berry DJ (2001) Epidemiology of instability after total hip replacement. Orthop Clin N Am 32(4):543–552

    Article  CAS  Google Scholar 

  4. American Joint Replacement Registry (2014) Annual Report. Avaible via http://www.ajrr.net/images/annual_reports/AJRR_2014_Annual_Report_final_11-11-15.pdf

  5. Swedish Hip Arthroplasty Register. Annual Report (2011). Avaible via http://www.shpr.se/en/default.aspx

  6. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report (2012). Avaible via http://aoanjrr.dmac.adelaide.edu.au/fr

  7. Torre M, Bellino S, Luzi I, Ceccarelli S, Salvatori G, Balducci MT, Piffer S, Zanoli G, Romanini E, Boniforti F, Carrani F (2016) Italian Register Arthroplasty Project. Third Report. Il Pensiero Scientifico Editore. Avaible via http://www.iss.it/binary/riap2/cont/3_Report_RIAPcompleto_2016.pdf

  8. Report of R.I.P.O, Regional Register of Orthopaedic Prosthetic Implantology. Annual report (2014). Available via https://ripo.cineca.it/pdf/RIPO_REPORT_2015_english_rev1.pdf

  9. Morrey BF (1992) Instability after total hip arthroplasty. Orthop Clin N Am 23:237–248

    CAS  Google Scholar 

  10. Dorr LD, Wan Z (1998) Causes of and treatment protocol for instability of total hip replacement. Clin Orthop Relat Res 355:144–151

    Article  Google Scholar 

  11. Hedlundh U, Karlsson M, Ringsberg K, Besjakov J, Fredin H (1999) Muscular and neurologic function in patients with recurrent dislocation after total hip arthroplasty: a matched controlled study of 65 patients using dual-energy X-ray absorptiometry and postural stability tests. J Arthroplasty 14:319–325

    Article  CAS  PubMed  Google Scholar 

  12. Soong M, Rubash HE, Macaulay W (2004) Dislocation after total hip arthroplasty. J Am Acad Orthop Surg 12:314–321

    Article  PubMed  Google Scholar 

  13. Dewal H, Maurer SL, Tsai P, Su E, Hiebert R, Di Cesare PE (2004) Efficacy of abduction bracing in the management of total hip arthroplasty dislocation. J Arthroplasty 19:733–738

    Article  PubMed  Google Scholar 

  14. Bourne RB, Mehin R (2004) The dislocating hip: what to do, what to do. J Arthroplasty 19(Suppl 1):111–114

    Article  PubMed  Google Scholar 

  15. Charissoux JL, Asloum Y, Marcheix PS (2014) Surgical management of recurrent dislocation after total hip arthroplasty. Orthop Traumatol Surg Res 100(1 Suppl):25–34

  16. Parvizi J, Picinic E, Sharkey PF (2008) Revision total hip arthroplasty for instability: surgical techniques and principles. J Bone Joint Surg Am 90(5):1134–1142

    PubMed  Google Scholar 

  17. Conroy JL, Whitehouse SL, Graves SE, Pratt NL, Ryan P, Crawford RW (2008) Risk factor for revision for early dislocation in total hip arthoplasty. J Arthroplasty 23(6):867–872

    Article  PubMed  Google Scholar 

  18. Von Knoch M, Berry DJ, Harmsen WS, Morrey BF (2002) Late dislocation after total hip arthroplasty. J Bone Joint Surg Am 84:1949–1953

    Article  Google Scholar 

  19. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip replacement arthroplasties. J Bone Joint Surg Am 60:217–220

    Article  CAS  PubMed  Google Scholar 

  20. Ritter MA (1976) Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res 21:92–94

    Google Scholar 

  21. Parvizi J, Kim KI, Goldberg G, Mallo G, Hozack WJ (2006) Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning. Clin Orthop Relat Res 447:60–65

    Article  PubMed  Google Scholar 

  22. Daly PJ, Morrey BF (1992) Operative correction of an unstable total hip arthroplasty. J Bone Joint Surg Am 74:1334–1343

    Article  CAS  PubMed  Google Scholar 

  23. Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip arthroplasty. A multivariate analysis. J Arthroplasty 17:282–288

    Article  CAS  PubMed  Google Scholar 

  24. Kim YH, Choi Y, Kim JS (2009) Influence of patient-, design-, and surgery-related factors on rate of dislocation after primary cementless total hip arthroplasty. J Arthroplasty 24:1258–1263

    Article  PubMed  Google Scholar 

  25. Berry DJ, Von Knoch M, Schleck CD, Harmsen WS (2004) The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 86:9–14

