Dislocation following total hip arthroplasty

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Reports of complications of total hip arthroplasty and strategies for management have increased in propor­ tion to the accelerated growth of the procedure as a routine orthopedic operation. With the advent of the revision hip surgery era, the occurrence of postopera­ tive hip dislocation has become perhaps the most tax­ ing complication to the arthroplasty surgeon. Dislocation now ranks as the most common clinically apparent complication of hip arthroplasty. The re­ ported incidence has ranged from under 1 % to 10% in various clinical series.1,2 In primary total hip arthro­ plasty, a 2% to 3% dislocation rate is probably repre­ sentative of the overall occurrence. With more than 120 000 hip arthroplasties performed annually in the U.S. and accepting a reoperation rate for dislocation of one-third of dislocations, the total number of reopera­ tions performed annually for dislocation is 1200. Experience of a single arthroplasty surgeon with dis­ location, however, is usually limited to a small num­ ber of cases annually. A thorough understanding of factors involved in dislocation assists in prevention and helps outline the strategy for operative manage­ ment in the recurrent case. This chapter reviews peri­ operative factors associated with dislocation and sum­ marizes current approaches to management.