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Hip Int. 2019 Mar 19:1120700019831628. doi: 10.1177/1120700019831628. [Epub ahead of print]

Multivariate analysis of risk factors for re-dislocation after revision for dislocation after total hip arthroplasty.

Author information

1
1 Department of Orthopaedic Surgery, Assuta Ashdod Medical Centre, Ashdod, Israel.
2
2 Ben-Guriun University Faculty of Medicine, Be'er-Sheva, Israel.
3
3 Department of Orthopaedics, University of British Columbia, Vancouver, Canada.

Abstract

BACKGROUND::

The treatment for recurrent dislocation of a total hip arthroplasty is surgical using varied techniques and technologies to reduce the chances of re-dislocation and re-revision. The goal of this study is to compare operative techniques to reduce re-dislocation and re-revision in revision hip arthroplasty due to recurrent dislocations.

METHODS::

A retrospective study of revision hip arthroplasties done due to recurrent dislocation prior to 01 January 2014. Electronic physician and provincial health records were used to collect patients' initial and follow-up data. Treatment failure was defined as either aseptic re-revision or re-dislocation without revision. Time to event was considered as the re-revision date or the date of second dislocation when the latter endpoint was used.

RESULTS::

Of 379 operations, 88 (23.2%) had aseptic repeat revision or recurrent dislocation. Of these: 66 (75.0%) due to dislocation with re-revision; 10 (11.4%) due to dislocation with no re-revision surgery; 5 (5.7%) due to aseptic loosening of components; 3 (3.4%) due to osteolysis; 3 (3.4%) due to pseudotumour; and 1 (1.1%) due to periprosthetic fracture. The following factors increase risk of failure: the use of augmented-liners (lipped, oblique and high-offset liners; HR = 1.68, 95% CI, 1.05-2.69), periprosthetic femur fracture (HR = 2.80, 95% CI, 1.39-8.21) and pelvic discontinuity (HR = 3.69, 95% CI, 1.66-8.21). Femur head sizes 36-40 mm are protective (HR = 0.54, 95% CI, 0.31-0.86). In abductor dysfunction the use of focal constrained liners decreases the risk of failure (HR = 0.13, 95% CI, 0.018-0.973).

CONCLUSIONS::

Larger head sizes and focal constrained liners (abductors dysfunction) should be used and fully constrained liners and augmented-liners should be avoided in a revision hip arthroplasty due to recurrent dislocations.

KEYWORDS:

Abductors deficiency; augmented liners; hip dislocation; hip revision

PMID:
30887851
DOI:
10.1177/1120700019831628

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