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. 2012 May;36(5):935-40.
doi: 10.1007/s00264-011-1353-0. Epub 2011 Sep 20.

Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case-control study

Rami Madanat  1 , Tatu J Mäkinen, Mikko T Ovaska, Martti Soiva, Tero Vahlberg, Jussi Haapala
Affiliations

Dislocation of hip hemiarthroplasty following posterolateral surgical approach: a nested case-control study

Rami Madanat et al. Int Orthop. 2012 May.

Abstract

Purpose: Hip hemiarthroplasty dislocation is a serious complication in treatment of displaced intracapsular hip fractures. We investigated factors associated with an increased risk of dislocation after cemented hip hemiarthroplasty following the posterolateral approach.

Methods: Between January 2002 and December 2008, 602 hip fractures were treated with cemented unipolar hip hemiarthroplasty. A registry-based analysis was carried out to determine the total number of hemiarthroplasty dislocations in these patients. A control group of 96 patients without dislocation was randomly selected. Logistic regression analysis was performed to evaluate clinical and operative factors associated with dislocation.

Results: Thirty-four patients (5.6%) experienced at least one dislocation. Most were the result of a fall and occurred within two months after surgery. There was a trend for increased dislocation in patients who had been operated on more than 48 hours after admission and in patients who had a longer operative time. Smaller centre-edge angle and hip offset were observed in patients with dislocation. Recurrent dislocation was a significant problem, as 18 patients (62%) experienced multiple dislocations.

Conclusions: The risk of hemiarthroplasty dislocation following the posterolateral surgical approach may be reduced by prompt surgical treatment and fall prevention in the early postoperative period. Patients with smaller acetabular coverage seem more predisposed to dislocation after the posterolateral approach and may be more suitable for other surgical approaches.

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Figures

Fig. 1
Fig. 1
Postoperative radiograph after hip hemiarthroplasty due to a displaced femoral neck fracture in a 79-year old female (left). The patient suffered a fall five weeks postoperatively and was unable to walk. The radiographs showed a hemiartroplasty dislocation (right)
Fig. 2
Fig. 2
Measurements from postoperative radiographs. a Centre-edge angle of Wiberg, b prosthesis neck/femoral shaft angle, c offset, d residual femoral neck length, e distance between the tip of the greater trochanter and the centre of the prosthesis head
Fig. 3
Fig. 3
Outcome in patients with dislocation
See this image and copyright information in PMC

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