The Risk Factors of the Hip Dislocation After Total Hip Arthroplasty (Literature Review)
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hip arthroplasty
arthroplasty complications
surgical tactics
risk factors

How to Cite

Zazirnyi, I., & Pinchuk, Y. (2022). The Risk Factors of the Hip Dislocation After Total Hip Arthroplasty (Literature Review). Herald of Orthopaedics, Traumatology and Prosthetics, (1(112), 60-71.


Summary. The dislocation of the endoprosthesis head is one of hip arthroplasty complications. In the vast majority of cases, the cause of dislocation is multifactorial. That is why only a thorough analysis of the patient’s peculiarities, surgery and rehabilitation will help to avoid the relapse. Risk factors associated with the patient include: old age, male gender, obesity, concomitant diseases, low level of preoperative physical activity, low compliance, and some others. The problem of biomechanical ratio in the segment “spine – pelvis – lower limb” deserves special attention. Besides, there are risk factors associated with the surgeon: access option, type of implant, fixation and position of endoprosthesis components, experience and surgical technique of the orthopedic surgeon. The strategy of dislocations rate reduction is based on a detailed study of dislocation causes and their elimination, and adequate surgery planning. The treatment of a patient with dislocation should take into account the multifactorial etiology of the condition.
ARTICLE PDF (Українська)


Amstutz H.C. Complications of total hip replacement. Clin Orthop Relat Res. 1970;72:123-137.

Fessy M.H., Putman S., Viste A., Isida R., Ramdane N., Ferreira A. et al. What are the risk factors for dislocation in primary total hip arthroplasty? A multicentre case-control study of 128 unstable and 438 stable hips. Orthop Traumatol Surg Res. 2017; 103(5):663-668. DOI: 10.1016/j.otsr.2017.05.014.

de Palma L., Procaccini R., Soccetti A., Marinelli M. Hospital cost of treating early dislocation following hip arthroplasty. Hip Int. 2012; 22(1):62-67. DOI: 10.5301/HIP.2012.9059.

Abdel M.P., Cross M.B., Yasen A.T., Haddad F.S. The functional and financial impact of isolated and recurrent dislocation after total hip arthroplasty. Bone Joint J. 2015; 97-B(8):1046-1049. DOI: 10.1302/0301-620X.97B8.34952.

Kunutsor S.K., Barrett M.C., Beswick A.D., Judge A., Blom A.W., Wylde V., Whitehouse M.R. Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements. Lancet Rheumatol. 2019; 1(2):E111-E121. DOI: 10.1016/S2665-9913(19)30045-1.

Brennan S.A., Khan F., Kiernan C., Queally J.M., McQuillan J., Gormley I.C., O’Byrne J.M. Dislocation of primary total hip arthroplasty and the risk of redislocation. Hip Int. 2012; 22(5):500-504. DOI: 10.5301/HIP.2012.9747.

Weidenhielm L., Olivecrona H., Maguire G.Q. Jr., Noz M.E. Prosthetic liner wear in total hip replacement: a longitudinal 13-year study with computed tomography. Skeletal Radiol. 2018; 47(6):883-887. DOI: 10.1007/s00256-018-2878-8.

Jørgensen C.C., Kjaersgaard-Andersen P., Solgaard S., Kehlet H. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors. Arch Orthop Trauma Surg. 2014; 134(11):1615-1622. DOI: 10.1007/s00402-014-2051-3.

Gausden E.B., Parhar H.S., Popper J.E., Sculco P.K., Rush B.N.M. Risk factors for early dislocation following primary elective total hip arthroplasty. J Arthroplasty. 2018; 33(5):1567-1571. DOI: 10.1016/j.arth.2017.12.034.

Houdek M.T., Watts C.D., Wyles C.C., Trousdale R.T., Milbrandt T.A., Taunton M.J. Total hip arthroplasty in patients with cerebral palsy: a cohort study matched to patients with osteoarthritis. J Bone Joint Surg Am. 2017; 99(6):488-493. DOI: 10.2106/JBJS.16.00528.

