Abstract：Objective To analyze the risk factors and preventive strategy of dislocation after total hip arthroplasty. Methods The database was searched and relevant references were analyzed. Risk factors of dislocation were identified and the advances in the prevention and treatment of dislocation were also analyzed. Results The cause of dislocation is multifactorial including patient related factors, surgery factors, prosthesis design, and soft tissue tension, etc. The strategy to decrease the risk including identifying the patient related factors, avoiding malposition of the prothesis, reconstruction of enough offset and soft tissue tension, maximum of the head-neck ratio, and applying to restrictive component in high risky patients. Conclusions Identifying the risk factors and taking the related preventive measure is necessary to decrease the dislocation risk. As for the recurrent case, finding out the cause of the hip instability and performing the revision surgery will often succeed.
董玉雷 翁习生. 全髋关节置换术后脱位的防治[J]. 中华解剖与临床杂志, 2014, 19(1): 67-70.
Dong Yulei, Weng Xisheng. The prevention and treatment of dislocation after total hip arthroplasty. Chinese Journal of Anatomy and Clinics, 2014, 19(1): 67-70.
Parvizi J, Picinic E, Sharkey PF. Revision total hip arthroplasty for instability: surgical techniques and principles[J].J Bone Joint Surg Am,2008 ,90(5):1134-1142.
[2]
Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States[J].J Bone Joint Surg Am,2009,91(1):128-133.
[3]
Moran M, Walmsley P, Gray A, et al. Does body mass index affect the early outcome of primary total hip arthroplasty[J]. J Arthroplasty,2005,20(7):866-869.
[4]
Davis AM, Wood AM, Keenan AC, et al. Does body mass index affect clinical outcome post-operatively and at five years after primary unilateral total hip replacement performed for osteoarthritis A multivariate analysis of prospective data[J].J Bone Joint Surg Br,2011,93(9):1178-1182
[5]
Elson LC, Barr CJ, Chandran SE, et al. Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning[J]. J Arthroplasty,2013,28(8 Suppl):41-44.
[6]
Barrack RL, Krempec JA, Clohisy JC, et al. Accuracy of acetabular component position in hip arthroplasty[J].J Bone Joint Surg Am,2013,95(19):1760-1768.
[7]
Brooks PJ. Dislocation following total hip replacement: causes and cures[J]. Bone Joint J,2013,95-B(11 Suppl A):67-69.
[8]
Hailer NP, Weiss RJ, Stark A, et al. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register[J]. Acta Orthop,2012,83(5):442-448.
[9]
Krenzel BA, Berend ME, Malinzak RA, et al. High preoperative range of motion is a significant risk factor for dislocation in primary total hip arthroplasty[J]. J Arthroplasty,2010,25(6 Suppl):31-35
[10]
Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation[J].Clin Orthop Relat Res,2002,(405):46-53.
[11]
Ji HM, Kim KC, Lee YK, et al. Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateralapproach[J].J Arthroplasty,2012,27(3):378-385.
[12]
Jameson SS, Mason J, Baker P, et al. A Comparison of Surgical Approaches for Primary Hip Arthroplasty: A Cohort Study of Patient Reported Outcome Measures (PROMs) and Early Revision Using Linked National Databases[J].J Arthroplasty,2013,pii: S0883-5403(13)00872-3.
[13]
Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip replacement arthoplasties[J].J Bone Joint Surg Am,1978,60(2):217-220.
[14]
Amuwa C, Dorr LD. The combined anteversion technique for acetabular component anteversion[J].J Arthroplasty,2008,23(7):1068-1170.
[15]
Nakashima Y, Hirata M, Akiyama M,et al. Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty.Int Orthop[J].Int Orthop,2014,38(1):27-32.
[16]
Archbold HAP, Mockford B, Molloy D, et al. The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability[J].J Bone Joint Surg Br,2006,88-B(7):883-886.
