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A magnified view of the dislocated right Exeter total hip replacement, with the prosthetic femoral head articulating freely within a neoacetabulum.
Source publication
Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly the...
Context in source publication
Context 1
... anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement ( Figure 1). The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating (Figures 2 and 3). He remained pain free on this side, had 5 cm of true leg length shortening, with a good range of movement, and was very pleased with his hip replacement. ...
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Citations
... However, dislocation remains the well-recognized challenging complication for the surgeon and the cause for pain and dissatisfaction for patients. According to the registers, dislocation occurs after 0.3% to 10% of primary total hip arthroplasties and after up to 28% of revision total hip arthroplasties [1][2][3][4]. ...
... Therefore, chronic dislocation is exceptionally unusual. Only less than ten cases of unilateral chronic dislocation following THA have been reported to date [1][2][3][4][5][6][7][8]. We report the first case of chronic THA dislocation with bilateral involvement caused by a malpositioned acetabular component in a 59-year-old patient. ...
... Dislocation following total hip arthroplasty (THA) is a complication which alarms both patient and surgeon. There have been numerous reports instancing the frequency of dislocation, with an overall incidence ranging from 0.3% to almost 10% after primary THA, with the highest risk believed to be within the first three months after surgery [1][2][3][4][5]. The incidence can be as high as 28% after revision surgery [9][10][11][12][13][14][15]. ...
... There are two types of joint instability: one is mechanical instability due to the disruption of anatomical structures of the hip joints and the other one is functional instability due to insufficient proprioception (joint position sense and kinesthetic sense) [1] [2]. Although mechanical instability [3] may be important as contributing factors of dislocation, the fact that some dislocations occur more than 10 years after operation indicates that the cause of dislocation is not only mechanical factors but also functional instability due to disruption of joint proprioception [4] [5]. Therefore, we analyzed the joint position sense in patients treated by THA through different approach and examined if there were any differences between the two surgical approaches in the hip joint position sense. ...
Introduction: The instability of the joint is classified roughly into mechanical and functional. It is reported that the postoperative dislocation often occurs by the posterior approach of the THA and may be caused by functionality instability due to the injury of the periarticular soft tissue. We analyzed the joint position sense of the hip according to an approach of the THA and examined effect to give postoperative dislocation. Materials & Methods: 92 patients (184 hip joints) who received THA in our hospital were selected in the study. Cases in which position sensation measurements were insufficient were excluded. As for the classification, the posterior approach (PL groups) was 39 hips, anterolateral approach (AL groups) was 30 hips, and control group was 37 hips. Results: There was no significant difference between the AL group and PL group in the absolute reproduction angle error score (ARAES). The relative reproduction angle error scores (RRAES) for passive internal and external rotations and active internal rotation were significantly lower in the AL and control groups than the PL group. Discussion: This study was suggested that the hip joint position sense in the AL group was better retained for the preservation of the soft tissue.
... While dislocation continues to be a major concern in total hip arthroplasties, the incidence of chronic dislocated prosthesis is rare. A comprehensive review of the literature was performed, and 7 reports of chronic hip prosthetic dislocations were discovered [6][7][8][9][10][11][12]. In 2 cases, the patients had no associated pain and were treated without intervention [8,11]. ...
... In 2 cases, the patients had no associated pain and were treated without intervention [8,11]. One patient underwent successful open reduction with soft tissue closure [12], and another with a revision total hip replacement [9]. In 1 case, the femoral component eroded through skin, and the component was removed and the patient followed [7]. ...
The typical treatment protocol for prosthetic hip dislocation is to first attempt closed reduction under neuromuscular relaxation with local or general anesthesia. If unsuccessful, the underlying etiology of the dislocation must be obtained and treated appropriately, frequently with surgical revision [
15
• Soong M.
• Rubash H.E.
• Macaulay W.
Dislocation after total hip arthroplasty.J Am Acad Orthop Surg. 2004; 12: 314
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]. In this case, closed reduction was attempted twice unsuccessfully before consenting the patient for surgery, which followed standard treatment protocols. While total hip arthroplasty dislocation is relatively uncommon, it is a diagnosis that will be encountered with some frequency by many orthopaedic surgeons; catastrophic failure is rare and requires a high index of suspicion. In retrospect, it is clear that our patient's hip was not dislocated anteriorly as suspected, seen most clearly on the lateral radiographs. Radiographic recognition of a central wear through the acetabular component could have prevented futile closed reduction maneuvers and confirmed the need to proceed with operative revision total hip arthroplasty. By discussing total hip arthroplasty dislocation in the setting of our patient's catastrophic failure, we hope that readers will be more adept at evaluating and treating both.
... Consistent with this notion are 2 reported cases of elderly patients who had suffered chronic dislocation of a surgically replaced femoral head without suffering pain from any bony or soft tissue structure on the side ipsilateral to the dislocation. 16,17 This case indicates that, unlike acquired hip joint dysfunction, developmental abnormalities of the hip joints (even when severe), leading to substantial biomechanical alterations in posture and gait, may not cause pain almost throughout life. It also indicates that a severe change in biomechanics of the spine as a result of the absence of hip joints produces a very different pattern of osteoarthritic change in the lumbar spine likely as a result of the alteration in the pattern of joint loading. ...
