Impact of surgical approach and size of femoral head in risk of dislocation post total hip arthroplasty

Rupesh Jung Belbase; Kumud Limbu; Anil Kumar Basnet; Pushpak Regmi

doi:10.18203/issn.2455-4510.IntJResOrthop20230458

Authors

Rupesh Jung Belbase Department of Orthopaedics, P. T. Birta City Hospital, Province 1, Birtamode, Nepal
Kumud Limbu Department of Orthopaedics, P. T. Birta City Hospital, Province 1, Birtamode, Nepal
Anil Kumar Basnet Department of Medicine, P. T. Birta City Hospital, Province 1, Birtamode, Nepal
Pushpak Regmi Department of Anaesthesia, P. T. Birta City Hospital, Province 1, Birtamode, Nepal

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20230458

Keywords:

Hip arthroplasty, Hip dislocation, Fixation

Abstract

Background: Total hip arthroplasty (THA) is one of the orthopedic procedures that are both economical and routinely successful. THA offers dependable benefits for patients with end-stage degenerative hip osteoarthritis (OA), including pain alleviation, functional recovery, and overall better quality of life.

Methods: This was a retrospective study which was conducted on patients who visited the hospital's outpatient department received THA and also received the revisions of THA, were included. The reasons for THA were analyzed and their revisions were studied. The patients were studied according to various approaches based on the hip surgery, such as, straight lateral, anterolateral, posterolateral, and anterior and also based on the sizes divided into three groups 22-28 mm, 32 mm, and 36 mm.

Results: The posterolateral approach (n=40) was used for the majority of THAs, followed by the straight lateral (n=35), anterior (n=25), and anterolateral (n=20) approaches. 22.5% of THAs that were done with a posterolateral approach used a 36-mm head. Each reason for different size of heads have been statistically analyzed. During the six-year follow-up, this (unadjusted) risk was 1.15% for femoral heads measuring 22 to 28 mm. THA with 32-mm heads had a considerably decreased risk of revision for dislocation (0.75%), compared to 36-mm heads (0.55%).

Conclusions: The study concluded that the patients who received THA at posterolateral approach, experienced dislocations more frequently and also it has been found that the patients using 22 to 28 mm femoral head had more dislocations.

Metrics

Metrics Loading ...

References

Varacallo M, Luo TD, Johanson NA. Total Hip Arthroplasty (THA) Techniques. PubMed; StatPearls Publishing. 2020.

Karachalios, T, Komnos, G, & Koutalos, A. (2018). Total hip arthroplasty. EFORT Open Rev. 2018;3(5):232-9.

Varacallo M, Luo TD, Johanson NA. Total Knee Arthroplasty Techniques. PubMed; StatPearls Publishing. 2022.

Learmonth ID, Young C, Rorabeck C. The Operation of the Century: Total Hip Replacement. Lancet (London, England). 2007.

Clegg TE, Roberts CS, Greene JW, Prather BA. Hip dislocations - Epidemiology, treatment, and outcomes. Injury. 2010;41(4):329-34.

Moran J, Cheng R, Schneble CA, Mathew JI, Kahan JB, Li D, Gardner EC. Epidemiology of Sports-Related Traumatic Hip Dislocations Reported in United States Emergency Departments, 2010-2019. Orthop J Sports Med. 2022;10(5):232596712210880.

Foulk DM, Mullis BH. Hip Dislocation: Evaluation and Management. Am Acad Orthop Surgeon. 2010;18(4):199-209.

Dawson-Amoah K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the Hip: A Review of Types, Causes, and Treatment. Ochsner J. 2018;18(3):242-52.

Beebe MJ, Bauer JM, Mir HR. Treatment of Hip Dislocations and Associated Injuries: Current State of Care. The Orthopedic Clin North Am. 2016;47(3):527-49.

Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation Following Total Hip Replacement. Dtsch Arztebl Int. 2014;111(51-52):884–90.

Zijlstra WP, De Hartog B, Van Steenbergen LN, Scheurs BW, Nelissen RGHH. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty. Acta Orthop. 2017;88(4):395-401.

Amlie E, Havelin LI, Furnes O, Baste V, Nordsletten L, Hovik O, et al. Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1,476 patients 1-3 years after surgery. Acta Orthop. 2014;85(5):463-9.

Zijlstra WP, De Hartog B, Van Steenbergen LN, Scheurs BW, Nelissen RGHH. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty. Acta Orthop. 2017;88(4):395-401.

Barrett WP, Turner SE, Leopold JP. Prospective Randomized Study of Direct Anterior vs Postero-Lateral Approach for Total Hip Arthroplasty. J Arthroplasty. 2013;28(9):1634-8.

Berry DJ. Effect of Femoral Head Diameter and Operative Approach on Risk of Dislocation After Primary Total Hip Arthroplasty. J Bone Joint Surg (Am). 2015;87(11):2456.

Ertaş ES, Tokgözoğlu AM. Dislocation after total hip arthroplasty: does head size really matter? HIP Int. 2020:112070001989840.

Howie DW, Holubowycz OT, Middleton R. Large Femoral Heads Decrease the Incidence of Dislocation After Total Hip Arthroplasty. J Bone Joint Surg. 2012;94(12):1095-102.

Kostensalo I, Junnila M, Virolainen P, Remes V, Matilainen M, Vahlberg T, et al. Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty. Acta Orthop. 2013;84(4):342-7.

Hailer NP, Weiss RJ, Stark A, Kärrholm J. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. Acta Orthop. 2012;83(5):442-8.

Christensen CP, Karthikeyan T, Jacobs CA. Greater Prevalence of Wound Complications Requiring Reoperation With Direct Anterior Approach Total Hip Arthroplasty. J Arthroplasty. 2014;29(9):1839-41.