Advertisement

Nonconcentric and Irregular Dislocations of Total Hip Arthroplasties: Radiographic Analysis and Review of the Literature

      Abstract

      Background

      Total hip arthroplasty (THA) is one of the most successful operations in all of medicine in improving patient pain and restoring function. However, complications do arise after primary and revision THA. Dislocation of a THA, also known as instability, occurs in 1–2% of primary THAs and up to 30% of revision THAs. Most dislocations in the United States are initially managed with closed reduction under procedural sedation in emergency departments (EDs) by on-call orthopedists or emergency medicine specialists.

      Objective

      In this review the characteristics of the articulations that may require closed reduction in the ED are described, as well as their radiographic findings prior to reduction. Finally, we present subtle radiographic findings associated with failed closed reductions.

      Discussion

      Due to the different types of implants that have been introduced, closed reduction can be challenging in certain cases. Iatrogenic intraprosthetic dislocations are becoming more common with the increased use of dual-mobility liners. There are also dislocations after staged revision THA cases with the use of spacers. In spacers with semi-constrained articulation, there is the possibility of partial reduction of the spacer.

      Conclusions

      Dislocation is one of the most common mechanical complications after primary and revision THA. In the majority of the cases, acute closed reduction can be achieved successfully in the ED setting. However, there are specific dislocation types that present unique challenges to acute reduction.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ethgen O.
        • Bruyère O.
        • Richy F.
        • Dardennes C.
        • Reginster J.-Y.
        Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature.
        J Bone Joint Surg Am. 2004; 86: 963-974
        • Lehil M.S.
        • Bozic K.J.
        Trends in total hip arthroplasty implant utilization in the United States.
        J Arthroplasty. 2014; 29: 1915-1918
        • Maradit Kremers H.
        • Larson D.R.
        • Crowson C.S.
        • et al.
        Prevalence of total hip and knee replacement in the United States.
        J Bone Joint Surg Am. 2015; 97: 1386-1397
        • Wolford M.L.
        • Palso K.
        • Bercovitz A.
        Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000–2010.
        NCHS Data Brief. 2015; : 1-8
        • Sutphen S.A.
        • Lipman J.D.
        • Jerabek S.A.
        • Mayman D.J.
        • Esposito C.I.
        Treatment of recurrent dislocation after total hip arthroplasty using advanced imaging and three-dimensional modeling techniques: a case series.
        HSS J. 2019; (Available at:)
        • Alberton G.M.
        • High W.A.
        • Morrey B.F.
        Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options.
        J Bone Joint Surg Am. 2002; 84: 1788-1792
        • Eftekhar N.S.
        Dislocation and instability complicating low friction arthroplasty of the hip joint.
        Clin Orthop. 2006; 453: 1-5
        • Guo L.
        • Yang Y.
        • An B.
        • et al.
        Risk factors for dislocation after revision total hip arthroplasty: a systematic review and meta-analysis.
        Int J Surg. 2017; 38: 123-129
        • Parvizi J.
        • Picinic E.
        • Sharkey P.F.
        Revision total hip arthroplasty for instability: surgical techniques and principles.
        J Bone Joint Surg Am. 2008; 90: 1134-1142
        • Philippot R.
        • Adam P.
        • Reckhaus M.
        • et al.
        Prevention of dislocation in total hip revision surgery using a dual mobility design.
        Orthop Traumatol Surg Res. 2009; 95: 407-413
        • Birdwell S.
        • Wilke E.
        Closed reduction of constrained total hip arthroplasty in the ED.
        J Emerg Med. 2011; 40: 162-166
        • Frymann S.J.
        • Cumberbatch G.L.A.
        • Stearman A.S.L.
        Reduction of dislocated hip prosthesis in the emergency department using conscious sedation: a prospective study.
        Emerg Med J. 2005; 22: 807-809
        • Germann C.A.
        • Geyer D.A.
        • Perron A.D.
        Closed reduction of prosthetic hip dislocation by emergency physicians.
        Am J Emerg Med. 2005; 23: 800-805
        • Zahar A.
        • Rastogi A.
        • Kendoff D.
        Dislocation after total hip arthroplasty.
        Curr Rev Musculoskelet Med. 2013; 6: 350-356
        • De Martino I.
        • Triantafyllopoulos G.K.
        • Sculco P.K.
        • Sculco T.P.
        Dual mobility cups in total hip arthroplasty.
        World J Orthop. 2014; 5: 180-187
        • Addona J.L.
        • Gu A.
        • De Martino I.
        • Malahias M.-A.
        • Sculco T.P.
        • Sculco P.K.
        High rate of early intraprosthetic dislocations of dual mobility implants: a single surgeon series of primary and revision total hip replacements.
        J Arthroplasty. 2019; 34: 2793-2798
        • De Martino I.
        • D’Apolito R.
        • Waddell B.S.
        • McLawhorn A.S.
        • Sculco P.K.
        • Sculco T.P.
        Early intraprosthetic dislocation in dual-mobility implants: a systematic review.
        Arthroplast Today. 2017; 3: 197-202
        • Waddell B.S.
        • De Martino I.
        • Sculco T.
        • Sculco P.
        Total hip arthroplasty dislocations are more complex than they appear: a case report of intraprosthetic dislocation of an anatomic dual-mobility implant after closed reduction.
        Ochsner J. 2016; 16: 185-190
        • Georgiou G.
        • Siapkara A.
        • Dimitrakopoulou A.
        • Provelengios S.
        • Dounis E.
        Dissociation of bipolar hemiarthroplasty of the hip after dislocation.
        Injury. 2006; 37: 162-168
        • Samona J.
        • Flanagan B.
        • Walter N.
        Acute disassembly and dissociation of a dual-mobility next-generation prosthesis.
        Orthopedics. 2016; 39: e980-e983
        • Schirmers J.
        • Horazdovsky R.
        • Marston S.
        Early intraprosthetic dislocation of dual-mobility total hip arthroplasty implant following attempted closed reduction: a case report.
        Reconstr Rev. 2014; 5: 23-26
        • Cvetanovich G.L.
        • Fillingham Y.A.
        • Della Valle C.J.
        • Sporer S.M.
        Intraprosthetic dislocation of dual-mobility bearings associated with closed reduction.
        JBJS Case Connect. 2015; 5: e26
        • Chalmers B.P.
        • Mabry T.M.
        • Abdel M.P.
        • Berry D.J.
        • Hanssen A.D.
        • Perry K.I.
        Two-stage revision total hip arthroplasty with a specific articulating antibiotic spacer design: reliable periprosthetic joint infection eradication and functional improvement.
        J Arthroplasty. 2018; 33: 3746-3753
        • Jacobs C.
        • Christensen C.P.
        • Berend M.E.
        Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection.
        J Am Acad Orthop Surg. 2009; 17: 356-368
        • Duncan C.P.
        • Beauchamp C.
        A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip.
        Orthop Clin North Am. 1993; 24: 751-759
        • Younger A.S.E.
        • Duncan C.P.
        • Masri B.A.
        Treatment of infection associated with segmental bone loss in the proximal part of the femur in two stages with use of an antibiotic-loaded interval prosthesis.
        J Bone Joint Surg Am. 1998; 80: 60-69
        • Scharfenberger A.
        • Clark M.
        • Lavoie G.
        • O’Connor G.
        • Masson E.
        • Beaupre L.A.
        Treatment of an infected total hip replacement with the PROSTALAC system. Part 2: Health-related quality of life and function with the PROSTALAC implant in situ.
        Can J Surg J Can Chir. 2007; 50: 29-33