The management of recurrent dislocations of hemiarthroplasty in elderly patient are very challenging. Even though various treatment options are described most of them are associated with increased morbidity and mortality and prevent these patients from early mobilisation. The use of captive acetabular avoid repeated dislocations, prolonged bed rest, wearing of a brace and all the complications associated with sustained immobilization. The drawbacks of using constrained cups are hip pain, limited hip movements and loosening.
Fracture of the femur including the greater trochanter can occur during insertion of the prosthesis. This problem is usually treated with fixation with cables and/or wires. Intra operative fractures range between 0.1-1.0% with cemented total hip replacements and is increased when using a cementless prosthesis (3-29%).
Similar to hip replacement surgery, a knee replacement is indicated when you have advanced osteoarthritis of the knee joint and non-operative measures (eg. Weight loss, anti-inflamatories , physiotherapy etc) are no longer controlling your pain.
All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hip replacements will survive 20-25 years.
This means the hip comes out of its socket. Precautions need to be taken with your new hip forever. It a dislocation occurs it needs to be put back into place with an anaesthetic. Rarely this becomes a recurrent problem needing further surgery.
The aim of this retrospective study was to identify and evaluate complications after hip spacer implantation other than reinfection and/or infection persistence.
Anterior dislocation of the hip occurs from a direct blow to the posterior aspect of the hip or, more commonly, from a force applied to an abducted leg that levers the hip anteriorly out of the acetabulum. The hip is forced into abduction and the force pushes the femur medially. Abduction causes the femoral neck or greater trochanter to jam against the superior segment of the acetabulum. The greater trochanter or femoral neck then acts like a lever, lifting the femoral head out of the acetabulum. A medially directed force then pushes the femoral head through the anterior acetabular capsule.
Shoulder is one of the most mobile and the least stable of all the joints in the body. This makes it the joint which is most vulnerable for dislocations or subluxations. In a proportion of these patients, the shoulder tends to dislocate or subluxate repeatedly after the first dislocation. Patients with a tendency for recurrent (repeated) dislocation or subluxation are said to have an unstable shoulder or shoulder instability.
Posterior dislocations account of more than 90% of dislocations and occur when the knee and hip are flexed and a posterior force is applied at the knee. Posterior hip dislocations occur typically during MVAs, especially head-on collisions, when the knees of the front-seat occupant strike the dashboard. Energy is transmitted along the femoral shaft to the hip joint. If the leg is struck while in an adducted position, a posterior dislocation may result. If the leg is in neutral or an abducted position when struck, an anterior dislocation or fracture/dislocation may occur. In the latter case, the posterior wall of the acetabulum is fractured, making subsequent reduction less stable.
The third type of hip dislocation is a central dislocation in which a direct impact to the lateral aspect of the hip forces the hip centrally through the acetabulum into the pelvis. This is a fracture-dislocation.
This is the most devastating complication and is fortunately uncommon (1 – 2% of patients). If infection cannot be eradicated by antibiotics, removal of the components may be required. Infection can occur at any time but often appears some time after the hip surgery. The incidence of infection is increased in patients with rheumatoid arthritis, an existing infection, obesity, diabetes, alcoholism and those patients who are taking immunosuppressive drugs and steroids.
A shoulder may dislocate after a significant injury like a fall on an outstretched hand or due to a direct blow to the shoulder (traumatic dislocation), or it may dislocate without a significant injury (atraumatic dislocation) in patients who have an inherent laxity of joints (loose jointed patients). In some patients like throwing athletes, the repetitive action of forceful throwing causes the anterior capsule to stretch out and can eventually lead to a dislocation or subluxation (microtraumatic dislocation).
Revision total hip replacement is performed when the original primary total hip
replacement has worn out or loosened in the bone. Revisions are also carried
out if the primary hip replacement fails due to recurrent dislocation, infection,
fracture or very rarely, ongoing pain and significant leg length discrepancy.