Is The Dislocation of Hemiarthroplasty Resolved?
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Published:
Oct 17, 2024
Keywords:
Hemiarthroplasty, dislocation, reduction, recurrence
Main Article Content
Abstract
Introduction: The hip hemiarthroplasty dislocation is a challenging complication due to patient frailty, associated comorbidities, poor bone and soft tissue quality.
Materials and Methods: We have studied 28 cases of dislocation after hemiarthroplasty and compared with 56 control patients with one year follow-up. Closed reduction under general anesthesia were made in 26 cases. The study analyzed recurrence episodes of dislocation, considering various factors influencing instability recurrence.
Results: Among the 28 patients with dislocation post-hemiarthroplasty, there was an overall mortality 42% within the first 12 months, compared to 21% in the group of patients who did not experience a dislocation episode (p<0.001.) Recurrence following the initial reduction occurred in 12 cases (42%). Cases resulting from trauma had a lower recurrence risk than those occurring spontaneously or with minor with a OR of 11. Similarly, dislocations in patients with moderate to severe cognitive decline had a higher recurrence riskcompared to those without cognitive decline, with an OR of 5.5
Conclusions: Hemiarthroplasty dislocation is associated with a significantly increased mortality rate. While closed reduction under general anesthesia is often considered the preferred management, it is associated with a high failure rate, especially in patients with moderate to severe cognitive decline or with spontaneousdislocations.
Materials and Methods: We have studied 28 cases of dislocation after hemiarthroplasty and compared with 56 control patients with one year follow-up. Closed reduction under general anesthesia were made in 26 cases. The study analyzed recurrence episodes of dislocation, considering various factors influencing instability recurrence.
Results: Among the 28 patients with dislocation post-hemiarthroplasty, there was an overall mortality 42% within the first 12 months, compared to 21% in the group of patients who did not experience a dislocation episode (p<0.001.) Recurrence following the initial reduction occurred in 12 cases (42%). Cases resulting from trauma had a lower recurrence risk than those occurring spontaneously or with minor with a OR of 11. Similarly, dislocations in patients with moderate to severe cognitive decline had a higher recurrence riskcompared to those without cognitive decline, with an OR of 5.5
Conclusions: Hemiarthroplasty dislocation is associated with a significantly increased mortality rate. While closed reduction under general anesthesia is often considered the preferred management, it is associated with a high failure rate, especially in patients with moderate to severe cognitive decline or with spontaneousdislocations.
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How to Cite
Nehme Abouzeid, F., Mardomingo Alonso, A., Rubio Quevedo, R., Sánchez Gutiérrez, S. J., & González López, M. (2024). Is The Dislocation of Hemiarthroplasty Resolved?. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 479-487. https://doi.org/10.15417/issn.1852-7434.2024.89.5.1841
Section
Clinical Research
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References
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outcome. Clin Orthop Relat Res 2006;442:230-8. https://doi.org/10.1097/01.blo.0000183741.96610.c3
3. Jobory A, Kärrholm J, Hansson S, Åkesson K, Rogmark C. Dislocation of hemiarthroplasty after hip fracture is
common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register. Acta Orthop 2021;92(4):413-8. https://doi.org/10.1080/17453674.2021.1906517
4. Enocson A, Pettersson H, Ponzer S, Törnkvist H, Dalén N, Tidermark J. Quality of life after dislocation of hip
arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up. Qual Life Res 2009;18(9):1177-84. https://doi.org/10.1007/s11136-009-9531-x
5. Blewitt N, Mortimore S. Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury
1992;23(5):320-2. https://doi.org/10.1016/0020-1383(92)90179-v
6. Fakler JKM, Rositzka M, Schopow N, Roth A, Zajonz D, Ghanem M, et al. Factors associated with dislocation after bipolar hemiarthroplasty through an (antero-)lateral approach in elderly patients with a femoral neck fracture: a retrospective cohort study with a nested case-control subanalysis of radiographic parameters. Eur J Trauma Emerg Surg 2022;48(5):3981-7. https://doi.org/10.1007/s00068-022-01918-x (2022)
7. Gill JR, Kiliyanpilakkill B, Parker MJ. Management and outcome of the dislocated hip hemiarthroplasty. Bone Joint J 2018;100-B(12):1618-25. https://doi.org/10.1302/0301-620X.100B12.BJJ-2018-0281.R1
8. Falsetto A, Dobransky J, Kreviazuk C, Papp S, Beaulé PE, Grammatopoulos G. Instability after hip
hemiarthroplasty for femoral neck fracture: an unresolved problem. Can J Surg 2022;65(1):E128-E134.
