Osteoarthritis of the hip is a degenerative joint disease that, besides being painful, also has a negative impact on mobility. An affected joint can be surgically replaced with an artificial prosthesis to alleviate pain and enhance mobility and quality of life. However, when the replacement hip is forced from its normal position-a so-called dislocation-these patients frequently experience injuries, undermining their trust in the artificial joint. Depending on the trauma that caused the dislocation, it may even be necessary to replace the prosthesis.
In their current review article published in Deutsches Ärzteblatt International (Dtsch Arztebl Int 2014; 111: 884-90), Jens Dargel et al. point out that the prevention of dislocation plays an important role and describe the risks that need to be addressed.
Approximately 1 in 50 patients who undergo total hip replacement for the first time will experience a dislocation. Among patients with total hip replacements that required revision and implant exchange surgeries, this rate can be as high as 1 in 4 patients (up to 28%). Here the risks include advanced age and concomitant neurological conditions. Moreover, patients should make sure to avoid certain movements, such as bending too far forward, as these can increase the risk for dislocation of the implant. Further risks arise at the time the surgery is performed: incorrect positioning of the implant, inadequate soft-tissue tension and inadequate experience of the surgeon all add to the risk for dislocation.
The authors recommend using a standardized approach for the management of dislocation following total hip replacement, based on a diagnostic and therapeutic algorithm.