REVISION FOR RECURRENT DISLOCATION AFTER THA

Abstract

Dislocation after THA is the most common complication in modern THA, The reported failure rate of reoperation for recurrent instability is higher than any other indication for revision surgery.

Treatment of dislocation after THA

Non-operative treatment

The first episode of dislocation after THA is usually treated by close reduction with or without brace treatment. There is no agreement about the role and effectiveness of bracing. Generally, bracing is indicated in the following circumstances:

1. First dislocation

2. Early laxity

3. No component malposition

4. Patients with poor general condition

The main management issues are about managing recurrent instability. Treatment choice is often complex and management begins by identifying the cause of instability.

Causes to consider:

1. Component issue

2. Impingement

3. Soft tissue imbalance

4. Laxtiy

5. Abductor weakness

6. Trochanteric non-uion

Surgical Treatment

The decision to use operative treatment to stabilize the hip joint is complex and the surgeon must take into consideration:

1. How many times the hip dislocated

2. Interveral between dislocation

3. How long after THA the dislocation occur

4. Can the problem be solved by an operation

5. Operative risks

Treatment choices depends on the underlying mechanism of dislocation:

1. Correction of malposition

2. Correction of soft tissue laxity

3. Release contractures

4. Addressing problems of impingement

5. Using a large femoral head

6. Constrained liners