Skip to content

Clinicians › Hip

Dislocation after hip replacement

76 citationsUpdated Sep 2026

Overview

Dislocation remains a significant complication following total hip arthroplasty, with a true cumulative incidence of 3.5% within two years for primary procedures performed between 2010 and 2014 in Denmark [16]. One in 20 patients undergoing total hip arthroplasty for fracture will experience dislocation within a year [3]. Community dislocation rates for primary total hip arthroplasty surgery appear to be similar to those reported in academic centers [7]. Higher-volume surgeons and hospitals have lower dislocation rates after total hip arthroplasty [10].

Several patient-specific factors influence risk. Patients with Parkinson's disease had an increased risk of hip dislocation during the first post-operative year [132]. Previous lumbar spine fusion increases the risk of dislocation following total hip arthroplasty in patients with hip-spine syndrome who received lumbar spine fusion first [9]. Total hip arthroplasty for displaced femoral neck fractures in the fit elderly has higher dislocation rates compared with hemiarthroplasty [12], and femoral neck fractures remain a major risk factor for long-term complications following total hip arthroplasty [34]. Patients with preoperative acetabular morphological risk factors for dislocation might be better candidates for total hip arthroplasty [6].

Prognostic assessment of dislocation risk allows for assessment of methods to reduce dislocation in high-risk patients [5]. Preservation and repair of the hip joint capsule caused an 88% reduction of the dislocation rate in primary total hip arthroplasty compared to standard technique with capsule resection [1]. At one year follow up, no dislocation was observed in the clinical component of a study using intertrochanteric partial osteotomy for posterior hip approach [2]. The use of a dual-mobility cup as primary treatment for hip fracture was associated with a lower risk of revision due to dislocation [15]. However, dual-mobility acetabular components carry concerns about the new mode of failure of intraprosthetic dislocation [33], and long-term results are required before recommending dual-mobility acetabular systems in all primary total hip arthroplasties [22]. Clear understanding of the cause of dislocation is essential for optimizing revision procedures and improving the rate of successful outcomes [8]. Revision arthroplasty was successful in preventing further subluxation or dislocation in 91% of patients with recurrent instability [4].

Anatomy & Pathophysiology

Bony Anatomy

The hip is a multiaxial joint formed by the articulation between the pelvis and femur, connecting the axial skeleton and the lower extremity [77]. The hemipelvis comprises the ilium, ischium, and pubis, which unite at the triradiate cartilage within the concave acetabulum [77]. The acetabulum consists of an articular crescent-moon-shaped lunate surface and a nonarticular central fossa that serves as the attachment point for the ligamentum teres [77]. It is incomplete inferiorly, forming a notch through which vital blood vessels and nerves pass to supply the joint [77]. The posterosuperior articular surface of the acetabulum is thickened to accommodate weight bearing [83]. The acetabulum is normally anteverted by 15 degrees and obliquely oriented in the coronal plane by 45 degrees caudally [83].

The femoral head forms two-thirds of a sphere, with a small depression at its center from which the ligamentum teres extends to connect to the acetabular notch [77]. The neck-shaft angle of the femur averages 125° [77], with a mean adult value of 130° ± 7° [87] and another reported average of 127 degrees, beginning at 141 degrees in the fetus [83]. Normal version, defined as the head-neck angle in the frontal plane, averages 15 to 20° [77]. The femoral neck is normally anteverted approximately 14 degrees in relation to the femoral condyles, with a range of 1–40 degrees [83], and the mean anteversion of the femoral neck is 10° ± 7° [87]. The weakest area in the femoral neck is located in the Ward triangle [87]. The calcar femorale is a medial area of dense trabecular bone that transfers stress from the femoral shaft to the inferior portion of the femoral neck [87]. Fractures of the proximal femur follow the path of least resistance [87].

Ligaments and Capsule

The hip is surrounded by a dense fibrous capsule extending from the periphery of the acetabulum to the intertrochanteric line of the femoral neck [77]. The capsule enhances joint stability by preventing translation of the femoral head in the acetabulum [77]. It attaches anteriorly and posteriorly along the periphery of the acetabulum outside the labrum [78]. Inferiorly, the hip capsule is attached to the acetabular labrum [78]. The capsule is attached to the femur anteriorly along the intertrochanteric crest [78]. On the posterior side, the capsule attaches only partially, such that the basicervical region of the femoral neck and the intertrochanteric region of the femur are not intracapsular [78]. The capsule is tight in extension and internal rotation, and relaxed in flexion and external rotation [74].

