Trefzer Raphael, Reichel Franz, Hariri Mustafa, Nees Timo, Reiner Tobias, Spranz David, Walker Tilman
Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
Orthopadie (Heidelb). 2025 May 31. doi: 10.1007/s00132-025-04662-3.
Dislocations represent one of the leading complications and the most common cause of early surgical revision in primary total hip arthroplasty (THA). Patient-, implant- and procedure-related factors can contribute causally by impairing soft tissue tension and/or impingement-free mobility.
Patient-specific factors, such as underlying neurological disorders or reduced spinopelvic mobility, should be carefully considered by the surgeon when selecting implants and devising a treatment strategy. Furthermore, the range of market-approved implants offers a broad spectrum of preventive measures for dislocation in both primary and revision settings.
Central to prevention is the precise and appropriate positioning of the implant, tailored to the patient's individual joint biomechanics. While tripolar acetabular systems are utilized in specific patient groups during primary surgery and revision procedures, constrained liners, should be reserved as a fallback strategy in exceptional cases. The occurrence of a THA dislocation constitutes a medical emergency, necessitating immediate radiographic evaluation and early reduction. In cases of a first-time dislocation, additional imaging may be warranted during follow-up, whereas recurrent dislocations mandate tomographic imaging to exclude malpositioning or loosening of the implant. This review summarizes the underlying causes and preventive strategies for THA instability, as well as the diagnostic and therapeutic algorithms for managing THA dislocations.
脱位是初次全髋关节置换术（THA）中主要的并发症之一，也是早期手术翻修最常见的原因。患者、植入物和手术相关因素可通过损害软组织张力和/或无撞击活动而导致脱位。
在选择植入物和制定治疗策略时，外科医生应仔细考虑患者特定因素，如潜在的神经系统疾病或脊柱骨盆活动度降低。此外，市场上批准的植入物系列为初次和翻修手术中的脱位提供了广泛的预防措施。
预防的关键是根据患者个体关节生物力学精确、适当地放置植入物。虽然在初次手术和翻修手术中，三极髋臼系统用于特定患者群体，但在特殊情况下，限制性衬垫应作为备用策略。THA脱位的发生是一种医疗急症，需要立即进行影像学评估和早期复位。对于首次脱位的病例，随访期间可能需要额外的影像学检查，而反复脱位则需要断层成像以排除植入物位置不当或松动。本综述总结了THA不稳定的潜在原因和预防策略，以及处理THA脱位的诊断和治疗算法。
