We reviewed the results of reoperation in ninety-five patients who had
acute subluxation (ten patients) or dislocation (eighty-five patients) of
the hip after conventional cemented total hip-replacement arthroplasty.
Postoperatively, fifty-eight patients (61 per cent) had no subsequent
dislocation or subluxation. Seven of thirty-seven patients who had had
recurrent dislocation had occasional subluxation during follow-up. Of the
remaining thirty patients in whom instability persisted after the
reoperation, twenty-eight had at least one dislocation, and nine had
bothersome subluxation. Ten of these thirty-seven patients had another
operation for the persistent instability. The causes of instability were
classified as malrotation of the component, disruption of the
trochanteric-abduction mechanism, impingement, or multiple and unknown, and
appropriate treatment was provided. The component was revised in forty-five
patients, revision and advancement of the trochanteric component was done
in twenty-five patients, and impinging bone or cement was removed from six
patients; a combination of these procedures was done in nineteen patients.
Over-all, fifty-eight procedures (61 per cent) were successful (no
additional subluxations or dislocations). We concluded that the results of
operative treatment for an unstable total hip replacement can be optimized
when a precise determination of the cause of the instability is made and
appropriate measures are applied.