Objective:
The purpose of this case report is to describe chiropractic management of an elderly man with untreated bilateral hip joint dysplasia presenting with mild acute mechanical low back pain.
Clinical features:
A 75-year-old man presented with an insidious-onset intermittent low back pain of 3 days' duration. Physical examination findings supported a mechanical cause for mild acute low back pain. Plain radiography revealed dysplasia of hip joints with absence of femoral heads and necks and bilateral high dislocation.
Intervention and outcome:
Chiropractic management included vibration, mobilization, light drop-piece adjustments of the lower lumbar and sacroiliac joints, and recommendation of the use of heat at home. Treatments were given 3 times over the course of 1 week. The low back pain intensity over this period dropped from 5 to 0 on an 11-point numerical rating scale, and the patient was discharged.
Conclusion:
This patient with substantial postural and gait abnormalities as a result of severe bilateral hip dysplasia associated with an unusual pattern of osteoarthritic change in the spine responded favorably to a short course of chiropractic care.
... 1 It may be long-standing and asymptomatic, typically involving the femoral portion. [2][3][4] This report describes a peculiar chronic dislocation of both components of a total hip prosthesis. A 93-year-old female patient, thin and of short stature, had come to our attention for recent onset of lumbar pain at the orthopaedic department. ...
[West J Emerg Med. 2014;15(1):107–108.]
... This work was performed at Spaarne Hospital, Spaarne Ziekenhuis, Hoofddorp, the Netherlands. seven concern chronic prosthetic dislocations [3,9,10,12,15,18,20]. ...
... Chronic dislocation of a prosthesis can be challenging. An unrecognized chronic dislocation of the liner forming a new articulation after dissociation has not been described previously and the literature contains only seven case studies of chronic dislocation and its treatment [3,9,10,12,15,18,20]. Recently Lidder et al. [12] described a 60-year old patient with a painless chronic prosthetic dislocation. ...
... An unrecognized chronic dislocation of the liner forming a new articulation after dissociation has not been described previously and the literature contains only seven case studies of chronic dislocation and its treatment [3,9,10,12,15,18,20]. Recently Lidder et al. [12] described a 60-year old patient with a painless chronic prosthetic dislocation. The dislocated femoral component had formed a neoacetabulum in the ilium in which it was freely articulating. ...
Background:
Dislocation or liner dissociation of a total hip prosthesis usually results in pain and discomfort. Although several reports describe chronic dislocation and its treatment, chronic liner dissociation is an unreported complication.
Case description:
We report an unrecognized dissociation and displacement of the liner of a total hip prosthesis after revision THA. The patient had virtually no pain or functional restrictions. The patient's only complaint was pain on the contralateral side, associated with a leg-length discrepancy. Since the patient had no complaints relative to the liner dissociation we elected not to pursue further treatment. The contralateral pain was treated successfully with a shoe lift.
Literature review:
Chronic dislocation of a THA is a rare complication and we found reports of only seven cases in the literature. We found no reports of chronic liner dissociation.
Clinical relevance:
Orthopaedic surgeons should be aware of the possibility of this rare complication. Our case and the literature suggest treatment can be nonsurgical or surgical.
... Chronic asymptomatic dislocation although reported in the literature can be difficult to diagnose particularly in an elderly demented patient. 4 We report an unusual case of chronically dislocated and asymptomatic THA with unique radiological signs of formation of a 'pseudoacetabulum' around the dislocated femoral head. ...
We report the presence of an unusual radiological feature of formation of pseudoacetabulum in a chronically dislocated and asymptomatic total hip arthroplasty. An elderly demented patient with a history of recurrent dislocations presented to us after an unwitnessed fall and leg length discrepancy. Radiographs showed a dislocated hip arthroplasty with a well-defined, concentric, radio-opaque shadow around the dislocated femoral head suggestive of a pseudoacetabulum. Previous radiographs revealed formation of heterotopic ossification in the soft tissues surrounding the hip. The dislocated joint was reduced under a general anaesthetic with difficulty. This case highlights the presence of heterotopic ossification and formation of pseudoacetabulum as subtle radiological features of chronic instability and dislocation.
... Chronic prosthetic hip dislocation is a medical entity rarely encountered or reported. To our knowledge, only 3 case reports exist of this condition [3][4][5]. We report an unusual case of a complication related to this medical condition-protrusion of the prosthetic femoral head through the skin. ...
... Salvage procedures, such as resection arthroplasty, are reserved for patients who are not candidates for reconstruction: noncompliant individuals, alcohol and drug abusers, elderly debilitated patients, and those with several previous failed attempts to stop recurrent dislocation [10]. Conservative noninterventional treatment for dislocation is not recommended, and to the best of our knowledge, only 1 case report describes a patient treated in this manner [3]. ...
... The true incidence is unknown. The medical literature reports only 3 cases of this complication [3][4][5]. ...
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