https://doi.org/10.1503/cjs.021220
9. Salem KM, Shannak OA, Scammell BE, Moran CG. Predictors and outcomes of treatment in hip hemiarthroplasty dislocation. Ann R Coll Surg Engl 2014;96(6):446-51. https://doi.org/10.1308/003588414X13946184903045
10. Enocson A, Tidermark J, Tornkvist H, Lapidus LJ. Dislocation of hemiarthroplasty after femoral neck fracture:
better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthop 2008;79(2):211-7. https://doi.org/10.1080/17453670710014996
11. Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after
posterior and lateral approaches to the hip. Ann R Coll Surg Engl 1994;76(5):327-9. PMID: 7979075
12. Lewis DP, Wæver D, Thorninger R, Donnelly WJ. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: A systematic review and meta-analysis. J Arthroplasty 2019;34(8):1837-43. https://doi.org/10.1016/j.arth.2019.03.070
13. Ninh CC, Sethi A, Hatahet M, Les C, Morandi M, Vaidya R. Hip dislocation after modular unipolar hemiarthroplasty. J Arthroplasty 2009;24(5):768-74. https://doi.org/10.1016/j.arth.2008.02.019
14. Blanco JF, da Casa C, Fidalgo H, García-Iglesias MA, González-Garcia L, Burón-Alvarez I, et al. Effect of hip
hemiarthroplasty dislocation on mortality after hip fracture surgery. Rev Esp Cir Ortop Traumatol 2023;67(1):3-11.
https://doi.org/10.1016/j.recot.2022.08.006
2. Sierra RJ, Schleck CD, Cabanela ME. Dislocation of bipolar hemiarthroplasty: rate, contributing factors, and
outcome. Clin Orthop Relat Res 2006;442:230-8. https://doi.org/10.1097/01.blo.0000183741.96610.c3
3. Jobory A, Kärrholm J, Hansson S, Åkesson K, Rogmark C. Dislocation of hemiarthroplasty after hip fracture is
common and the risk is increased with posterior approach: result from a national cohort of 25,678 individuals in the Swedish Hip Arthroplasty Register. Acta Orthop 2021;92(4):413-8. https://doi.org/10.1080/17453674.2021.1906517
4. Enocson A, Pettersson H, Ponzer S, Törnkvist H, Dalén N, Tidermark J. Quality of life after dislocation of hip
arthroplasty: a prospective cohort study on 319 patients with femoral neck fractures with a one-year follow-up. Qual Life Res 2009;18(9):1177-84. https://doi.org/10.1007/s11136-009-9531-x
5. Blewitt N, Mortimore S. Outcome of dislocation after hemiarthroplasty for fractured neck of the femur. Injury
1992;23(5):320-2. https://doi.org/10.1016/0020-1383(92)90179-v
6. Fakler JKM, Rositzka M, Schopow N, Roth A, Zajonz D, Ghanem M, et al. Factors associated with dislocation after bipolar hemiarthroplasty through an (antero-)lateral approach in elderly patients with a femoral neck fracture: a retrospective cohort study with a nested case-control subanalysis of radiographic parameters. Eur J Trauma Emerg Surg 2022;48(5):3981-7. https://doi.org/10.1007/s00068-022-01918-x (2022)
7. Gill JR, Kiliyanpilakkill B, Parker MJ. Management and outcome of the dislocated hip hemiarthroplasty. Bone Joint J 2018;100-B(12):1618-25. https://doi.org/10.1302/0301-620X.100B12.BJJ-2018-0281.R1
8. Falsetto A, Dobransky J, Kreviazuk C, Papp S, Beaulé PE, Grammatopoulos G. Instability after hip
hemiarthroplasty for femoral neck fracture: an unresolved problem. Can J Surg 2022;65(1):E128-E134.
https://doi.org/10.1503/cjs.021220
9. Salem KM, Shannak OA, Scammell BE, Moran CG. Predictors and outcomes of treatment in hip hemiarthroplasty dislocation. Ann R Coll Surg Engl 2014;96(6):446-51. https://doi.org/10.1308/003588414X13946184903045
10. Enocson A, Tidermark J, Tornkvist H, Lapidus LJ. Dislocation of hemiarthroplasty after femoral neck fracture:
better outcome after the anterolateral approach in a prospective cohort study on 739 consecutive hips. Acta Orthop 2008;79(2):211-7. https://doi.org/10.1080/17453670710014996
11. Unwin AJ, Thomas M. Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after
posterior and lateral approaches to the hip. Ann R Coll Surg Engl 1994;76(5):327-9. PMID: 7979075
12. Lewis DP, Wæver D, Thorninger R, Donnelly WJ. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: A systematic review and meta-analysis. J Arthroplasty 2019;34(8):1837-43. https://doi.org/10.1016/j.arth.2019.03.070
13. Ninh CC, Sethi A, Hatahet M, Les C, Morandi M, Vaidya R. Hip dislocation after modular unipolar hemiarthroplasty. J Arthroplasty 2009;24(5):768-74. https://doi.org/10.1016/j.arth.2008.02.019
14. Blanco JF, da Casa C, Fidalgo H, García-Iglesias MA, González-Garcia L, Burón-Alvarez I, et al. Effect of hip
hemiarthroplasty dislocation on mortality after hip fracture surgery. Rev Esp Cir Ortop Traumatol 2023;67(1):3-11.
https://doi.org/10.1016/j.recot.2022.08.006