Abstract
Introduction: Despite relatively low incidence, dislocation remains one of the main reasons for total hip arthroplasty (THA) revision. It is a devastating complication for a patient and a surgeon, and has high burden on the healthcare system. The aim of the present study was to assess and compare the risk factors for revision after early and delayed THA dislocations.Methods: Some 3403 THA through posterior approach for primary osteoarthritis were retrospectively studied in the Lithuanian Arthroplasty Register from 2011 to 2018. Three months after THA was the splitting time between the first event of early and delayed dislocations. Revision was set as outcome measure. Gender, affected side, number of dislocations, femoral head and neck size, and prosthesis fixation type were tested as risk factors for revision after early and delayed THA dislocations.Results: Dislocation occurred in 108 patients (3.2%), and 26 cases (0.8%) required revision. Men had statistically significant higher risk for revision due to early dislocation [hazard ratio (HR) 4.7; 1.3-17.7 confidence interval (CI)] and considerably lower risk for revision due to delayed dislocation (HR 0.5; 0.1-1.7 CI). The left side THA had twice the risk as compared to the right in the early settings (HR 2.1; 0.6-6.9 CI) which equalized after three months (HR 1.1; 0.4-3.1 CI). Some 32 mm femoral head had significantly lower risk in the early group as compared to 28 mm head (HR 0.3; 0.1-0.5 CI). Short head was associated with increased risk for revision after early dislocation, although, not statistically significant. Prosthesis fixation type was not a risk factor for revision surgery neither after early nor after delayed dislocation.Conclusion: The unique finding of gender separation was found -- men tend for revision after early dislocation and women after delayed dislocation. In early stage, additional precautions should be considered when 28 mm short metal heads are used.
Highlights
Despite relatively low incidence, dislocation remains one of the main reasons for total hip arthroplasty (THA) revision
With an aging population and growing demand for improved mobility and life quality in the increased cases of arthritis, joint replacement surgery is believed to become the most common elective surgical procedure in the following decades [1]. It is indicated in the United States that the number of patients with total joint replacement is similar to the number of patients with public’s attention catching chronic diseases, such as stroke or myocardial infarction and that the prevalence of total joint replacement is considerably higher than heart failure [1]
In the Cox regression analysis, risk of revision due to early dislocation was statistically significantly higher in males than in females (HR 4.7; 1.3-17.7 confidence interval (CI), p = 0.02), while risk of revision due to delayed dislocation was considerably lower in men (HR 0.5; 0.1-1.7 CI, p = 0.26)
Summary
Dislocation remains one of the main reasons for total hip arthroplasty (THA) revision. It is a devastating complication for a patient and a surgeon, and has high burden on the healthcare system. A similar situation can be seen in Lithuania, where 66.2% of all revisions after THA are performed due to recurrent dislocations [5] It is a devastating complication for a patient and a surgeon and has a high burden on the healthcare system [6].
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