Factors Predicting Total Hip Arthroplasty Dislocation: Retrospective Analysis
DOI:
https://doi.org/10.82189/spot.77Keywords:
Arthroplasty, Replacement, Hip, Hip Dislocation, Risk FactorsAbstract
Introduction: The dislocation rate following primary total hip arthroplasty (THA) ranges from 0.2% to 10%, making it one of the most common complications. In the Portuguese population, literature on this topic is scarce, and there is ongoing debate regarding the individual and surgical factors that best predict the risk of instability.
Objectives: To identify the prevalence of predictive factors for total hip arthroplasty dislocation in patients undergoing surgical intervention due to joint instability.
Methods: Retrospective, observational, and descriptive study involving 70 patients who underwent revision surgery for THA instability. Sociodemographic, clinical, surgical, and radiographic data were analyzed.
Results: Statistically significant differences were observed between the mean acetabular inclination (p<0.001) and anteversion angles (p<0.001) and their respective target values; however, no significant difference was found for femoral anteversion (p=0.088). Notably, half of the patients exhibited femoral anteversion values outside the safe zone. Furthermore, no statistically significant differences were found between prosthetic and native values for femoral offset, horizontal center of rotation, or vertical center of rotation (p=0.291; p=0.824; p=0.135, respectively). A statistically significant correlation was identified between the type of surgical treatment and acetabular inclination (p=0.011), whereas no significant correlations were observed between the type of treatment and acetabular anteversion (p=0.289), or between inclination and anteversion angles (p=0.052).
Conclusion: In this study, excessive acetabular inclination [verticalization] emerged as the main predictive factor for dislocation. Other surgical parameters associated with instability included excessive acetabular anteversion and improper femoral orientation.
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Learnonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508-19. doi: 10.1016/S0140-6736(07)60457-7.
Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018;392:1662-71. doi: 10.1016/S0140-6736(18)31777-X.
Bleß HH, Kip M, editors. White Paper on Joint Replacement: Status of Hip and Knee Arthroplasty Care in Germany. Berlin:Springer;2018.
Dreinhöfer KE, Dieppe P, Stümer T, Gröber-Grätz D, Flören M, Günther KP, et al. Indications for total hip replacement: comparison of assessments of orthopaedic surgeons and referring physicians. Ann Rheum Dis. 2006;65:1346-50. doi: 10.1136/ard.2005.047811.
Scholl L, Longaray J, Raja L, Lee R, Faizan A, Herrera L, et al. Friction in modern total hip arthroplasty bearings: Effect of material, design, and test methodology. Proc Inst Mech Eng H. 2016;230:50-7. doi: 10.1177/0954411915619452.
Spir IAZ, Anzai A, Utino A, Katayama H, Tosello G, Nery MM, et al. Comparison between ceramic-on-polyethylene versus metal-on-polyethylene prostheses in Total Hip Arthroplasties: a systematic review and meta-analysis. Rev Assoc Med Bras. 2022;68:1611-8. doi: 10.1590/1806-9282.02206812.
Bader R, Steinhauser E, Zimmermann S, Mittelmeier W, Scholz R, Busch R. Differences between the wear couples metal-on-polyethylene and ceramic-on-ceramic in the stability against dislocation of total hip replacement. J Mater Sci Mater Med. 2004;15:711-8. doi: 10.1023/b:jmsm.0000030214.79180.13.
Willert HG, Buchhorn GH. Osseointegration of cemented and noncemented implants in artificial hip replacement: long-term findings in man. J Long Term Eff Med Implants. 1999;9:113-30.
Abdulkaim A, Ellanti P, Motterlini N, Fahey T, O'Byne JM. Cemented versus uncemented fixation in total hip replacement: a systematic review and meta-analysis of randomized controlled trials. Orthop Rev. 2013;5:e8. doi: 10.4081/or.2013.e8.
World Health Organization. Body mass index (BMI). Global Health Observatory data portal; 2025 [accessed 7 Aug 2025]. Available from: https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/body-mass-index
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217-20.
Cardoso A, Duarte M, Viegas R, Oliveira F, Pinto P, Rego P. Measuring Acetabular Version after Total Hip Arthroplasty: A Comparison of Two Radiographic Methods. Rev Bras Ortop. 2021;56:513-6. doi: 10.1055/s-0040-1721360.
Danoff JR, Bobman JT, Cunn G, Murtaugh T, Gorroochum P, Geller JA, et al. Redefining the Acetabular Component Safe Zone for Posterior Approach Total Hip Arthroplasty. J Arthroplasty. 2016;31:506-11. doi: 10.1016/j.arth.2015.09.010.
Lombard C, Gillet P, Germain E, Boubaker F, Blum A, Gondim Teixeira PA, et al. Imaging in Hip Arthroplasty Management Part 2: Postoperative Diagnostic Imaging Strategy. J Clin Med. 2022;11:4416. doi: 10.3390/jcm11154416.
Manjunath KS, Soruban V, Gopalakrishna KG. Evaluation of radiological methods of assessing cup anteversion in total hip replacement. Eur J Orthop Surg Traumatol. 2015;25:1285-92. doi: 10.1007/s00590-015-1702-6.
