Abstract
Aim
To determine the outcome, the need for revision surgery, quality of life (QOL) of patients and the financial implications of instability following successful closed reduction of dislocation after primary total hip arthroplasty (THA).
Methods
Retrospective study. Parameters studied include indications for primary hip replacement, femoral head size, outcome in terms of the rate of recurrent dislocation, time to second dislocation and the need for revision surgery. QOL assessment was made cross-sectionally at a minimum follow-up of 1 year using the Oxford Hip Score (OHS) and the EuroQol-5 Dimension (EQ-5D) questionnaire.
Results
Over a 6-year period, 99 patients presented with 101 first time dislocated primary total hip replacements. Mean patient age was 71 years. Head size used was 28mm or smaller in all the hips. All the dislocations underwent successful closed reduction. 61 (60.4%) hips re-dislocated and the median time to the second episode was 103 days. At one-year follow up, 7 patients had died. Of the remaining 94 hips in 92 patients, 48 (51%) THAs have undergone revision procedures. Post-revision, 15% of the hips re-dislocated and more than half of those needed a further surgical procedure to correct the instability. The mean OHS and the EQ-5D health state was observed to get worse with recurrent dislocation and revision surgery and the difference between the mean Oxford hip scores of the revision surgery group and the other 2 groups was statistically significant. The total cost of instability exceeded well over half a million pounds in our series.
Discussion
Dislocation following primary THA continues to be a problem and recurrent dislocation presents a significant management challenge. Revision surgery is expensive, has a high failure rate when performed for instability and significantly worsens the QOL of these patients. The financial impact of the burden of revision surgery continues to increase.
