JBJS Case Connections—Preventing and Managing Post-THA Hip Dislocations

Hip dislocation is one of the most common perioperative complications of total hip arthroplasty (THA). The latest “Case Connections” article examines an often-overlooked spinal basis for THA dislocations, 2 cases of dual-mobility hip-bearing dissociations during attempted closed reduction for post-THA dislocations, and a unique application of Ilizarov distraction to treat a chronic post-THA dislocation.

The springboard case report, from the February 22, 2017, edition of JBJS Case Connector, describes the case of a 63-year-old woman who had experienced 4 anterior dislocations in less than 3 years after having her left hip replaced. Each dislocation was accompanied by lower back pain, and the patient also reported substantial pain in the contralateral hip. The authors emphasize the importance of recognizing pelvic retroversion and sagittal spinal imbalance before performing total hip arthroplasty.

Two additional JBJS Case Connector case reports summarized in the article focus on:

• The risks of performing closed reduction on patients with a dislocated dual-mobility hip design.
• A unique application of Ilizarov distraction to lengthen soft tissues for femoral-component reduction in a patient with a chronically dislocated hip replacement.

While closed reduction with the patient under sedation is a frequently employed first-line tactic that is often successful for dislocated THAs, these 3 cases show that creative surgical interventions may be necessary for optimal outcomes in patients with “complicated” hips and/or recurrent dislocations.