Klim SM, Reinbacher P, Smolle MA, Hecker A, Maier M, Friesenbichler J, et al. Femoral Anteversion in Total Hip Arthroplasty: Retrospective Comparison of Short- and Straight-Stem Models Using CT Scans. J Clin Med. 2023;12:2391. doi: 10.3390/jcm12062391.
Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469:319-29. doi: 10.1007/s11999-010-1487-1.
Dorr LD, Wan Z, Malik A, Zhu J, Dastane M, Deshmane P. A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am. 2009;91:2598-604. doi: 10.2106/JBSJ.H.01225.
Sheth NP, Melnic CM, Paprosky WG. Evaluation and management of chronic total hip instability. Bone Joint J. 2016;98:84-49. doi: 10.1302/0301-620X.98B1.36516.
Aggarwal VK, Elbuluk A, Dundon J, Herrero C, Hernandez C, Vigdorchik JM, et al. Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J. 2019;101:8:646-51. doi: 10.1302/0301-620X.101B6.BJJ-2018-1474.R1.
Petis S, Howard JL, Lanting BL, Vasarhelyi EM. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg. 2015;58:128-39. doi: 10.1503/cjs.007214.
Gulbrandsen TR, Muffly SA, Shamrock A, O'Reilly O, Bedard NA, Otero JE, et al. Total Hip Arthroplasty: Direct Anterior Approach Versus Posterior Approach in the First Year of Practice. Iowa Orthop J. 2022;42:127-36.
Meemans G, Konan S, Das R, Volpin A, Haddad FS. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2017;99-B:732-40. doi: 10.1302/0301-620X.99B6.38053.
Wetters NG, Murray TG, Moric M, Sporer SM, Paprosky WG, Della Valle CJ. Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res. 2013;471:410-6. doi: 10.1007/s11999-012-2561-7.
Dargel J, Oppermann J, Bruggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014;111:884-90. doi: 10.3238/arztebl.2014.0884.
Lu Y, Xiao H, Xue F. Causes of and treatment options for dislocation following total hip arthroplasty. Exp Ther Med. 2019;18:1715-22. doi: 10.3892/etm.2019.7733.
Berry DJ, von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am. 2004;86:9-14. doi: 10.2106/00004623-200401000-00003.
Werner BC, Brown TE. Instability after total hip arthroplasty. World J Orthop. 2012;3:122-30. doi: 10.5312/wjo.v3.i8.122.
Dawson-Ameh K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the Hip: A Review of Types, Causes, and Treatment. Ochsner J. 2018;18:242-52. doi: 10.31486/toj.17.0079.
Kunutsor SK, Barrett MC, Beswick AD, Judge A, Blom AW, Wylde V, et al. Risk factors for dislocation after primary total hip replacement: meta-analysis of 125 studies involving approximately five million hip replacements. Lancet Rheumatol. 2019;1:e111-21. doi: 10.1016/s2665-9913(19)30045-1.
Komiyama K, Fukushi JL, Motomura G, Hamai S, Ikenura S, Fujii M, et al. Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip? Int Orthop. 2019;43:2057-63. doi: 10.1007/s00264-018-4154-x.
Ha YC, Yoo JI, Ahn JM, Lee YK, Kang Y, Koo KH. Trans-lateral decubitus radiograph of the hip: A new view to measure the anteversion of the femoral stem. Asian J Surg. 2021;44:99-104. doi: 10.1016/j.asjsur.2020.03.016.
Gaio V, Antunes L, Namorado S, Barreto M, Gil A, Kyslaya I, et al. Prevalence of overweight and obesity in Portugal: Results from the First Portuguese Health Examination Survey (INSEF 2015). Obes Res Clin Pract. 2018;12:40-50. doi: 10.1016/j.orcp.2017.08.002.
Rehm J. The risks associated with alcohol use and alcoholism. Alcohol Res Health. 2011;34:135-43.
Ribeiro C, Guerreiro C, Ferreira L, Bento A, Neto H, Mendes R. Relatório Anual 2022 - A Situação do País em Matéria de Álcool. [consultado Jan 2025] Disponível em: http://hdl.handle.net/10400.26/51628
Santana I, Farinha F, Freitas S, Rodrigues V, Carvalho Á. Epidemiologia da Demência e da Doença de Alzheimer em Portugal: Estimativas da Prevalência e dos Encargos Financeiros com a Medicação. Acta Med Port. 2015;28:182-8.
Antunes A, Frasquilho D, Azeredo-Lopes S, Neto D, Silva M, Cardoso G, et al. Disability and common mental disorders: Results from the World Mental Health Survey Initiative Portugal. Eur Psychiatry. 2018;49:56-61. doi: 10.1016/j.eurpsy.2017.12.004.
American Society of Anesthesiologists. ASA physical status classification system. Anesthesiology.2014;120:185. doi:10.1097/ALN.0000000000000002
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Copyright (c) 2026 Joana Araújo de Azevedo, Eduardo Antunes Lobo, David Ferreira, Ana Vilela, Pedro Varanda, Bandeira Rodrigues
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