Hip Dislocation After Surgery

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Hip Dislocation After Surgery

Hip Dislocation After Surgery

Hip arthroscopy

Hip arthroscopy is one of the most exciting and expanding fields of orthopedic surgery. Traditional surgery using larger open incisions has been performed on the hip since the early 1890s

  •  Arthroscopic surgery for the hip was originally described in 1931, but only in the last two decades has the use of hip arthroscopy experienced significant growth.
  •  By some estimates, the use of hip arthroscopy to treat painful pathology around the hip will grow exponentially over the next decade.

Use of arthroscopic instrumentation in other joints such as the knee and shoulder has led to greater understanding of injuries in these joints. Techniques such as anterior cruciate ligament reconstruction of the knee and labrum and rotator cuff repairs of the shoulder are now routinely performed arthroscopically, as the understanding of these joints has improved with arthroscopy.

Now, as equipment has progressed and surgeons have developed arthroscopic techniques for treatment of the hip, surgeons are now able to investigate and treat hip pain in a minimally invasive manner with results equal to and in some cases superior to those achieved with open surgery.

In the future, hip arthroscopy will likely become the gold standard for painful hip pathology in the non-arthritic to a moderately arthritic patient.

Hip Dislocation After Surgery

The hip can be divided into four anatomically based compartments that contain specific structures. Common conditions in these compartments can be treated arthroscopically.

In all areas of the hip, understanding of pathology has increased significantly; however, treatment of anomalies and tears of the fibrocartilaginous labrum has shown some of the greatest promises in terms of reducing pain in the hip.

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Many sources of hip pathology that are associated with arthritis of the hip can be treated early in their stages via arthroscopy. Early intervention in the hip may delay the onset of arthritis such that the overall cost of hip care worldwide may be reduced by prolonging the time until hip replacement becomes necessary or obviating the need for replacement.

What To Expect After Hip Arthroscopy ?

Hip Dislocation After Surgery

Although total hip arthroplasty (THA) is regarded as a highly effective procedure in terms of reducing pain and improving quality of life, the associated complications are significant.

As the volume of THA procedures is predicted to grow substantially in the next few decades, management of associated complications is going to place a significant burden on the healthcare system. Our discussion will focus on the early complications of THA, including dislocation, nerve injury, limb length discrepancy (LLD), and infection.

 

Hip Dislocation After Surgery

Dislocation is a complication that can lead to a poor result, patient dissatisfaction, and the need for revision surgery. A review of over 60,000 primary THA and 13,000 revision THA procedures from 1995 showed a dislocation rate of 3.9% in the first six months for primary THA and 14.4% for revision THA.

  •  Approximately two-thirds of dislocations occur in the first month after surgery.
  • Patient factors, surgical technique, and implant design can all contribute to the risk of dislocation.
  • Patient factors associated with an increased risk for dislocation include increased age, female gender, neuromuscular disease, dementia, alcohol abuse, previous hip surgery, history of fracture or osteonecrosis, and a higher level of patient activity.
  • Surgical factors that can affect dislocation include surgical approach and component alignment.
  • Given the recent interest in minimally invasive techniques for THA, the effect of surgical approach on dislocation has become an increasingly important topic.
  • The posterior approach has been the mainstay for most surgeons but has an inherent risk for dislocation because most dislocations are posterior.
  • The approach involves compromising the posterior soft tissues by splitting the gluteus maximus fibers, dividing the insertion of the external rotators of the femur, and opening the joint capsule.
  • The dislocation rate for the posterior approach without capsule repair is 3.95%, and with repair is 2.05%.9 Others studies have found an eight-fold (0.49 versus 4.46%) increase in dislocation rate for the posterior approach if the soft tissues are not repaired.
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