    Article  PubMed  Google Scholar 

  26. Caton J, Aslanian T, Prudhon JL, Ferreira A, Descamps L, Dehri G, Puch JM (2016) Dual Mobility Cup: a new THA revolution. E-Mémories de l’Académie Nationale de Chirurgie 15(1):004–010

    Google Scholar 

  27. Berry DJ, Von Knoch M, Schleck CD, Harmsen WS (2005) Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 87:2456–2463

    PubMed  Google Scholar 

  28. Berend KR, Sporer SM, Sierra RJ, Glassman AH, Morris MJ (2010) Achieving stability and lower-limb length in total hip arthroplasty. J Bone Joint Surg Am 92:2737–2752

    PubMed  Google Scholar 

  29. Rittmeister M, Callitsis C (2006) Factors influencing cup orientation in 500 consecutive total hip replacements. Clin Orthop Relat Res 445:192–196

    CAS  PubMed  Google Scholar 

  30. Ala Eddine T, Migaud H, Chantelot C, Cotton A, Fontaine C, Duquennoy A (2001) Variations of pelvic anteversion in the lying and standing positions: analysis of 24 control subjects and implications for CT measurement of position of a prosthetic cup. Surg Radiol Anat 23:105–112

    Article  Google Scholar 

  31. Puri L, Lapinski B, Wixson RL, Lynch J, Hendrix R, Stulberg SD (2006) Computed tomographic follow-up evaluation of operative intervention for periacetabular lysis. J Arthroplasty 21(6 Suppl 2):78–82

    Article  PubMed  Google Scholar 

  32. Parratte S, Argenson JN (2007) Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. J Bone Joint Surg Am 89:494–498

    PubMed  Google Scholar 

  33. Dorr LD, Malik A, Dastane M, Wan Z (2009) Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res 467:119–127

    Article  PubMed  Google Scholar 

  34. Confalonieri N, Manzotti A, Montironi F, Pullen C (2008) Leg length discrepancy, dislocation rate and offset restoration in total hip replacement using a short modular stem: navigation vs conventional freehand. Orthopedic 31(10 Suppl 1). pii: orthosupersite.com/view.asp?rID=35541

  35. Lombardi AV, Skeels MD, Berend KR, Adams JB, Franchi OJ (2011) Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty? Clin Orthop Relat Res 469:1547–1553

    Article  PubMed  Google Scholar 

  36. Howie DW, Holubowycz OT, Midelton R (2012) Large femoral heads decrease the incidence of dislocation after total hip arthroplasty. A randomised controlled trial. J Bone Joint Surg Am 94:1095–1102

    Article  PubMed  Google Scholar 

  37. Triclot P, Gouin F, Richter D, Musset T, Bonnan J, Ollivier H et al (2011) Update ‘big-head’: the solution to the problem of hip implant dislocation? Orthop Traumatol Surg Res 97S:120–127

    Google Scholar 

  38. Malik A, Maheshawari A, Dorr LD (2007) Impingement with total hip replacement. J Bone Joint Surg Am 89:1832–1842

    PubMed  Google Scholar 

  39. Cooper HJ, Della Valle CJ (2014) Large diameter femoral heads: is bigger always better? Bone Joint J 96B (11 Suppl. A):23–26

  40. Del Balso C, Teeter MG, Tan SC, Howard JL, Lanting BA (2015) Trunnionosis: does head size affect fretting and corrosion in total hip arthroplasty? J Arthroplasty 31(10):2332–2336

    Article  Google Scholar 

  41. Merle C, Waldstein W, Pegg E, Streit MR, Gotterbarm T, Aldinger PR et al (2012) Femoral offset is underestimated on anteroposterior radiographs of the pelvis but accurately assessed on anteroposterior radiographs of the hip. J Bone Joint Surg (Br) 94:477–482

    Article  CAS  Google Scholar 

  42. Parvizi J, Sharkey PF, Bissett GA, Rothman RH, Hozack WJ (2003) Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am 85:2310–2317

    Article  PubMed  Google Scholar 

  43. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

    Google Scholar 

  44. Barrack RL, Butler RA, Laster DR, Andrews P (2001) Stem design and dislocation after revision total hip arthroplasty: clinical results and computer modeling. J Arthroplasty 16(8 Suppl 1):8–12

    Article  CAS  PubMed  Google Scholar 

  45. Earll M, Fehring T, Griffin WL, Mason JB, McCoy TH (2004) Early osteolysis associated with trunion-liner impingement. Clin Orthop Relat Res 418:153–156

    Article  Google Scholar 

  46. Kelley SS, Lachiewicz PF, Hickman JM, Paterno SM (1998) Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res 355:163–170

