This 2004 JAAOS review by Soong, Rubash, and Macaulay examines why THA dislocations occur and how to manage them. It covers patient risk factors, every major surgical variable, and a stepwise treatment algorithm from closed reduction through salvage procedures.
When you see a THA dislocation, follow the algorithm: confirm reduction with fluoroscopy, brace in abduction with a flexion stop for at least 6 weeks, and investigate the cause.
Timing is your first diagnostic clue: Early (weeks to months) → soft tissue, component position, infection, noncompliance Late (>1 year) → polyethylene wear or soft-tissue stretch
When planning a posterior-approach THA in a high-risk patient (fracture indication, prior hip surgery, neuromuscular disorder), routine posterior capsular repair and strict attention to the Lewinnek safe zone are your two strongest modifiable levers.
For recurrent instability, target the cause before reaching for a constrained cup — constrained cup dislocation rates range from 4% to 29% depending on design, and they transmit high forces to the bone-prosthesis interface.
This 2004 JAAOS review by Soong, Rubash, and Macaulay examines why THA dislocations occur and how to manage them. It covers patient risk factors, every major surgical variable, and a stepwise treatment algorithm from closed reduction through salvage procedures.
When you see a THA dislocation, follow the algorithm: confirm reduction with fluoroscopy, brace in abduction with a flexion stop for at least 6 weeks, and investigate the cause.
Timing is your first diagnostic clue: Early (weeks to months) → soft tissue, component position, infection, noncompliance Late (>1 year) → polyethylene wear or soft-tissue stretch
When planning a posterior-approach THA in a high-risk patient (fracture indication, prior hip surgery, neuromuscular disorder), routine posterior capsular repair and strict attention to the Lewinnek safe zone are your two strongest modifiable levers.
For recurrent instability, target the cause before reaching for a constrained cup — constrained cup dislocation rates range from 4% to 29% depending on design, and they transmit high forces to the bone-prosthesis interface.