25.07.2019 | Original Article | Sonderheft 2/2020 Open Access
Treatment of Recurrent Dislocation after Total Hip Arthroplasty Using Advanced Imaging and Three-Dimensional Modeling Techniques: A Case Series
- Zeitschrift:
- HSS Journal ® > Sonderheft 2/2020
Wichtige Hinweise
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The online version of this article (https://doi.org/10.1007/s11420-019-09704-z) contains supplementary material, which is available to authorized
users.
Level of Evidence: Therapeutic Study Level IV
Abstract
Background
Surgical treatment options for addressing recurrent dislocation
after total hip arthroplasty (THA) vary. Identifying impingement mechanisms in
an unstable THA may be beneficial in determining appropriate treatment.
Questions/Purposes
We sought to assess the effectiveness of developing pre-operative
plans for treating hip instability after THA. We used advanced imaging and
three-dimensional modeling techniques to perform impingement analyses in
patients with unstable THA.
Methods
We evaluated a series of eight patients who would require revision
THA to treat recurrent dislocation. Using a pre-operative algorithmic approach,
we built patient-specific models and evaluated hip range of motion with computed
tomographic scanning and biplanar radiography. This information was used to
determine a surgical treatment plan that was then executed intra-operatively.
Patients were followed for 2 years to determine whether they experienced
another hip dislocation following treatment.
Results
Pre-operative kinematic modeling showed four of the eight patients
had limited hip range of motion during flexion and internal rotation; a
prominent anterior inferior iliac spine (AIIS) was found to limit hip range of
motion in some of these cases. In the other four patients, range of motion was
acceptable, suggesting soft-tissue causes of dislocation. No patients in this
series experienced dislocation after undergoing revision THA.
Conclusion
Advanced modeling techniques may be useful for identifying the
impingement mechanisms responsible for instability after THA. Once variables
contributing to limited hip range of motion are identified, surgeons can develop
treatment plans to improve patient outcomes. Resecting a hypertrophic AIIS may
improve hip range of motion and may be an important consideration for hip
surgeons when revising unstable THAs.
