Preventing Hip Replacement Dislocation

Hip replacement surgery is an effective treatment for hip pain caused by arthritis. He has an arthritic hip, but normally smooth cartilage surface of the hip joint is worn away. Hip replacement surgery replaces the worn out by re-creating the normal hip joint with an artificial implant., Smooth articulation between the top of the thigh bone in the pelvis, simple movements including walking, climbing stairs, and getting up from a seated position can become pain-free again. The implants used for hip replacements can be made of combinations of metal, plastic, and ceramic.

Complications of hip replacement surgery are not common, but can occur. When complications occur, a repeat hip replacement, called a revision hip replacement, may become necessary to fix a problem with the implanted joint. The most common reason for requiring a repeat hip replacement surgery is dislocation of the hip replacement. A dislocation occurs when the ball is separated from the socket of the hip replacement. While the ball and socket of the hip replacement are very tightly fit together, they are not actually connected, and if enough force is applied, they can become separated. While the risk of hip replacement dislocation has come down over the past decade, this is still the most common reason for requiring revision hip replacement.

X-ray illustration of hip replacement / Getty Images

Hip Replacement Dislocation

Hip replacement dislocations occur when the ball of the ball-and-socket joint replacement comes out of the socket. While it is often possible to reposition the hip replacement without a surgical incision, the chance of additional dislocations or damage to the implants is high. Therefore, hip replacement dislocation is the most common reason why a revision hip replacement is performed.

Determining why the hip joint dislocated is important to determine the appropriate treatment. Possible reasons for a hip replacement dislocation include the type of implant used, the positioning of the implant in the body, traumatic injury, or underlying medical conditions the patient has (for example, Parkinson's disease). Once the cause of the dislocation is determined, appropriate treatment can be recommended, which may include a second surgical procedure to redo the hip replacement, and possibly use a different type of implant.

Preventing Hip Replacement Dislocations

Recent studies have investigated why a given patient may be more likely to experience hip replacement dislocation. Not all factors can be controlled; for example, a patient with Parkinson's disease cannot lower their risk of dislocation by changing their condition. Another factor that cannot be controlled is age; patients over the age of 85 had a higher chance of hip replacement dislocation. However, there are factors that have been shown to contribute to hip replacement dislocation that can be controlled:

  • Implant Size
    • Femoral head size, or the size of the ball of the ball-and-socket, can be increased to help prevent dislocation of the hip replacement. Larger sized femoral heads are less likely to dislocate from the socket. Using special implants, such as metal-on-metal hip replacements, allows your surgeon to use a larger size femoral head, and thus lower dislocation risk. Femoral head size options have increased dramatically in the past decade.
  • Surgeon Experience
    • Another factor to control hip replacement dislocation is surgeon volume. Surgeons who perform less than 5 hip replacements a year have a much higher chance of having a patient with a hip replacement dislocation. On the other hand, surgeons performing more that 50 hip replacements each year have a much lower chance of having a patient have a hip replacement dislocation.

One other factor that has been recently investigated is the type of surgical approach used to access the hip joint. More and more hip replacements are being performed through an anterior surgical approach, and some surgeons feel the chance of dislocation is much lower with this approach. There is conflicting data about how much of a factor surgical approach may be, but this could be another step helpful at reducing the chance of dislocation.

Bottom Line: What Should I Do?

Patients undergoing hip replacement should be aware of the potential risk of dislocation of the hip replacement. In patients who are most at-risk for sustaining a dislocation, special implants may be selected to help prevent the chance of this complication. If a hip replacement dislocation does occur, a careful assessment of the cause of this complication should be performed. For people particularly concerned about dislocation, they can discuss with their surgeon how specific implants or surgical approaches may lower there risk of having a dislocation complication.

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