Surgical management of recurrent dislocation after total hip arthroplasty

Dislocation is a major complication of total hip arthroplasty (THA), whose frequency has been unaffected by improvements in surgical techniques and implants. The dislocation rate depends on multiple factors related to the patient, hip disease, and surgical procedure and is therefore also dependent on the surgeon. The many published studies on THA dislocation, its causes, and its treatment have produced conflicting results. The objective of this work is to review the management of THA dislocation, which is a severe event for both the patient and the surgeon. This lecture starts with a brief review of data on THA dislocation rates and the many factors that influence them. Emphasis is then put on the evaluation for a cause and, more specifically, on the challenges raised by detecting suboptimal cup position. Next, reported techniques for treating THA dislocation and the outcomes of each are discussed. Finally, a management strategy for patients selected for revision surgery is suggested. (C) 2013 Elsevier Masson SAS. All rights reserved.