    Article  Google Scholar 

  47. Carter AH, Sheehan EC, Mortazavi J, Purtill JJ, Sharkey PF, Parvizi J (2011) Revision for recurrent instability. What are the predictors of failure? J Arthroplasty 26:46–52

    Article  PubMed  Google Scholar 

  48. Toomey SD, Hopper RH Jr, McAuley JP, Engh CA (2001) Modular component exchange for treatment of recurrent dislocation of a total hip replacement in selected patients. J Bone Joint Surg Am 83:1529–1533

    Article  PubMed  Google Scholar 

  49. Earll MD, Fehring TK, Griffin WL, Mason JB, McCoy T, Odum S (2002) Success rate of modular component exchange for the treatment of an unstable total hip arthroplasty. J Arthroplasty 17:864–869

    Article  PubMed  Google Scholar 

  50. Blom AW, Astle L, Loveridge J, Learmonth ID (2005) Revision of an acetabular liner has a high risk of dislocation. J Bone Joint Surg (Br) 87(12):1636–1638

    Article  CAS  Google Scholar 

  51. Barrack RL, Burke DW, Cook SD, Skinner HB, Harris WH (1993) Complications related to modularity of total hip components. J Bone Joint Surg (Br) 75:688–692

    Article  CAS  Google Scholar 

  52. Morrey BF (2004) Results of reoperation for hip dislocation: the big picture. Clin Orthop Relat Res 429:94–101

    Article  Google Scholar 

  53. Insull PJ, Cobbett H, Frampton CM, Munro JT (2014) The use of a lipped acetabular liner decreases the rate of revision for instability after total hip replacement: a study using data from the New Zealand Joint Registry. Bone Joint J 96-B(7):884–888

    Article  CAS  PubMed  Google Scholar 

  54. McConway J, O’Brien S, Doran E, Archbold P, Beverland D (2007) The use of a posterior lip augmentation device for a revision of recurrent dislocation after primary cemented Charnley/Charnley Elite total hip replacement. Results at a mean follow-up of six years and nine months. J Bone Joint Surg (Br) 89:1581–1585

    Article  CAS  Google Scholar 

  55. Bousquet G, Argenson C, Godeneche JL, Cisterne JP, Gazielly DF, Girardin P, Debiesse JL (1986) Recovery after aseptic loosening of cemented total hip arthroplasties with Bousquest’s cementless prosthesis. Apropos of 136 cases. Rev Chir Orthop Reparatrice Appar Mot 72(Suppl 2):70–74

    PubMed  Google Scholar 

  56. Prudhon JL, Steffan F, Ferreira A, Verdier R, Aslanian T, Caton J (2014) Cementless dual mobility cup in total hip arthroplasty revision. Int Orthop 38:2463–2468

    Article  PubMed  Google Scholar 

  57. Caton JH, Prudhon JL, Ferreira A, Aslanian T, Verdier R (2014) A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess wether a dual mobility cup has a decresead dislocation risk. Int Orthop 38:1125–1129

    Article  PubMed  PubMed Central  Google Scholar 

  58. Leclercq S, El Bidi S, Aubriot JH (1995) Bousquet’s prosthesis for recurrent total hip prosthesis dislocation. Rev Chir Orthop 81:389–394

    CAS  PubMed  Google Scholar 

  59. Leiber-Wackenheim F, Brunschweiler B, Ehlinger M, Gabrion A, Mertl P (2011) Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: a 59 cases series with a mean 9 years’ follow-up. Orthop Traumatol Surg Res 97:8–14

    Article  CAS  PubMed  Google Scholar 

  60. Guyen O, Pibarot V, Vaz G, Chevillotte C, Béjui-Hugues J (2009) Use of dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res 467:465–472

    Article  PubMed  Google Scholar 

  61. Civinini R, Carulli C, Matassi F, Nistri L, Innocenti M (2012) A dual-mobility cup reduces risk of dislocation in isolated acetabular revisions. Clin Orthop Relat Res 470(12):3542–3548

    Article  PubMed  PubMed Central  Google Scholar 

  62. Delaunay C, Hamadouche M, Girard J, Duhamel A (2013) What are the causes for failures of primary hip arthroplasties in France? Clin Orthop Relat Res 471(12):3863–3869

    Article  PubMed  PubMed Central  Google Scholar 

  63. Massin PH, Orain V, Philippot R, Farizon F, Fessy MH (2012) Fixation failures of dual mobility cups. A mid-term study of 2601 hip replacements. Clin Orthop Relat Res 470:1932–1940