[17]
Sotereanos NG, Miller MC, Smith B, et al. Using intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty[J]. J Arthroplasty,2006,21(6):832-840.
[18]
Bargar WL, Jamali AA, Nejad AH. Femoral anteversion in THA and its lack of correlation with native acetabular anteversion[J].Clin Orthop Relat Res,2010,468(2):527-532.
[19]
Merle C, Grammatopoulos G, Waldstein W, et al. Comparison of native anatomy with recommended safe component orientation in total hip arthroplasty for primary osteoarthritis[J].J Bone Joint Surg Am,2013,95(22):e1721-1727.
[20]
MalkaniAL, OngKL, LauE, et al. Early and late-term dislocation risk after primary hip arthroplasty in the Medicare population[J].J Arthroplasty,2010,25(6 Suppl):21-25.
[21]
Muratoglu OK, Bragdon CR, O’Connor D, et al. Larger diameter femoral heads used in conjunction with a highly crosslinked ultra-high molecular weight polyethylene: a new concept[J].J Arthroplasty,2001,16(8 Suppl 1):24-30.
[22]
HammerbergEM,Wan Z, Dastane M, et al .Wear and range of motion of different femoral head sizes[J].J Arthroplasty,2010,25(6):839-843.
[23]
Lachiewicz PF, Heckman DS, Soileau ES, et al .Femoral head size and wear of highly cross-linked polyethylene at 5 to 8 years[J].ClinOrthopRel Res,2009,467(12):3290-3296.
[24]
Peter R, Lübbeke A, Stern R, et al . Cup size and risk of dislocation after primary total hip arthroplasty[J].J Arthroplasty,2011,26(8):1305-1309.
[25]
Bader R, Scholz R, SteinhauserE, et al. The influence of head and neck geometry on stability of total hip replacement: a mechanical test study[J]. Acta Orthop Scand,2004,75(4):415-421.
[26]
Cobb TK, Morrey BF, Ilstrup DM. Effect of the elevated-rim acetabular liner on loosening after total hip arthroplasty[J]. J Bone Joint Surg Am,1997,79(9):1361-1364
[27]
Parvizi J, Kim KI, Goldberg G, et al. Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning[J]. Clin Orthop Relat Res,2006,447:60-65.
[28]
ToomeySD, HopperRHJr, McAuleyJP, et al. Modular component exchange for treatment of recurrent dislocation ofa totalhip replacement in selectedpatients[J].J Bone Joint Surg Am,2001,83-A(10):1529-1533.
[29]
Lachiewicz PF, Soileau E, Ellis J. Modular revision for recurrent dislocation of primary or revision total hip arthroplasty[J].J Arthroplasty,2004,19(4):424-429.
[30]
Hailer NP, Weiss RJ, Stark A, et al. Dual-mobility cups for revision due to instability are associated with a low rate of re-revisions due to dislocation: 228 patients from the Swedish Hip Arthroplasty Register[J]. Acta Orthop,2012,83(6):566-571.
[31]
Mertl P, Combes A, Leiber-Wackenheim F, et al. Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years[J]. HSS J,2012,8(3):251-256.
[32]
Noble PC, Durrani SK, Usrey MM, et al. Constrained cups appear incapable of meeting the demands of revision THA[J].Clin Orthop Relat Res,2012,470(7):1907-1916.
[33]
Munro JT, Vioreanu MH, Masri BA, et al. Acetabular liner with focal constraint to prevent dislocation after THA[J].Clin Orthop Relat Res,2013,471(12):3883-3890.
[34]
Van Warmerdam JM, McGann WA, Donnelly JR, et al. Achilles allograft reconstruction for recurrent dislocation in total hip arthroplasty[J]. J Arthroplasty,2011,26(6):941-948.
[35]
Kaplan SJ, Thomas WH, Poss R. Trochanteric advancement for recurrent dislocation after total hip arthroplasty[J].J Arthroplasty,1987,2(2):119-124.
2014, Vol. 19 
