Total Hip Replacement Dislocation

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton and Kim Jackson  

Introduction[edit | edit source]

Dislocated hip replacement

Total hip replacement (THR) dislocation is a complication of THR usually occurring due to patient noncomplicance with post-operative precautions, implant malposition, or soft-tissue deficiency. This type of dislocation normally caused by minimal trauma, usually falls or turning, moving into the contra-indicated positions, and putting stress on the capsule that was incised for the replacement surgery.[1][2]

Epidemiology[edit | edit source]

Incidence: 1-3% with 70% occur within first month and 75-90% being posterior dislocations.[2]

Risk Factors[edit | edit source]

Dislocated hip prosthesis

Following a THR the normal hip anatomy and support structures is altered. This violation may cause a decrease in the amount of inherent/anatomic force that assists in maintaining the femoral head within the acetabulum. Consequently the amount of energy necessary for a dislocation to occur is reduced.  Significant risk factors mechanically predisposing individuals with THRs to dislocation include:

  • Surgical approach used, for example, anterior or posterior
  • Kind of prosthesis (hemi or total arthroplasty)
  • Previous hip surgery
  • Female
  • Malposition of the prosthesis during surgery
  • Drug/alcohol abuse
  • Neuromuscular disease for example Parkinson, Demetia. [3]
  • Polyethylene wear, a common cause of late instability occurring >5 years after surgery.[2]

Presentation[edit | edit source]

Typically the dislocation include falls, bending down to tie one's shoes, sitting on a low/short chair then trying to stand, or sitting, standing, or lying down with crossed legs.[3] eg After a fall patient presents with a painful affected hip and shortened and internally rotated affected leg.[4]

Diagnosis[edit | edit source]

Diagnosis is with plain x-rays of the hip. CT of the pelvis assists with assessing for implant malpositioning.[2]

Treatment[edit | edit source]

Treatment is closed reduction of the hip. Surgical management with possible revision THA is advisable for irreducible dislocations, recurrent instability, and implant malposition.[2]

Treatment of recurrent hip dislocation starts looking for the cause.

  • Component position needs careful evaluated, as does hip offset and leg length.
  • When planning a reconstruction, it is generally not a good idea to compensate for malposition of one component by overcorrecting the other.
  • Patients needs to be informed that stability may require lengthening of the leg.[5]

Roughly 66% of cases are successfully treated; one third of cases will require surgical treatment (including revision arthroplasty with use of constrained liners, elevated rim liners or dual mobility implants or trochanteric advancement)[6]

Surgical options include exchange of modular components to increase soft-tissue tension, or a switch to a larger head diameter, including bipolar or tripolar arthroplasty, and use of an acetabular lip. Malposition and impingement must be corrected. Soft-tissue or trochanteric advancement, and the use of constrained liners should be a last resort.[6]

Physiotherapy[edit | edit source]

This follows the same protocol as Total Hip Surgery (see link). Be aware however that the surgeon may have specific advice to follow, especially as this is a more complex procedure. The total rehabilitation phase in hospital and home may also be longer due to more extensive damage and repair.

References[edit | edit source]

  1. Radiopedia Hip dislocation Available (accessed 7.1.2023)
  2. 2.0 2.1 2.2 2.3 2.4 Orthobullets THA Dislocation Available:https: (accessed 7.1.2023)
  3. 3.0 3.1 Masiewicz S, Mabrouk A, Johnson DE. Posterior hip dislocation.Available: (accessed 7.1.2023)
  4. Radiopedia Dislocated hip prosthesis Available: (accessed 7.1.2023)
  5. Brooks PJ. Dislocation following total hip replacement: causes and cures. The bone & joint journal. 2013 Nov;95(11_Supple_A):67-9. Available: (accessed 7.1.2023)
  6. 6.0 6.1 Lu Y, Xiao H, Xue F. Causes of and treatment options for dislocation following total hip arthroplasty. Experimental and Therapeutic Medicine. 2019 Sep 1;18(3):1715-22.Available: (accessed 7.1.2023)