Management of Dislocated Total Hip Replacement caused by Soft Tissue Imbalance

Abstract

Background:With the improvement of the surgical techniques and prosthesis design, the rate of dislocation after total hip arthroplasty (THA) has decreased to 0.05-3.9%. The dislocations of THA are not only related to soft tissue tension but also related to the basic situation of patients, surgeon’s operation, surgical methods, hip prosthesis design, and prosthesis placement.

Aim of the study: To evaluate the functional outcome and importance of soft tissue reconstruction in total hip dislocations.

Patients and methods:The current prospective and retrospective cohort study was carried in Orthopedic Department, Zagazig University Hospitalsin Egypt and Misurata central hospital in Libya on 18 Patient with post recurrent THR dislocation caused by soft tissue defect underwent dislocated total hip arthroplasty to evaluates the functional outcome and importance of soft tissue reconstruction in total hip dislocations.

Results:Femur head size in 1ry total Hip Replacement for studied patients ranged from 28 to 36 mm (77.7% by 36mm). 66.7 % of patients complaint from dislocation after 2nd month after Total Hip Replacement caused by Soft Tissue Imbalance, while 33.3% third at second months. 16 (77.8%) of patients free from complication, while 2(11.1%) of patients came with Superficial infection post operatively. The main procedure was applied to manage dislocated THR caused by Soft Tissue Imbalance was increase neck length with enhanced soft tissue repair and bracing for 44.4% of patients, 33.3% were treated with only enhanced soft tissue reconstruction and restore tension with bracing, and greater trochanteric advancement with soft tissue reconstruction and bracing in 22.2% of patients. There was a statistically significant increase in points of all parameters postoperative.All patients had pre-operative Harris poor grade, with mean 21.9±9.8 and range from 10 to 38. While postoperative Harris grade for studied group was 33.3% fair 44.4% good and 22.2 % of them had excellent Harris grade. with mean 82±8.27 and range from 70 to 94 with difference statistically significance.

Conclusion:THR is one of most successful surgery, rare cases of replacement may complaining from early or late complications, dislocation is one of these complications, one cause of dislocation is soft tissue imbalance and not good repair and restoring tension.