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Recurrent instability after THA usually amenable to nonoperative or surgical management
Instability, a common but significant complication of primary total hip arthroplasty (THA), can be managed with conservative management or revision surgery, but patient and surgical factors also affect the frequency with which this problem occurs, according to this published study.
The researchers reported that in published studies, 50% to 70% of dislocations occurred 5 weeks to 3 months postoperatively, with more than 75% of them detected in the first postoperative year.
“Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for experienced joint surgeons,” the study authors wrote.
They stressed the important role that preoperative planning — and conservative management in patients without neurological disorders — plays in the care of patients with an unstable THA.
Should conservative management fail, surgical options to restore hip stability should be considered, such as revision of malpositioned components, modular component exchanges, bipolar arthroplasty, using a constrained liner, soft tissue reinforcement and advancement of the greater trochanter. In the some of the studies cited the latter increased hip stability in 81% to 90% of cases because it improved the abductor mechanism resting length and function.
Patient risk factors should also be considered preoperatively, the authors noted, however patients that do not respond to either treatment may be candidates for end-stage revision to a resection arthroplasty.
“Surgeon experience is the final surgical risk factor for THA instability. The rate of dislocation has an inverse relationship to the experience of the surgeon. For every ten primary arthroplasties performed yearly, there is a 50% reduction in the postoperative dislocation rate. There is also a high dislocation rate amongst surgeons who perform less than thirty THAs yearly,” the researchers stated in the study.