The iliofemoral ligament, also known as the Y ligament of Bigelow, is the thickest and strongest of the three main ligaments supporting the hip [77] and is the strongest ligament in the body [74]. It originates at the AIIS and inserts at the intertrochanteric line [78]. The medial portion connects the anterior inferior iliac spine to the anterior intertrochanteric line [77], while the lateral portion originates slightly superior to the medial arm and attaches to the anterior greater trochanter [77]. The iliofemoral ligament becomes taut in full extension, preventing anterior dislocation and hyperextension of the hip [78]. It functions to limit external rotation [77], and in isolation, the lateral arm limits extension of the joint [77]. In severe hip arthritis, the iliofemoral ligament may become very contracted and may require release at surgery to relieve an internal and flexion contracture of the hip [78].

The pubofemoral ligament attaches to the inferior and medial part of the capsule [78] and extends from the obturator crest of the pubic bone to the femoral neck [77]. It acts to limit abduction of the joint [77] and may cause a hip adduction contracture [78]. The ischiofemoral ligament reinforces the posterior capsule [78], extending from the ischial margin of the acetabulum to the greater trochanter of the femur [77]. It provides support posteriorly and restricts internal rotation motion [77], providing a check to internal rotation of the hip [78]. The ischiofemoral and pubofemoral ligaments are weaker but provide additional stability [74]. Deep fibers from all three ligaments merge to form the zona orbicularis, which circumvents the femoral head [77]. The twisted orientation of the hip ligaments provides a screw mechanism for the hip in full extension [78].

Labrum and Ligamentum Teres

The acetabular labrum is a fibrocartilaginous ring that extends the articulating surface area and increases femoral head coverage [77]. It is triangular in cross section [77], a shape that contributes to its ability to create a pressurized seal of the central compartment of the hip during loading [77]. The fibrocartilaginous labrum deepens the acetabulum, enhancing stability [74]. Labral functions include load transmission, maintenance of vacuum seal, regulation of synovial fluid hydrodynamics, and joint lubrication [74]. Only the external one-third of the labrum contains blood vessels, leaving the majority of the structure avascular [77]. This avascular nature limits its healing ability following injury [77]. The labrum is highly innervated, with the presence of both mechanoreceptors and nociceptors [77]. The labrum is absent in the area of the inferior acetabular notch, where the transverse acetabular ligament serves as the continuation of the labrum [77]. The transverse acetabular ligament connects the anterior and posterior lunate surfaces of the acetabulum [77].

The ligamentum teres originates in the cotyloid fossa and attaches on the fovea of the femoral head [78]. It arises from the apex of the cotyloid notch and attaches to the fovea of the femoral head [74]. The ligamentum teres transmits an arterial branch of the posterior division of the obturator artery to the femoral head [74]. The arterial supply from the ligamentum teres is less significant in adults [74].

Muscles and Range of Motion

The average range of motion of a normal hip that is unaffected by arthritis is approximately 120° of flexion, 30° of extension, 45° of abduction, 20° to 30° of adduction, 35° of internal rotation, and 45° of external rotation [85]. Normal gait function requires hip flexion of 30°, hyperextension of 10°, abduction and adduction of 5°, and internal and external rotation of 5° [85]. The primary hip flexor muscles are the iliopsoas, rectus femoris, and sartorius muscles [85]. The gluteus maximus and hamstring muscles are the most important hip joint extensors [85]. The abductors of the hip are predominantly the gluteus medius and minimus muscles [85]. The gluteus medius and minimus muscles function together to maintain and abduct the femur during the stance phase of gait [85]. A Trendelenburg lurch is an attempt by the body to compensate for abductor weakness by bringing the center of gravity closer to the hip center, forcing the patient to lean toward the affected side [85]. The approach used for THA does not appear to influence the prevalence of postoperative Trendelenburg gait [85]. Damage and/or weakness to the abductor muscles can occur during surgical approaches to the hip [85]. When damage to the abductor muscles occurs, hip stability is greatly affected, and the use of constrained hip implants may be necessary [85].