    Article  PubMed  Google Scholar 

  64. Fabry C, Langlois J, Hamadouche M, Bader R (2016) Intra-prostethic dislocation of dual-mobility cups after total hip arthroplasty: potentialcauses from a clinical and biomechanical perspective. Int Orthop 40(5):901–990

    Article  PubMed  Google Scholar 

  65. Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J et al (2008) Survival of dual mobility socket with a mean 17 years follow-up. Rev Chir Orthop 94:43–48

    CAS  PubMed  Google Scholar 

  66. Lautridou C, Lebel B, Burdin G, Vielpeau C (2008) Survival of the cementless Bousquet dual mobility cup: minimum 15-year follow-up of 437 total hip arthroplasties. Rev Chir Orthop Reparatrice Appar Mot 94:731–739

    Article  CAS  PubMed  Google Scholar 

  67. Rodriguez JA, Rathod PA (2012) Management factorials in THA. Large diameter heads. Is bigger always better? J Bone Joint Surg Br 94 Suppl A:52–54

  68. Amstutz HC, Le Duff MJ, Beaulé PE (2004) Prevention and treatment of dislocation after total hip replacement using large diameter balls. Clin Orthop Relat Res 429:108–116

    Article  Google Scholar 

  69. Garbuz DS, Masri BA, Duncan CP, Greidanus NV, Bohm ER, Petrak MJ et al (2012) Dislocation in revision THA. Do large heads (36 and 40 mm) result in reduced dislocation rates in a randomised clinical trial? Clin Orthop Relat Res 470:351–356

    Article  PubMed  Google Scholar 

  70. Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Maas M, Verheyen CC (2012) High incidence of pseudotumour formation after large-diameter metal-metal total hip replacement. A prospective cohort study. J Bone Joint Surg (Br) 94:755–761

    Article  CAS  Google Scholar 

  71. Anderson MJ, Murray WR, Skinner HB (1994) Constrained acetabular components. J Arthroplasty 9:17–23

    Article  CAS  PubMed  Google Scholar 

  72. Goetz DD, Bremner BRB, Callaghan JJ, Capello WN, Johnston RC (2004) Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component. A concise follow-up of a previous report. J Bone Joint Surg Am 86:2419–2423

    Article  PubMed  Google Scholar 

  73. Shapiro GS, Weiland DE, Markel DC, Padgett DE, Sculco TP, Pellicci PM (2003) The use of a constrained acetabular component for recurrent dislocation. J Arthroplasty 18:250–258

    Article  PubMed  Google Scholar 

  74. Cooke CC, Hozack W, Lavernia C, Sharkey P, Shastri S, Rothman RH (2003) Early failure mechanisms of constrained tripolar acetabular sockets used in revision total hip arthroplasty. J Arthroplasty 18:827–833

    Article  PubMed  Google Scholar 

  75. Callaghan JJ, Parvizi J, Novak CC, Bremner B, Shrader W, Lewallen DG, Johnston RC, Goetz DD (2004) A constrained liner cemented into a secure cementless acetabular shell. J Bone Joint Surg Am 86:2206–2211

    Article  PubMed  Google Scholar 

  76. Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV (2012) Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res 470:1907–1916

    Article  PubMed  Google Scholar 

  77. Ekelund A (1993) Trochanteric osteotomy for recurrent dislocation of total hip arthroplasty. J Arthroplasty 8:629–632

    Article  CAS  PubMed  Google Scholar 

  78. Kaplan SJ, Thomas WH, Poss R (1987) Trochanteric advancement for recurrent dislocation after total hip arthroplasty. J Arthroplasty 2:119–124

    Article  CAS  PubMed  Google Scholar 

  79. Beaulé PE, Ebramzadeh E, Le Duff M, Prasad R, Amstutz C (2004) Cementing a liner into a stable cementless acetabular shell: the double-socket technique. J Bone Joint Surg Am 86:929–934

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic and Traumatology Department, S. Spirito Hospital, Lungotevere in Sassia,1, Rome, Italy

    Francesco Falez, Fabio Favetti, Gabriele Panegrossi, Filippo Casella & Gianluca Mazzotta

  2. Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy

    Matteo Papalia

Authors
  1. Francesco Falez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matteo Papalia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabio Favetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabriele Panegrossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Filippo Casella
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gianluca Mazzotta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Falez.

Ethics declarations

Conflict of interest

The authors declare that they did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

Ethical standards

All procedures were in accordance with the ethical standards of the institutional and/or national research committee.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Falez, F., Papalia, M., Favetti, F. et al. Total hip arthroplasty instability in Italy. International Orthopaedics (SICOT) 41, 635–644 (2017). https://doi.org/10.1007/s00264-016-3345-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-016-3345-6

Keywords

Search

Navigation