Case Reports
Closed Reduction of a Dislocated Total Hip Athroplasty With a Constrained Acetabular Component
Am J Orthop. 2009 October;38(10):523-525
Author and Disclosure Information
Robert J. Gaines, MD, and Mitchell Hardenbrook, MD
Dr. Gaines is Lieutenant Commander, Medical Corps, United States Navy, and Resident, Department of Orthopedic Surgery, Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia.
Dr. Hardenbrook is Lieutenant Commander, Medical Corps, United States Navy, and Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Department of Orthopedic Surgery, Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia.
Abstract not available. Introduction provided instead.
Hip dislocation is a troubling complication of total hip arthroplasty. The rate of dislocation for a primary hip arthroplasty may be as high as 10% and more than double that for revised total hip arthroplasty, secondary to recurrent dislocations.1,2 With most primary dislocations, successful treatment can be mobtained with closed reduction and bracing or casting.3 However, hips with recurrent dislocations may require further operative treatment to address the cause of instability. These procedures include capsulorrhaphy, trochanteric
advancement, the use of elevated liners, and revision of the femoral or acetabular component. Constrained liners have been used as a salvage procedure.
The use of constrained liners has been shown to decrease the rate of dislocation in patients with deficient soft tissues.1,4,5 However, these components restrict motion and, as a consequence, impart higher stresses across implant-host interfaces.1,4 These devices, when combined with proper patient selection, offer a reasonable treatment option to confer stability to the hip. Anderson and colleagues4 reported a 71% success rate using a constrained acetabular component for patients undergoing revision hip arthroplasty for instability. Despite the design of constrained implants to improve inherent stability, they still have significantly high rates of dislocation. Some experienced surgeons report 9% to 29% dislocation rates.4,5 Historically, treatment of a dislocated total hip arthroplasty with a constrained liner required open reduction of the prosthesis and revision of the damaged polyethylene liner and locking ring mechanism. More recently, there have
been reports of successful closed reduction of dislocated constrained total hip arthroplasty provided the constrained liner remained secured to the acetabular component.6,7
We present a case report of a modification of a previously described method for reduction of a dislocated constrained total hip arthroplasty.