The external rotators of the hip include the obturator internus and externus, superior and inferior gemelli, quadratus femoris, and piriformis muscles [85]. The piriformis forms the reference structure for the posterior part of the hip [85]. The superior gluteal nerve and artery exit the pelvis above the piriformis muscle [85]. The pudendal nerve, internal pudendal artery, nerve to the obturator internus, posterior femoral cutaneous nerve, sciatic nerve, inferior gluteal nerve, inferior gluteal artery, and nerve to the quadratus femoris all exit the pelvis below the piriformis [85]. In 10% of cases, the common peroneal component of the sciatic nerve can pass through the division in the piriformis [85]. Most often, the sciatic nerve passes below the piriformis and is situated on top of the short external rotators [85]. The most consistent internal rotators of the hip joint are the gluteus medius and tensor fascia latae muscles [85].

Vascular Anatomy

The medial femoral circumflex artery is the main blood supply to the femoral head [87]. It terminates in the posterior aspect of the extracapsular arterial ring [87]. The lateral femoral circumflex artery gives rise to the anterior aspect of the arterial ring [87]. The superior and inferior gluteal arteries also contribute branches to the extracapsular arterial ring [87]. The ascending cervical arteries originate from the extracapsular arterial ring and are divided into four distinct groups based on their anatomic relationship to the femoral neck: lateral, medial, posterior, and anterior [87]. The lateral group of ascending branches is the main blood supply to the femoral head [87]. The ascending branches give off multiple perforator vessels to the femoral neck and terminate in the subsynovial arterial ring located at the margin of the articular surface of the femoral head [87]. The lateral epiphyseal artery penetrates the femoral head and is believed to be the dominant blood supply to the femoral head from this system [87]. Fractures that disrupt the ascending blood flow to the lateral epiphyseal vessel have an increased risk of osteonecrosis [87].

The artery of the ligamentum teres arises from either the obturator or medial femoral circumflex artery [87]. It does not provide sufficient blood supply to maintain the viability of the femoral head [87]. From birth to approximately 4 years of age, the major blood supply to the femoral head comes from the medial and lateral femoral circumflex arteries, with major contributions from the artery of the ligamentum teres [90]. From the age of 4 years to adulthood, the posterosuperior and posteroinferior retinacular arteries (from the medial circumflex artery) are the major blood supply to the femoral head [90]. In adulthood, the major blood supply to the femoral head is from the medial femoral circumflex and lateral epiphyseal arteries [90]. The common femoral vessels are the most commonly reported extrapelvic vascular structures that are injured during THA [90]. The most common mechanism of injury to the common femoral vessels during THA is errant retractor placement anterior to the acetabulum [90].

Pathophysiology of Instability and Dislocation

Preservation and repair of the hip joint capsule caused an 88% reduction of the dislocation rate in primary THA compared to standard technique with capsule resection [1]. One in 20 patients undergoing THA for fracture will experience dislocation within a year, though most will not require revision [3]. Revision arthroplasty was successful in preventing further subluxation or dislocation in 91% of patients with recurrent instability after total hip arthroplasty [4]. At a population level, the lifetime risk of revision hip replacement remains low at <1 in 50 people in 2017 [14]. Hips at greatest risk of failure have advanced arthrosis or a combination of impingement and instability preoperatively [21].

Patients with preoperative acetabular morphological risk factors for dislocation might be better candidates for total hip arthroplasty than hemiarthroplasty [6]. Total hip arthroplasty for displaced femoral neck fractures in the fit elderly may lead to higher patient-based outcomes but has higher dislocation rates compared with hemiarthroplasty [12]. Morphological factors related to hip dysplasia and a shallow acetabulum, which can be assessed with a radiograph alone, were found to be predictors of instability following hemiarthroplasty in the elderly [64]. In dysplastic hips, labral tears are thought to be a consequence of high shear stresses and subsequent instability attributable to inadequate coverage of the femoral head by the dysplastic acetabulum [137]. Trends in acetabular loading characteristics showed peak pressures within the joint were increased and concentrated into a smaller area with increases in ante- and retroversion, potentially leading to chondrolabral injury [106]. Acetabular component overhang is more severe when the pelvis tilts posteriorly [111].

