Dislocation After Total Hip Arthroplasty: A Randomized Clinical Trial of a Posterior Approach and a Modified Lateral Approach

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Abstract

We compared the dislocation rate of total hip arthroplasty between posterior approach and lateral approach in a prospective randomized trial. One hundred ninety-six hips were randomly chosen for a posterior approach with a posterior soft tissue repair (99 hips) or a lateral approach (97 hips). The average duration of follow-up was 37.9 months. Three hips (3%) dislocated in the lateral group, whereas none from the posterior group dislocated. At the final follow-up, the Harris hip score and limping were similar in the 2 groups. The joint stability obtained by the posterior soft tissue repair in the posterior approach group seemed to produce more favorable result when compared to the stability obtained from the lateral approach group.

Section snippets

Study Design

From July 2004 to November 2005, 245 primary total hip arthroplasties were performed in 228 patients at the authors' hospital. Seven fused hips and 9 highly dislocated hips after childhood septic arthritis and 7 hips with a unilateral Crowe type IV developmental dislocation were excluded because they necessitated extensile approaches and/or other prostheses. In 17 patients who underwent bilateral total hip arthroplasty, a first single hip was included in the randomization to adjust clustering

Dislocation

Three hips (3.1%) dislocated in the lateral group, whereas no hip dislocated in the posterior group. Two dislocations in the lateral group were found in immediate postoperative radiograph. In these 2 dislocations, the hip was dislocated anteriorly, which was reduced by flexion and internal rotation under the fluoroscopy. These 2 hips were kept in 30° flexion with use of a hip brace and patients walked with non–weight bearing with the aid of 2 crutches for 6 weeks after surgery.

At the

Discussion

Dislocation remains the leading early complication after total hip arthroplasty with a reported frequency between 0.2% and 9.5% 4, 5, 6, 7, 8, 14. Numerous influencing factors for dislocation after total hip arthroplasty have been reported; the presence of previous surgery, old age, female sex, mental disorders, neuromuscular disease, alcoholism, surgical approach, soft tissue repair, patient's positional factor, soft tissue laxity, implant design, alignment of components, and surgical

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    The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.06.007.

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