King G., Hunt L.P., Wilkinson J.M., Blom A.W. National Joint Registry for England, Wales, and Northern Ireland. Good outcome of total hip replacement in patients with cerebral palsy: A comparison of 389 patients and 425,813 controls from the National Joint Registry for England and Wales. Acta Orthop. 2016; 87(2):93-99. DOI: 10.3109/17453674.2015.1137439.

von Knoch M., Berry D.J., Harmsen W.S., Morrey B.F. Late dislocation after total hip arthroplasty. J Bone Joint Surg Am. 2002; 84(11):1949-1953. DOI: 10.2106/00004623-200211000-00007.

Peter R., Lubbeke A., Stern R., Hoffmeyer P. Cup size and risk of dislocation after primary total hip arthroplasty. J Arthroplasty. 2011; 26(8):1305-1309. DOI: 10.1016/j.arth.2010.11.015.

Dargel J., Oppermann J., Brüggemann G.P., Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014; 111(51-52):884-890. DOI: 10.3238/arztebl.2014.0884.

Esposito, C.I., Gladnick, B.P., Lee, Y.Y., Lyman, S., Wright, T.M., Mayman D.J. et al. Cup position alone does not predict risk of dislocation after hip arthroplasty. J Arthroplasty. 2015; 30(1):109-113. DOI: 10.1016/j.arth.2014.07.009.

Kelley S.S., Lachiewicz P.F., Hickman J.M., Paterno S.M. Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res. 1998;(355): 163-170. DOI: 10.1097/00003086-199810000-00017.

Perfetti D.C., Schwarzkopf R., Buckland A.J., Paulino C.B., Vigdorchik J.M. Prosthetic Dislocation and Revision After Primary Total Hip Arthroplasty in Lumbar Fusion Patients: A Propensity Score Matched-Pair Analysis. J Arthroplasty. 2017; 32(5):1635-1640.e1. DOI: 10.1016/j.arth.2016.11.029.

Buckland A.J., Puvanesarajah V., Vigdorchik J., Schwarzkopf R., Jain A., Klineberg E.O. et al. Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion. Bone Joint J. 2017; 99-B(5):585-591. DOI: 10.1302/0301-620X.99B5.BJJ-2016-0657.R1.

Sing D.C., Barry J.J., Aguilar T.U., Theologis A.A., Patterson J.T., Tay B.K. et al. Prior Lumbar Spinal Arthrodesis Increases Risk of Prosthetic- Related Complication in Total Hip Arthroplasty. J Arthroplasty. 2016; 31(9 Suppl): 227-232.e1. DOI: 10.1016/j.arth.2016.02.069.

DelSole E.M., Vigdorchik J.M., Schwarzkopf R., Errico T.J., Buckland A.J. Total hip arthroplasty in the spinal deformity population: does degree of sagittal deformity affect rates of safe zone placement, instability, or revision? J Arthroplasty. 2017; 32(6): 1910-1917. DOI: 10.1016/j.arth.2016.12.039.

Seagrave K.G., Troelsen A., Malchau H., Husted H., Gromov K. Acetabular cup position and risk of dislocation in primary total hip arthroplasty. Acta Orthop. 2017; 88(1): 10-17. DOI: 10.1080/17453674.2016.1251255.

Lewinnek G.E., Lewis J.L., Tarr R., Compere C.L., Zimmerman J.R. Dislocations after total hip replacement arthroplasties. J Bone Joint Surg Am. 1978; 60(2): 217-220.

Callanan M.C., Jarrett B., Bragdon C.R., Zurakowski D., Rubash H.E., Freiberg A.A., Malchau H. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011; 469(2): 319-329. DOI: 10.1007/s11999-010-1487-1.

Abdel M.P., von Roth P., Jennings M.T., Hanssen A.D., Pagnano M.W. What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position. Clin Orthop Relat Res. 2016; 474(2): 386-391. DOI: 10.1007/s11999-015-4432-5.

Sadhu A., Nam D., Coobs B.R., Barrack T.N., Nunley R.M., Barrack R.L. Acetabular component position and the risk of dislocation following primary and revision total hip arthroplasty: a matched cohort analysis. J Arthroplasty. 2017; 32(3): 987-991. DOI: 10.1016/j.arth.2016.08.008.

