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The Journal of Bone and Joint Surgery.... Jan 2016Hip dysplasia is a leading precursor of osteoarthritis and is seen in 20% to 40% of patients with osteoarthritis of the hip. An increase in mechanical stress on the... (Review)
Review
Hip dysplasia is a leading precursor of osteoarthritis and is seen in 20% to 40% of patients with osteoarthritis of the hip. An increase in mechanical stress on the cartilage matrix with failure of the acetabular labrum represents the major pathomechanism of degeneration. Because the prevalence of associated femoral deformities is high (>50%), the structural anatomy of the dysplastic hip must be assessed in multiple planes using radiographs and, if needed, advanced imaging modalities. Acetabular osteotomy (periacetabular and/or rotational) is the most commonly used procedure for the treatment of the majority of dysplastic hips in adults. Modern total hip replacement remains an excellent option for the more arthritic joints. Difficulties can arise from anatomical abnormalities and previous operations.
Topics: Acetabulum; Adolescent; Arthroplasty, Replacement, Hip; Arthroscopy; Disease Progression; Female; Follow-Up Studies; Hip Dislocation; Humans; Male; Osteoarthritis, Hip; Osteotomy; Risk Assessment; Severity of Illness Index; Stress, Mechanical; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 26738905
DOI: 10.2106/JBJS.O.00109 -
Deutsches Arzteblatt International Dec 2014Hip replacement ranks among the more successful operations on the musculoskeletal system, but it can have serious complications. A common one is dislocation of the total... (Review)
Review
BACKGROUND
Hip replacement ranks among the more successful operations on the musculoskeletal system, but it can have serious complications. A common one is dislocation of the total hip endoprosthesis, an event that arises in about 2% of patients within 1 year of the operation. Physicians should be aware of how this problem can be prevented and, if necessary, treated, so that the degree of trauma due to hip dislocation after hip replacement surgery can be kept to a minimum.
METHODS
The authors searched Medline selectively for pertinent publications and analyzed the annual reports of international endoprosthesis registries.
RESULTS
The rate of dislocation of primary hip replacements ranges from 0.2% to 10% per year, while that of artificial hip joints that have already been surgically revised can be as high as 28%, depending on the patient population, the follow-up interval, and the type of prosthesis. Patient-specific risk factors for displacement of a hip endoprosthesis include advanced age, accompanying neurologic disease, and impaired compliance. Patients should scrupulously avoid hip movements such as bending far forward from a standing position, or internal rotation of the flexed hip. Operation-specific risk factors include suboptimal implant position, insufficient soft-tissue tension, and inadequate experience of the surgeon. Conservative treatment is justified the first time dislocation occurs without any identifiable cause. If a mechanical cause of instability is found, then operative revision should be performed as recommended in a standardized treatment algorithm, because, otherwise, dislocation is likely to recur.
CONCLUSION
The dislocation of a total hip endoprosthesis is an emotionally traumatizing event that should be prevented if possible. Preoperative risk assessment should be performed and the operation should be performed with optimal technique, including the best possible physical configuration of implant components, soft-tissue balance, and an adequately experienced orthopedic surgeon.
Topics: Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Prosthesis; Humans; Immobilization; Physical Therapy Modalities; Reoperation
PubMed: 25597367
DOI: 10.3238/arztebl.2014.0884 -
Orthopaedic Surgery Dec 2019Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA... (Review)
Review
Total hip arthroplasty (THA) of Crowe type IV developmental dysplasia of the hip (DDH) is challenging. Although traditional (lateral, posterolateral, and posterior) THA approaches have been used with great anatomic success, they damage periarticular muscles, which are already quite weak in type IV DDH. The recently developed direct anterior approach (DAA) can provide an inter-nerve and inter-muscle approach for THA of type IV dysplasia hips. However, femur exposure with the DAA could be difficult during surgery and it is hard to apply femoral shortening osteotomy. THA techniques used for type IV DDH include anatomic hip center techniques (true acetabular reconstruction) and high hip center techniques, wherein an acetabulum is reconstructed above the original one. Although anatomic construction of the hip center is considered "the gold standard" treatment, it is impossible if the anatomical acetabular is too small and shallow. Procedures used to support type IV DDH reduction with anatomic hip center techniques include greater trochanter osteotomy, lesser trochanter osteotomy, and subtrochanteric osteotomy. However, these techniques have yet to be standardized, and it is unclear which is best for type IV DDH. One-state and two-state non-osteotomy reduction techniques have also been introduced to treat type IV DDH. Potential complications of THA performed in patients with type IV DDH include leg length discrepancy (LLD), peri-operative femur fracture, nonunion of the osteotomy site, and nerve injury. It is worth noting that nowadays an increasing number of Crowe type IV DDH patients are more sensitive to postoperative LLD.
