What Factors Reduce the Incidence of Early Dislocations in Aseptic Total Hip Revisions with Stem Retention?

Abstract

It is unclear which factors are the most important protectors for early postoperative dislocation in aseptic total hip arthroplasty (THA) revisions with stem retention. Therefore, we sought to determine what factors reduce the incidence of dislocations among these patients. Single institution retrospective review was made of 83 consecutive aseptic THA revisions of the head/liner and/or cup performed by five surgeons between 2017 and 2020. Periprosthetic infections and femoral component revisions were excluded. Demographics, preoperative diagnosis, revision type, surgical approach, use of dual mobility systems, length of stay, skin-to-skin time, transfusions, complications, and dislocations were assessed. Pearson correlation/logistic regression analyses were used to determine association/independent predictors of dislocation; α was set at 0.05. The overall dislocation rate was 12%. In Pearson correlation, only preoperative diagnosis (instability vs. other, −0.241, p = 0.028) and revision type (only liner vs. cup, −0.304, p = 0.005) were significantly associated with dislocations. In logistic regression, only preoperative diagnosis other than instability (odds ratio [OR] = 0.235, p = 0.038) and cup revision (OR = 0.130, p = 0.014) were found significant protectors against dislocation. Surgical approach and dual mobility systems were not independent predictors of dislocations (p = 0.184 and p = 0.083, respectively). Dislocation rates were significantly different between those cases that had the cup revised (4.0%) and those that did not (24.2%; p = 0.012). Preoperative diagnosis other than instability and cup revision seemed to be protective against early dislocation. Revision of the cup, in particular, seemed to be the most important factor to avoid dislocations while use of dual mobility liners per se did not significantly reduce that risk. The role of isolated liner exchanges in revision THA continues to evolve and should be reserved for appropriately selected patients.

Keywords

aseptic revision - dislocation - total hip arthroplasty - liner exchange - acetabular cup

Publication History

Received: 24 February 2021

Accepted: 03 March 2021

Article published online:
15 June 2021

• References

• 1 Faldini C, Stefanini N, Fenga D. et al. How to prevent dislocation after revision total hip arthroplasty: a systematic review of the risk factors and a focus on treatment options. J Orthop Traumatol 2018; 19 (01) 17
• 2 Herman A, Masri BA, Duncan CP, Greidanus NV, Garbuz DS. Multivariate analysis of risk factors for re-dislocation after revision for dislocation after total hip arthroplasty. Hip Int 2020; 30 (01) 93-100
• 3 Yoshimoto K, Nakashima Y, Aota S. et al. Re-dislocation after revision total hip arthroplasty for recurrent dislocation: a multicentre study. Int Orthop 2017; 41 (02) 253-258
• 4 Horsthemke MD, Koenig C, Gosheger G, Hardes J, Hoell S. The minimalinvasive direct anterior approach in aseptic cup revision hip arthroplasty: a mid-term follow-up. Arch Orthop Trauma Surg 2019; 139 (01) 121-126
• 5 Berend KR, Kavolus JJ, Morris MJ, Lombardi Jr AV. Primary and revision anterior supine total hip arthroplasty: an analysis of complications and reoperations. Instr Course Lect 2013; 62: 251-263
• 6 Nogler MM, Thaler MR. The direct anterior approach for hip revision: accessing the entire femoral diaphysis without endangering the nerve supply. J Arthroplasty 2017; 32 (02) 510-514
• 7 Manrique J, Chen AF, Heller S, Hozack WJ. Direct anterior approach for revision total hip arthroplasty. Ann Transl Med 2014; 2 (10) 100
• 8 Darrith B, Courtney PM, Della Valle CJ. Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J 2018; 100-B (01) 11-19
• 9 Schmidt A, Batailler C, Fary C, Servien E, Lustig S. Dual mobility cups in revision total hip arthroplasty: efficient strategy to decrease dislocation risk. J Arthroplasty 2020; 35 (02) 500-507
• 10 Hartzler MA, Abdel MP, Sculco PK, Taunton MJ, Pagnano MW, Hanssen AD. Otto Aufranc Award: dual-mobility constructs in revision THA reduced dislocation, rerevision, and reoperation compared with large femoral heads. Clin Orthop Relat Res 2018; 476 (02) 293-301
• 11 Abdel MP. Dual-mobility constructs in revision total hip arthroplasties. J Arthroplasty 2018; 33 (05) 1328-1330
• 12 Seagrave KG, Troelsen A, Malchau H, Husted H, Gromov K. Acetabular cup position and risk of dislocation in primary total hip arthroplasty. Acta Orthop 2017; 88 (01) 10-17
• 13 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
• 14 Itokawa T, Nakashima Y, Yamamoto T. et al. Late dislocation is associated with recurrence after total hip arthroplasty. Int Orthop 2013; 37 (08) 1457-1463
• 15 Meek RM, Allan DB, McPhillips G, Kerr L, Howie CR. Late dislocation after total hip arthroplasty. Clin Med Res 2008; 6 (01) 17-23