PRACTICE PEARLS: Managing Instability after THA

    When a patient presents with dislocation less than 6 months after total hip arthroplasty, a closed, non-surgical approach to treatment is generally successful.

    But when dislocation occurs 5 or more years following the procedure, surgery is usually indicated to address 1 or more the following issues:

    • Polyethylene wear
    • Neuromuscular decline
    • Trochanteric compromise
    • Weight loss

    At ICJR’s instructional course on joint replacement at the 9th Congress of the Chinese Academy of Orthopaedic Surgeons, Wayne G. Paprosky, MD, noted that the threshold for surgical management is 3 episodes of dislocation following THA. He reviewed the options for treatment:

    • Modular head/liner exchange
    • Component revision
    • Trochanteric advancement
    • Soft-tissue reconstruction
    • Constrained liner

    The question is: Which option is right for which patient?

    To answer that question, Dr. Paprosky and his colleagues at Rush University Medical Center in Chicago, Illinois, developed an algorithmic approach that matches the cause of instability with the surgical treatment most likely to successfully address the issue.

    During his presentation, Dr. Paprosky reviewed the algorithm and then discussed research he and his colleagues conducted to validate it.

    Click on the image above to watch Dr. Paprosky’s presentation and learn more about the algorithm.