Saiz A.M., Lum Z.C., Pereira G.C. Etiology, Evaluation, and Management of Dislocation After Primary Total Hip Arthroplasty. JBJS Rev. 2019; 7(7):e7. DOI: 10.2106/JBJS.RVW.18.00165.

Heckmann N., McKnight B., Stefl M., Trasolini N.A., Ike H., Dorr L.D. Late dislocation following total hip arthroplasty: spinopelvic imbalance as a causative factor. J Bone Joint Surg Am. 2018; 100(21): 1845-1853. DOI: 10.2106/JBJS.18.00078.

Elkins J.M., Callaghan J.J., Brown T.D. The 2014 Frank Stinchfield Award: The “landing zone” for wear and stability in total hip arthroplasty is smaller than we thought: a computational analysis. Clin Orthop Relat Res. 2015; 473(2): 441-452. DOI: 10.1007/s11999-014-3818-0.

Tezuka T., Heckmann N.D., Bodner R.J., Dorr L.D. Functional Safe Zone Is Superior to the Lewinnek Safe Zone for Total Hip Arthroplasty: Why the Lewinnek Safe Zone Is Not Always Predictive of Stability. J Arthroplasty. 2019; 34(1): 3-8. DOI: 10.1016/j.arth.2018.10.034.

Stefl M., Lundergan W., Heckmann N., McKnight B., Ike H., Murgai R., Dorr L.D. Spinopelvic mobility and acetabular component position for total hip arthroplasty. Bone Joint J. 2017; 99-B(1 Supple A):37-45. DOI: 10.1302/0301-620X.99B1.BJJ-2016-0415.R1.

Espisito C.I., Miller T.T., Kim H.J., Barlow B.T., Wright T.M., Padgett D.E. et al. Does degenerative lumbar spine disease influence femoral acetabular flexion in patients undergoing total hip arthroplasty. Clin Orthop Relat Res. 2016; 474(8): 1788-1797. DOI: 10.1007/s11999-016-4787-2.

Lum Z.C., Coury J.G., Cohen J.L., Dorr L.D. The Current Knowledge on Spinopelvic Mobility. J Arthroplasty. 2018; 33(1): 291-296. DOI: 10.1016/j.arth.2017.08.013.

Dorr L.D., Callaghan J.J. Death of the Lewinnek “Safe Zone”. J Arthroplasty. 2019; 34(1):1-2. DOI: 10.1016/j.arth.2018.10.035.

Nakashima Y., Hirata M., Akiyama M., Itokawa T., Yamamoto T., Motomura G. et al. Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty. Int Orthop. 2014; 38(1): 27-32.

Tripuraneni K.R., Munson N.R., Archibeck M.J., Carothers J.T. Acetabular abduction and dislocations in direct anterior vs posterior total hip arthroplasty: a retrospective, matched cohort study. J Arthroplasty. 2016; 31(10): 2299-2302. DOI: 10.1016/j.arth.2016.03.008.

Sheth D., Cafri G., Inacio M.C., Paxton E.W., Namba R.S. Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk. Clin Orthop Relat Res. 2015; 473(11): 3401-3408. DOI: 10.1007/s11999-015-4230-0.

Maratt J.D., Gagnier J.J., Butler P.D., Hallstrom B.R., Urquhart A.G., Roberts K.C. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty. 2016; 31(9 Suppl): 127-130. DOI: 10.1016/j.arth.2016.02.071.

Guo L., Yang Y., An B., Yang Y., Shi L., Han X., Gao S. Risk factors for dislocation after revision total hip arthroplasty: A systematic review and metaanalysis. Int J Surg. 2017; 38:123-129. DOI: 10.1016/j.ijsu.2016.12.122.

Kong X., Grau L., Ong A., Yang C., Chai W. Adopting the direct anterior approach: experience and learning curve in a Chinese patient population. J Orthop Surg Res. 2019; 14(1): 218.

Miki H., Sugano N., Yonenobu K., Tsuda K., Hattori M., Suzuki N. Detecting cause of dislocation after total hip arthroplasty by patient-specific four-dimensional motion analysis. Clin Biomech (Bristol, Avon). 2013; 28(2): 182-186. DOI: 10.1016/j.clinbiomech.2012.11.009.

