The unstable total hip arthroplasty
Gösta UllmarkHip
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One of the most common causes for revision surgery following total hip arthroplasty (THA) is dislocation.
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Dislocation is associated with a considerable amount of suffering and risks for the patient, and extra costs for the health care system.
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Compared with degenerative arthritis, the dislocation rate is doubled for avascular necrosis and multiplied by three times for congenital dislocation, four for fracture, five for nonunion, malunion or a failed hip arthroplasty, and eleven times after surgery for prosthetic instability.
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In analysing instability the cause may be assessed as 1) locally caused within the hip with explanatory radiographic findings, 2) locally caused without explanatory radiographic findings or 3) non-locally caused, i.e. non-compliant patient, neuromuscular or cognitive disorders.
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Revision strategies for instability are typically directed to correct the underlying aetiology, but also to strive for an upsizing of the head and liner.
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