Hip iSAWE 4

Causes

• Patient factors, including age, female sex, neuromuscular disease, cognitive impairment, alcohol and spinal fusion with a stiff spine
• Component malposition, with cup version and inclination outside the target zone or a retroverted stem
• Soft tissue tension, with reduced offset or leg length
• Impingement of bone or components
• Abductor deficiency or trochanteric nonunion
• Late dislocation from polyethylene wear

Assessment

• Mechanism and direction of dislocation and timing
• Radiographs, and CT for cup and stem version
• Inflammatory markers and aspiration to exclude infection
• Assess abductor function and spinopelvic mobility

Management

• Closed reduction under anaesthesia and examination of stability
• A first early dislocation with well placed components is often managed non-operatively with precautions
• Revision for recurrent dislocation, addressing the cause
• Correct malpositioned components, restore offset and length, remove impingement
• Dual mobility or constrained liners for abductor deficiency or high risk patients

Related pages

• Primary Total Hip Arthroplasty