Hip and Knee Questions and Answers.

Edited By: Seth S. Leopold, M.D.
Last updated Wednesday, February 09, 2005

Dislocation after total hip replacement

Available treatments

Total hip replacement is widely considered one of the most reliable operations devised in the 20th century. The reason for this is that the likelihood of success (and the benefits of a good hip replacement) far outweighs the chance of failure.

However, when a hip replacement fails, it can be a serious problem. Hip dislocation (when the ball comes out of the socket) is painful and inconvenient. Until the dislocation is reduced (put back in the socket), it is all but impossible to even walk.

The chance that a hip replacement will dislocate varies depending on many circumstances. The likelihood that this complication will occur ranges from less than 1 percent to 10 percent, depending on a number of risk factors. But the initial treatment of a first dislocation is typically the same: the patient will be sedated (made sleepy), and by manipulating the joint, the ball usually can be put back into the socket. Sometimes, this does not succeed, and in those cases, the hip may need to be surgically opened again and the dislocation treated with an operation to put the ball back in the socket. Sometimes a brace may be worn after a first-time dislocation.

A majority of patients who have one hip dislocation will never have another.

But a significant minority (20-30 percent or more) of patients will re-dislocate, either early or later on.

The treatment for someone with multiple (or recurrent) dislocations is nearly always surgery, and is geared towards identifying and treating the cause of the dislocation. Common causes include:

• Unsatisfactory position of the component parts of the hip replacement (either the cup or the stem); this is by far the most common problem
• Incorrect soft-tissue tension of or poor functioning of the muscles around the hip
• Impingement (levering) of the thigh bone or the component in it against the pelvis
• Infection
• Severe soft-tissue deficiencies around the hip joint

There are surgical treatments that specifically address each of those causes, and sometimes more than one cause is present. There are also specially designed hip implants that, by design, resist dislocation; however, those devices can cause other problems, and it is best to avoid using them if possible.

This is a very complex problem, and none of the reliable surgical solutions are technically easy to perform. This is reflected in the success rate of surgery, which is only about 80 percent in the best of circumstances.

Because of this, it is reasonable to seek advice from a surgeon who has particular expertise in the treatment of this difficult problem. Most orthopaedic surgeons consider this a challenge best addressed by a joint replacement specialist.

Surgery for Hip and Knee at the University of Washington

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