When considering any life-altering operation, we consider the benefits and potential challenges that may arise after the procedure, and weigh these up against quality of life if the decision is taken not to have the operation.
Total hip or knee replacements are chosen/recommended for over 160,000 people every year in England and Wales, and the procedure involves substituting a patient’s original bone joint with an artificial replacement. The results are usually very positive, with improved mobility, reduction of pain, and a better quality of life typically experienced in the months and years following the operation.
With any artificial hip, there are risks, and something many patients seem to be concerned about is whether the artificial joint could dislocate. In fact, hip implant dislocation is probably the short-term complication which patients worry about the most.
Although it is a rare complication, it does happen. Around 1% of patients are at risk of this occurring, and there are certain characteristics which place some people at greater risk than others. Recurrent dislocation is the most common reason for revision in North America and also a common reason in the UK, so avoiding this has obvious health and also economic benefits.
A new hip implant solution in development
It has recently been reported that there are now ways to identify which patients are most at risk from a dislocation in their new joint. The announcement was detailed in the Best Poster in the Adult Reconstruction Hip at the American Academy of Orthopaedic Surgeons (AAOS) 2018 Annual Meeting, held recently in New Orleans.
Researchers at NYU Langone discovered that there was a link between those who have a spinal deformity and those who tend to pose a higher risk of hip replacement dislocation and the need for follow-up surgery. This discovery enabled researchers to address this link head on, and they began working to develop a ‘predication tool’ which would identify those who fell into this higher risk category. If patients are identified as sitting within this higher risk bracket, then surgeons can “implement a treatment algorithm to help reduce that risk”.
Choosing the right approach for the patient
An appropriate treatment option for someone in the high-risk category would be and using an alternative bearing type – the ‘dual mobility’ joint is ideal for cases such as this. A dual mobility joint is a newer model of artificial hip joint, it is designed to have a greater range of motion and this helps mitigate the risk of dislocation.
Essentially, it’s about ensuring that surgeons are given the information required to be as proactive as possible, rather than having to react retrospectively to problems caused post-operatively. Dr Jonathan Vigdorchik, an assistant professor of orthopaedic surgery at NYU School of Medicine and associate fellowship director of the Division of Adult Reconstructive Surgery at NYU Langone Orthopaedic Hospital, explains “Orthopaedic surgeons need to be more aware of this problem and think about the risk of dislocation prior to performing a hip replacement instead of just dealing with the complications after the surgery. We need to be proactive in our approach.”