Topics: Arthroplasty, Replacement, Hip; Hip Dislocation; Humans; Osteotomy; Postoperative Complications
PubMed: 31755242
DOI: 10.1111/os.12576 -
Acta Orthopaedica Dec 2020Background and purpose - Hip precautions limiting flexion, adduction, and internal rotation have been prescribed traditionally to minimize dislocation rates following...
Background and purpose - Hip precautions limiting flexion, adduction, and internal rotation have been prescribed traditionally to minimize dislocation rates following THA. We assessed the prevalence of hip dislocation following posterior approach total hip arthroplasty without postoperative hip precautions. Methods - A systematic review of multiple medical databases was performed using the PRISMA guidelines and checklist. All clinical outcome studies that reported dislocation rates and postoperative instructions following posterior approach, primary surgery, published within the last 6 years, were included. Results - 6,900 patients were included from 7 Level I-IV studies, with 3,517 treated with and 3,383 without precautions. There was no statistically significant difference in the rates of dislocation between groups (2.2% in restricted group vs. 2.0% in unrestricted group). All but 1 study demonstrated no statistically significant differences in patient-reported outcome scores between restricted and unrestricted groups, including those pertaining to return to function, confidence, and pain. Interpretation - The review found no impact on dislocation rates following total hip arthroplasty performed through a posterior approach, regardless of the use of hip precautions. We also found no impact of the prescription of hip precautions on patient-reported outcome scores.
Topics: Arthroplasty, Replacement, Hip; Early Ambulation; Hip Dislocation; Humans; Patient Reported Outcome Measures; Postoperative Complications
PubMed: 32718213
DOI: 10.1080/17453674.2020.1795598 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Despite the progress made in the past decades, hip disorders are one of the most common orthopedic problems in the context of paralysis. The etiology can be congenital... (Review)
Review
Despite the progress made in the past decades, hip disorders are one of the most common orthopedic problems in the context of paralysis. The etiology can be congenital (malformation such as myelomeningoceles, genetic neuromuscular disorders) or acquired (cerebral palsy, post-traumatic). In these conditions, the orthopedic deformities are minimal at birth. They can develop as the child grows, at different ages, depending on the etiology, severity of the neuromuscular disorder and functional potential. Hip subluxation and dislocation can compromise standing and walking capacities, but also the quality of the seated position and the personal care. Daily life activities and participation are restricted and influence the disabled person's quality of life. Paralytic dislocation of the hip is the orthopedic deformity that has be biggest impact on day-to-day life, general health and the overall orthopedic result in adulthood. Neuro-orthopedic care is challenging. However, there are basic principles that one must know to ensure good long-term quality of life in patients suffering from paralytic dislocations of the hip. When planning the treatment strategy, it is essential to take into consideration the day-to-day life and to integrate the patient's experiences and needs, along with those of their caretakers. The objective of this review is to outline the differences in paralytic dislocations of the hip of diverse etiology, to present evaluation principles useful in daily clinical practice and to help practitioners in choosing a treatment strategy.
Topics: Adult; Cerebral Palsy; Child; Hip Dislocation; Humans; Infant, Newborn; Joint Dislocations; Paralysis; Quality of Life
PubMed: 34871796
DOI: 10.1016/j.otsr.2021.103166 -
Ugeskrift For Laeger Jul 2014Hip dysplasia and femoroacetabular impingement are frequent causes of hip pain and can often be treated with joint preserving surgery to prevent secondary osteoarthritis... (Review)
Review
Hip dysplasia and femoroacetabular impingement are frequent causes of hip pain and can often be treated with joint preserving surgery to prevent secondary osteoarthritis (OA). Patient education, progressive resistance training and weight loss at a BMI > 27 kg/m(2) has documented effect on pain and function in primary hip OA. If wound infection occurs after total hip arthroplasty the patient should not be treated with peroral antibiotics but instead be referred to an orthopaedic surgeon. There is no documentation that post-operative movement restrictions prevent dislocation of hip after total hip arthroplasty.
Topics: Arthroplasty, Replacement, Hip; Femoracetabular Impingement; Hip Dislocation; Humans; Osteoarthritis, Hip; Pain; Pain Management; Patient Education as Topic; Resistance Training
PubMed: 25292227
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Feb 2019The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial... (Review)
Review
The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the spastic and retracted muscles to displace the femoral head, eventually causing it to dislocate. The risk of hip dislocation increases with the severity and extent of CP, exceeding 70% in the most severe cases. Hip dislocation causes pain in up to 30% of cases, carries a risk of orthopaedic and cutaneous complications and hinders patient installation and nursing care. These adverse outcomes warrant routine screening, which has been proven effective in lessening the frequency and severity of hip displacement. Preventive techniques including physical therapy, orthoses and treatments to alleviate spasticity are strongly recommended in every case. The beneficial effects of treating spasticity, if needed via neurosurgical procedures, have been convincingly established. Orthopaedic surgery is required when prevention fails. Soft-tissue release is designed to correct the asymmetry in the forces applied by the muscles. Femoral osteotomy creates the possibility for spontaneous correction of secondary acetabular dysplasia. Progress has been made in standardising the use of multilevel surgery involving the soft tissues, femur and pelvis, which is often effective in correcting the morphological abnormalities and stabilising the joint. When hip pain or alterations are severe, hip resection or total hip arthroplasty are highly effective in alleviating the pain and improving patient comfort. The spastic hip is a complex condition in which currently available screening protocols and treatment strategies have been proven effective in benefitting patient outcomes.
