RECURRENT DISLOCATION AFTER TOTAL HIP ARTHROPLASTY: TREATMENT WITH AN ACHILLES TENDON ALLOGRAFT

Abstract

Surgical treatment of recurrent dislocation after total hip arthroplasty (THA) is challenging with often disappointing results. The influence of the posterior hip capsule is important, and restoration of its function is a major goal of treatment. We describe our experience using an Achilles tendon allograft as a checkrein to limit hip internal rotation and to prevent posterior instability. Twenty unstable THAs were treated using this technique, eliminating instability in fifteen. At an average follow-up of 3.6 years, Achilles tendon allograft augmentation has proven a useful adjunct for the treatment of recurrent posterior dislocation after THA in selected patients.

The purpose of this study is to review our results with a novel treatment for recurrent dislocation after total hip arthroplasty (THA) using an Achilles tendon allograft as a checkrein to prevent instability.

Achilles tendon allograft augmentation has proved to be a useful adjunct for the treatment of recurrent posterior dislocation after THA in selected patients.

Surgical treatment of recurrent dislocation after total hip arthroplasty (THA) is challenging with often disappointing results. Among possible causes of dislocation, the influence of the static soft tissue restraint provided by the hip capsule is important, and restoration of its integrity and function is a major goal of treatment. We describe a new technique in which an Achilles tendon allograft is employed as a checkrein to limit hip internal rotation and to prevent posterior instability.

Twenty unstable THAs with recurrent instability were treated using this technique, eliminating instability in fifteen at an average follow-up of 3.6 (0.5 to 6.6) years.

Prospective data was collected and reviewed on the first twenty patients with recurrent THA instability stabilized with an Achilles tendon allograft. Head and liner exchanges accompanied the allograft. Use of a constrained cup was considered a failure.

Instability was successfully controlled in 75% of patients with use of the Achilles allograft. The technique is an important addition to the treatment arsenal of this difficult problem.