Conversion hip arthroplasty for posttraumatic conditions is associated with higher risks of dislocation because the greater trochanter and abductor mechanism may be deficient from prior trauma or surgeries [63]. Residual deformity in posttraumatic conditions may make accurate implant positioning during reconstruction more difficult, in terms of femoral and acetabular version, increasing the risk of instability [63]. The risk of instability in posttraumatic conversion hip arthroplasty may be mitigated by using a larger diameter femoral head or a dual mobility articulation [63]. Dual-mobility components are associated with a reduced risk of dislocation and with no significant difference in the risk of revision for any cause within two years of THA when compared to standard acetabular components with 36 mm femoral heads [47].

Classification

Femoral Head Fracture Epidemiology: Fracture of the femoral head is a complication found in 6 to 15% of cases of traumatic hip dislocation [122]. This injury most often occurs in posterior dislocation but also in anterior dislocation [122].

Prognostic Value: Descriptive classifications of femoral head fractures are of little prognostic value [122]. In contrast, Pipkin III femoral neck fracture is associated with poor prognosis [122].

Imaging and Lesion Spectrum: A separated osteochondral fragment associated with round ligament avulsion is easily identified and is now systematically screened for on post-reduction CT [122]. Femoral head lesions may be limited to cartilage impaction without true fracture separation [122], or to mere change in subchondral signal on MRI [122].

Other Considerations: In his grade-IV femoral head fracture in the weight-bearing area, Yoon recommends total hip replacement (THR) as a primary treatment [122]. The authors believe that the three-part posterior fracture dislocation of the hip without fracture of the femoral head merits inclusion in the existing classification system of fracture dislocation of hip for management and prediction of outcome [17].

Clinical Presentation

The clinical context for post-arthroplasty dislocation is defined by specific demographic and comorbid risk factors. One in 20 patients undergoing total hip arthroplasty for hip fracture will experience dislocation within a year [3]. Patients aged 75 years or older are at increased risk of dislocations after fast-track total hip arthroplasty [39]. Additionally, patients with pharmacologically treated psychiatric disease are at increased risk of dislocations after fast-track total hip arthroplasty [39]. In patients with hip-spine syndrome who underwent both lumbar spine fusion and total hip arthroplasty, those who received lumbar spine fusion first displayed an increased risk of hip dislocation after subsequent total hip arthroplasty [9].

Preoperative activity levels also correlate with dislocation risk in younger cohorts. Dislocators under 50 years old were less active preoperatively than nondislocators [26].

Acetabular Fracture Complications

Acetabular fractures with an associated dislocation present with worse long-term functional outcomes compared to acetabular fractures without a dislocation [11]. These patients also have higher rates of complications compared to acetabular fractures without a dislocation [11]. Furthermore, acetabular fractures with an associated dislocation have higher rates of conversion to late total hip arthroplasty compared to acetabular fractures without a dislocation [11].

Neurological Involvement

Traumatic sciatic nerve injuries in the studied cohort involved the posterior wall or posterior column in all cases [40]. Most patients with traumatic sciatic nerve injury in the studied cohort had posterior dislocation of the hip joint [40].

Prognosis

Most patients who experience dislocation after total hip arthroplasty for hip fracture will not require revision surgery [3].

Investigations

Risk Stratification and Epidemiology: Prognostic assessment of dislocation risk allows for the evaluation of methods to reduce dislocation in high-risk patients [5]. One in 20 patients undergoing total hip arthroplasty for fracture will experience dislocation within a year, though most will not require revision [3]. Higher-volume surgeons and hospitals have better outcomes and, more specifically, lower dislocation rates after total hip arthroplasty [10]. Acetabular fractures with an associated dislocation have worse long-term functional outcomes with higher rates of complications and conversion to late total hip arthroplasty compared to acetabular fractures without a dislocation [11].