Topics: Adolescent; Arthrodesis; Cerebral Palsy; Child; Conservative Treatment; Femur; Hip Dislocation; Hip Joint; Humans; Muscle Spasticity; Neurosurgical Procedures; Osteotomy; Pain; Physical Examination; Quality of Life; Radiography
PubMed: 30056240
DOI: 10.1016/j.otsr.2018.03.018 -
The Bone & Joint Journal Nov 2013Dislocation is one of the most common causes of patient and surgeon dissatisfaction following hip replacement and to treat it, the causes must first be understood.... (Review)
Review
Dislocation is one of the most common causes of patient and surgeon dissatisfaction following hip replacement and to treat it, the causes must first be understood. Patient factors include age greater than 70 years, medical comorbidities, female gender, ligamentous laxity, revision surgery, issues with the abductors, and patient education. Surgeon factors include the annual quantity of procedures and experience, the surgical approach, adequate restoration of femoral offset and leg length, component position, and soft-tissue or bony impingement. Implant factors include the design of the head and neck region, and so-called skirts on longer neck lengths. There should be offset choices available in order to restore soft-tissue tension. Lipped liners aid in gaining stability, yet if improperly placed may result in impingement and dislocation. Late dislocation may result from polyethylene wear, soft-tissue destruction, trochanteric or abductor disruption and weakness, or infection. Understanding the causes of hip dislocation facilitates prevention in a majority of instances. Proper pre-operative planning includes the identification of patients with a high offset in whom inadequate restoration of offset will reduce soft-tissue tension and abductor efficiency. Component position must be accurate to achieve stability without impingement. Finally, patient education cannot be over-emphasised, as most dislocations occur early, and are preventable with proper instructions.
Topics: Age Factors; Arthroplasty, Replacement, Hip; Clinical Competence; Comorbidity; Hip Dislocation; Hip Prosthesis; Humans; Patient Education as Topic; Postoperative Complications; Prosthesis Design; Radiography; Recurrence; Reoperation; Risk Factors; Sex Factors
PubMed: 24187356
DOI: 10.1302/0301-620X.95B11.32645 -
Acta Orthopaedica Feb 2017Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have... (Review)
Review
Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods - A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results - 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors. Interpretation - The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Global Health; Hip Dislocation; Hip Prosthesis; Humans; Incidence; Patient Positioning; Risk Factors; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 27879150
DOI: 10.1080/17453674.2016.1251255 -
The Journal of the American Academy of... Nov 2022Total hip arthroplasty (THA) may be complicated by dislocation. The incidence of and risk factors for dislocation are incompletely understood. This study aimed to...
INTRODUCTION
Total hip arthroplasty (THA) may be complicated by dislocation. The incidence of and risk factors for dislocation are incompletely understood. This study aimed to determine the incidence and predictors of hip dislocation within 2 years of primary THA.
METHODS
The 2010 to 2020 PearlDiver MHip database was used to identify patients undergoing primary THA for osteoarthritis with a minimum of 2 years of postoperative data. Dislocation was identified by associated codes. Age, sex, body mass index, Elixhauser Comorbidity Index, fixation method, and bearing surface were compared for patients with dislocation versus control subjects by multivariate regression. Timing and cumulative incidence of dislocation were assessed.
RESULTS
Among 155,185 primary THAs, dislocation occurred within 2 years in 3,630 (2.3%). By multivariate analysis, dislocation was associated with younger age (<65 years), female sex, body mass index < 20, higher Elixhauser Comorbidity Index, cemented prosthesis, and use of metal-on-poly or metal-on-metal implants ( P< 0.05 for each). Among patients who experienced at least one dislocation, 52% of first-time dislocations occurred in the first 3 months; 57% had more than one and 11% experienced >5 postoperative dislocation events. Revision surgery was done within 2 years of index THA for 45.6% of those experiencing dislocation versus 1.8% of those who did not ( P < 0.001).
CONCLUSION
This study found that 2.3% of a large cohort of primary THA patients experienced dislocation within 2 years, identified risk factors for dislocation, and demonstrated that most patients experiencing dislocation had recurrent episodes of instability and were more likely to require revision surgery.
Topics: Humans; Female; Aged; Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Prosthesis; Incidence; Retrospective Studies; Reoperation; Joint Dislocations; Risk Factors; Osteoarthritis; Prosthesis Failure
PubMed: 35947825
DOI: 10.5435/JAAOS-D-22-00150