Vaishya R., Vijay V., Vaish A. Successful salvage of an unstable Girdlestone’s excision arthroplasty with a megaprosthesis of the hip. J Clin Orthop Trauma. 2015; 6(4):269-272.

Girard J., Kern G., Migaud H., Delaunay C., Ramdane N., Hamadouche M. Société française de chirurgie orthopédique et traumatologique. Primary total hip arthroplasty revision due to dislocation: prospective French multicenter study. Orthop Traumatol Surg Res. 2013; 99(5): 549-553. DOI: 10.1016/j.otsr.2013.03.026.

Howie D.W., Holubowycz O.T., Middleton R. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012; 94(12): 1095-1102. DOI: 10.2106/JBJS.K.00570.

Hailer N.P., Weiss R.J., Stark A., Karrholm J. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop. 2012; 83(5): 442-448. DOI: 10.3109/17453674.2012.733919.

Girard J. Femoral head diameter considerations for primary total hip arthroplasty. Orthop Traumatol Surg Res. 2015; 101(1 Suppl):S25-29. DOI: 10.1016/j.otsr.2014.07.026.

Magee T.H., Schaeffer J.F., Buck D.S., Gililland J.M., Hofmann A.A. Effect of Femoral Head Diameter on Risk of Dislocation after Primary Total Hip Arthroplasty. JArthritis.2013; 2(1): 109. doi:10.4172/2167-7921.1000109.

Berend K.R., Lombardi A.V. Jr., Mallory T.H., Adams J.B., Russell J.H., Groseth K.L. The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures. J Arthroplasty. 2005; 20(7 Suppl 3): 93-102. DOI: 10.1016/j.arth.2005.06.001.

Haughom B.D., Plummer D.R., Moric M., Della Valle C.J. Is there a benefit to head size greater than 36 mm in total hip arthroplasty? J Arthroplasty. 2016; 31(1):152- 155. DOI: 10.1016/j.arth.2015.08.011.

Munro J.T., Vioreanu M.H., Masri B.A., Duncan C.P. Acetabular liner with focal constraint to prevent dislocation after THA. Clin Orthop Relat Res. 2013; 471(12): 3883-3390. DOI: 10.1007/s11999-013-2858-1.

Pace T., Finley S., Snider R., Looper J., Tanner S. Short-term results of novel constrained total hip arthroplasty. Orthop Rev (Pavia). 2015;7(2):5779. DOI: 10.4081/or.2015.5779.

Gill K., Whitehouse S.L., Hubble M.J., Wilson M.J. Short-term results with a constrained acetabular liner in patients at high risk of dislocation after primary total hip arthroplasty. Hip Int. 2016; 26(6):580-584. DOI: 10.5301/hipint.5000396.

Prietzel T., Hammer N., Schleifenbaum S., Adler D., Pretzsch M., Kohler L., et al. [The impact of capsular repair on the dislocation rate after primary total hip arthroplasty: a retrospective analysis of 1972 cases]. Z Orthop Unfall. 2014; 152(2):130-143. (In German). DOI: 10.1055/s-0034-1368209.

Forde B., Engeln K., Bedair H., Bene N., Talmo C., Nandi S. Restoring femoral offset is the most important technical factor in preventing total hip arthroplasty dislocation. J Orthop. 2018; 15(1):131-133. DOI: 10.1016/j.jor.2018.01.026.

Matsushita A., Nakashima Y., Jingushi S., Yamamoto T., Kuraoka A., Iwamoto Y. Effects of the femoral offset and the head size on the safe range of motion in total hip arthroplasty. J Arthroplasty. 2009; 24(4):646-651. DOI: 10.1016/j.arth.2008.02.008.

Robinson M., Bornstein L., Mennear B., Bostrom M., Nestor B., Padgett D., et al. Effect of restoration of combined offset on stability of large head THA. Hip Int. 2012;22(3):248-253. DOI: 10.5301/HIP.2012.9283.