Plain Radiography: Conventional radiographs remain critical in the initial imaging evaluation of the hip and can be used to diagnose various conditions including fractures, developmental dysplasia of the hip, femoroacetabular impingement, and osteoarthritis [50]. A complete hip series usually is composed of a combination of views, including an anterior-posterior pelvis, a centered anterior-posterior hip, a lateral view (frog-leg, cross-table, Dunn 45° or 90°), and a false-profile (Lequesne) view [50]. Acetabular morphology is assessed on anterior-posterior pelvis radiographs for overcoverage and undercoverage, while specific views of the hip detect abnormalities of the femoral head-neck junction seen with femoroacetabular impingement [50]. The femoral head-neck junction morphology is often assessed using the alpha angle [50]. Some studies have shown that radiographs, in particular the Dunn 45° view, may be more accurate for determining the alpha angle measurement than computed tomography or magnetic resonance imaging [50].

Post-operative radiographic assessment reveals great variability in cup orientation, caused equally by variability in the orientation at which the cup is implanted and the change in pelvic position between impaction and post-operative radiograph [144]. Patients with acetabular dysplasia have an increased frequency of spinal anomalies seen on standard hip radiographs [143]. In patients with a hybrid total hip arthroplasty and a 28-mm head, there was a 2 times greater risk of dislocation among those with a larger cup diameter (≥56 mm) [52]. Cup position alone does not predict risk of dislocation after hip arthroplasty [26]. A computer-assisted analysis of young adult hip radiographs generally demonstrates substantial to excellent levels of interobserver reliability for most parameters [57].

MRI: The soft-tissue contrast of magnetic resonance imaging is superior to other imaging modalities in assessing both intra-articular and extra-articular hip pathology [79]. For patients suspected of soft tissue or intra-articular pathology, magnetic resonance imaging is the modality of choice, given its superior sensitivity and specificity [94]. Magnetic resonance arthrography can further increase conspicuity of intra-articular lesions and is useful following hip preservation surgeries [79]. Magnetic resonance arthrography is more appropriate to determine injuries to the labrochondral structures and the ligamentum teres and identify the presence of loose bodies and synovial chondromatosis [94]. In the accurate detection and staging of articular cartilage lesions, the utility of magnetic resonance arthrography is reduced, with sensitivity reported to be less than 50% compared with arthroscopic findings [94].

CT: Computed tomography overcomes the limitations of radiography by providing three-dimensional assessment of bony morphology and, to some degree, assessment of soft-tissue abnormalities [79]. Computed tomography is helpful in fracture evaluation, particularly in the setting of negative radiographs, or for further defining fracture morphology in patients requiring surgical reduction [79]. Computed tomography scans are effective for examining cortical and cancellous bone and can be used to create three-dimensional reconstructions of the hip for use in surgical planning [94]. Measurements of femoral head coverage and acetabular and femoral impingement can also be performed reliably using computed tomography images [94].

Ultrasonography: Ultrasonography provides real-time dynamic assessment of the hip and is useful in diagnosing soft-tissue abnormalities about the hip joint, and to a lesser degree, within the hip joint itself [79]. Ultrasonography is particularly useful in providing real-time guidance during diagnostic and therapeutic procedures [79]. Although ultrasonography is a valuable tool to examine pediatric hip conditions, its utility in evaluating the adult hip is limited [94]. Ultrasonography can be an effective modality to identify musculotendinous disruptions, effusions associated with intra-articular pathology, or inflammatory conditions, such as bursitis [94]. Ultrasonography is also being increasingly used for targeted injections into muscles, tendons, or intra-articularly around the hip, for use with corticosteroids or biologic treatments emerging as a more recognized modality [94].

Clinical Examination and Diagnostic Principles: The complexity of the hip and pelvic region can make accurate diagnosis of painful conditions difficult, necessitating a thorough understanding of normal anatomy and biomechanics to identify pathology [49]. A comprehensive clinical examination is required to determine a differential diagnosis because many hip conditions present with similar symptoms [49]. Findings from imaging studies should complement clinical examination findings to provide the most accurate diagnosis [49]. A thorough history is essential to differentiating between common causes of hip pain, and clinical examination tests and imaging findings should be used to confirm a suspected clinical diagnosis [49]. The study helps to establish a baseline that can be used for further refinement and clarification of hip pathoanatomy, potentially allowing range of motion and provocative testing to be used as screening tests to develop preventative strategies and reduce the need for imaging studies [56].

