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A majority of dislocation events happen outside of the first year following the index procedure
5%
16/322
A higher comorbidity burden is associated with an increased risk of dislocation
72%
233/322
The incidence of dislocation following primary THA is between 5 and 10%
19%
61/322
The utilization of uncemented components is associated with an increased risk of dislocation
2%
8/322
The utilization of a ceramic-on-polyethylene bearing surface is associated with an increased risk of dislocation
1%
4/322
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Dislocation is a complication that affects 1-3% of total hip arthroplasties (THA), and 70% occur within the first month. Patients with a higher comorbidity burden, as determined by either the Elixhauser Comorbidity Index or American Society of Anesthesiologists Score (ASA), are at increased risk of experiencing a postoperative dislocation (Answer 2).Dislocation following THA can occur secondary to a variety of factors including, but not limited to, patient noncompliance, implant malposition, and/or soft-tissue deficiency. Patients often present reporting the performance of an activity that put them in a position that provoked his or her dislocation. Anterior dislocations typically occur with extension and external rotation of the hip, while posterior dislocations occur secondary to flexion, internal rotation, and adduction of the hip.The treatment of a dislocated THA is closed reduction with immobilization, and up to two-thirds of early dislocations can be treated without additional surgery. In the setting of component malposition, soft-tissue deficiency, or bearing-surface wear, revision THA is often necessary.Gillinov et al. provide an up-to-date investigation into the risk factors for dislocation following primary total hip arthroplasty for osteoarthritis. The authors utilized the PearlDiver MHip database, and their study population consisted of 155,185 primary THAs. Overall, 3,630 patients (2.3%) experienced dislocation within two years. The authors identified the following risk factors for dislocation: patient age <65, female sex, BMI < 20, higher Elixhauser Comorbidity index, cemented prosthesis, and the use of metal-on-poly or metal-on-metal implants. 52% occurred within the first 3 months following surgery, and 57% of patients experienced multiple dislocations.Hermansen et al. utilized the Danish Hip Arthroplasty Register to determine the true incidence of and risk factors for dislocation following primary THA. Their study included 1,861 dislocations in 1,079 patients, an incidence of 3.5%. The authors identified age >= 75, male sex, ASA score, head size and type, fixation method and surgical approach as significant factors for dislocation.Stavrakis et al. performed a comparative study to investigate the complications following THA in patients with or without osteonecrosis. The authors utilized a statewide database that consisted of 202,987 patients, 5,627 of whom underwent THA for osteonecrosis. Overall, the authors identified osteonecrosis as a risk factor for sepsis and readmission but noted that it did not confer an increased risk for postoperative instability or mortality.Incorrect Answers:Answer 1: A majority of dislocations happen within the first year of surgery, and 52% occur within the first three months.Answer 3: The incidence of dislocation following primary THA is approximately 1-3%.Answer 4: The utilization of cemented components is a risk factor for postoperative dislocation.Answer 5: The utilization of metal-on-poly or metal-on-metal bearing surfaces is a risk factor for postoperative dislocation.
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