Gerhardt D.M., Bisseling P., de Visser E., van Susante J.L. Modular necks in primary hip arthroplasty without anatomical deformity: no clear benefit on restoration of hip geometry and dislocation rate. An exploratory study. J Arthroplasty. 2014; 29(8):1553-1558. DOI: 10.1016/j.arth.2014.02.009.

De Fine M., Romagnoli M., Toscano A., Bondi A., Nanni M., Zaffagnini S. Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res. 2017; 103(3):349-355. DOI: 10.1016/j.otsr.2016.12.013.

Goldstein W.M., Gleason T.F., Kopplin M., Branson J.J. Prevalence of dislocation after total hip arthroplasty through a posterolateral approach with partial capsulotomy and capsulorrhaphy. J Bone Joint Surg Am. 2001; 83-A Suppl 2(Pt 1):2-7. DOI: 10.2106/00004623-200100021-00002.

Zhang D., Chen L., Peng K., Xing F., Wang H., Xiang Z. Effectiveness and safety of the posterior approach with soft tissue repair for primary total hip arthroplasty: a meta-analysis. Orthop Traumatol Surg Res. 2015; 101(1):39-44. DOI: 10.1016/j.otsr.2014.10.01.

Spaans E.A., Spaans A.J., van den Hout J.A., Bolder S.B. The result of transmuscular versus transosseous repair of the posterior capsule on early dislocations in primary hip arthroplasty. Hip Int. 2015; 25(6):537-542. DOI: 10.5301/hipint.5000279.

Suh K.T., Roh H.L., Moon K.P., Shin J.K., Lee J.S. Posterior approach with posterior soft tissue repair in revision total hip arthroplasty. J Arthroplasty. 2008; 23(8):1197-1203. DOI: 10.1016/j.arth.2007.08.009.

Aota S., Kikuchi S.I., Ohashi H., Kitano N., Hakozaki M., Konno S.I. Soft tissue reinforcement with a Leeds-Keio artificial ligament in revision surgery for dislocated total hip arthroplasty. Hip Int. 2018; 28(3):324-329. DOI: 10.5301/hipint.5000573.

van Heumen M., Heesterbeek P.J., Swierstra B.A., van Hellemondt G.G., Goosen J.H. Dual mobility acetabular component inrevisiontotal hip arthroplasty for persistent dislocation: no dislocations in 50 hips after 1-5 years. J Orthop Traumatol. 2015; 16(1):15-20. DOI: 10.1007/s10195-014-0318-7.

Jones S.A. The prevention and treatment of dislocation following total hip arthroplasty: efforts to date and future strategies. Hip Int. 2015;25(4):388-392. DOI: 10.5301/hipint.5000273.

García-Rey E., García-Cimbrelo E. Abductor Biomechanics Clinically Impact the Total Hip Arthroplasty Dislocation Rate: A Prospective Long-Term Study. J Arthroplasty. 2016; 31(2):484-490. DOI: 10.1016/j.arth.2015.09.039.

Werner B.C., Brown T.E. Instability after total hip arthroplasty. World J Orthop. 2012; 3(8):122-130. DOI: 10.5312/wjo.v3.i8.122.

Potter H.G., Foo L.F., Nestor B.J. What is the role of magnetic resonance imaging in the evaluation of total hip arthroplasty? HSS J. 2005; 1(1):89-93. DOI: 10.1007/s11420-005-0112-4.

Zahar A., Rastogi A., Kendoff D. Dislocation after total hip arthroplasty. Curr Rev Musculoskelet Med. 2013; 6(4):350-356. DOI: 10.1007/s12178-013-9187-6.

Wera G.D., Ting N.T., Moric M., Paprosky W.G., Sporer S.M. Della Valle C.J. Classification and management of the unstable total hip arthroplasty. J Arthroplasty. 2012; 27(5):710-715. DOI: 10.1016/j.arth.2011.09.010.

Parvizi J., Kim K.I., Goldberg G., Mallo G., Hozack W.J. Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning. Clin Orthop Relat Res. 2006; 447:60-65.

Salassa T., Hoeffel D., Mehle S., Tatman P., Gioe T.J. Efficacy of revision surgery for the dislocating total hip arthroplasty: report from a large community registry. Clin Orthop Relat Res. 2014; 472(3):962-967.

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