Treatment of Recurrent Dislocation after Total Hip Arthroplasty Using Advanced Imaging and Three-Dimensional Modeling Techniques: A Case Series.

Abstract

Surgical treatment options for addressing recurrent dislocation after total hip arthroplasty (THA) vary. Identifying impingement mechanisms in an unstable THA may be beneficial in determining appropriate treatment. We sought to assess the effectiveness of developing pre-operative plans for treating hip instability after THA. We used advanced imaging and three-dimensional modeling techniques to perform impingement analyses in patients with unstable THA. We evaluated a series of eight patients who would require revision THA to treat recurrent dislocation. Using a pre-operative algorithmic approach, we built patient-specific models and evaluated hip range of motion with computed tomographic scanning and biplanar radiography. This information was used to determine a surgical treatment plan that was then executed intra-operatively. Patients were followed for 2years to determine whether they experienced another hip dislocation following treatment. Pre-operative kinematic modeling showed four of the eight patients had limited hip range of motion during flexion and internal rotation; a prominent anterior inferior iliac spine (AIIS) was found to limit hip range of motion in some of these cases. In the other four patients, range of motion was acceptable, suggesting soft-tissue causes of dislocation. No patients in this series experienced dislocation after undergoing revision THA. Advanced modeling techniques may be useful for identifying the impingement mechanisms responsible for instability after THA. Once variables contributing to limited hip range of motion are identified, surgeons can develop treatment plans to improve patient outcomes. Resecting a hypertrophic AIIS may improve hip range of motion and may be an important consideration for hip surgeons when revising unstable THAs.