Other Considerations: National implant registers define the epidemiology of primary and revision surgery and, in conjunction with individual subjective patient data and radiography, contribute to the development of evidence-based total hip arthroplasty surgery [20].

Treatment

Non-Operative

The provided evidence does not detail specific conservative management protocols such as weight loss, physical therapy regimens, or pharmacological interventions for the prevention or treatment of dislocation.

Operative

Surgical Approach / Technique: Anterior and anterolateral approaches for total hip arthroplasty (THA) are associated with lower dislocation risk without higher revision risk [55]. A meta-analysis demonstrated short-term superiority of the direct anterior approach, including length of stay and dislocation rate [129]. However, the use of the anterior approach has been associated with an increased rate of complications, including femoral perforations, trochanteric fractures, and calcar fractures, with a 6.7% overall risk of adverse events requiring a second procedure [129]. Surgeons performing hip replacements should be adept at multiple surgical approaches and tailor the approach to the needs and requirements of the individual patient [129]. Early postoperative rehabilitation (EPSTR) decreased dislocation after total hip arthroplasty performed with a posterior approach [53].

Implant Selection: Dislocation is the most common cause of revision, with large-head prostheses associated with a lower revision risk for dislocation [48]. Dual-mobility (DM) prostheses have a lower rate of revision for dislocation than standard heads for the first 3 months only [48]. The use of a dual-mobility cup (DMC) as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular [15]. The series proves the good long-term behaviour of dual-articulation acetabular components in primary arthroplasty, with an excellent survivorship rate and the absence of episodes of prosthetic instability [32]. The benefit of dual-mobility components must be balanced against continuing concerns about the additional modularity, and the new mode of failure of intraprosthetic dislocation [33]. While early results are encouraging, long-term results are required before recommending dual-mobility acetabular systems in all primary THAs [22]. Treatment of THA for elderly displaced femoral neck fracture could provide better results of reduced reoperation rate and pain relief; however, HA yielded a lower incidence of postoperative dislocation [69]. Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing hemiarthroplasty or dual-mobility total hip arthroplasty [44].

Revision: Gradual distraction with an external fixator is a viable option for the treatment of chronic dislocation following total hip arthroplasty, restoring a much higher level of function and equal limb lengths while avoiding an open procedure [58]. Conversion of hemiarthroplasty to THA carries an increased risk of reoperation compared with primary and revision THA [105]. Surgeons should approach conversion THA as a challenging procedure, and patients undergoing this procedure should be counseled about the elevated risks [105].

Other Considerations: The literature to date strongly indicates higher-volume surgeons and hospitals have better outcomes and, more specifically, lower dislocation rates, after total hip arthroplasty [10]. In hip-spine syndrome (HSS) patients who underwent both lumbar spine fusion (LSF) and THA, those who received LSF first displayed an increased risk of hip dislocation after subsequent THA [9]. Patients aged 75 years or older and those with pharmacologically treated psychiatric disease may be at increased risk of dislocations after fast-track total hip arthroplasty [39].

Complications

Instability: Dislocation is the most common cause of revision in total hip arthroplasty (THA) for fractured femoral neck [48] and the most common diagnosis leading to revision after cementless hip replacement in octogenarians [116]. The true cumulative incidence of dislocations within 2 years after primary THA performed between 2010 and 2014 in Denmark was 3.5% [16]. One in 20 patients undergoing THA for fracture will experience dislocation within a year [3]. Community dislocation rates for primary THA surgery appear to be similar to those reported in academic centers [7]. Hemiarthroplasty yielded a lower incidence of postoperative dislocation compared to THA for elderly displaced femoral neck fracture [69]. Cementless acetabular components, particularly when combined with smaller femoral heads, have a significantly higher rate of revision for dislocation compared to cemented acetabular components [140]. In patients with hip-spine syndrome who underwent both lumbar spine fusion and THA, those who received lumbar spine fusion first displayed an increased risk of hip dislocation after subsequent THA [9]. Bearing surface had little association with the incidence of late dislocation [71]. Conversion hip arthroplasty for posttraumatic conditions is associated with higher risks of dislocation than total hip arthroplasty for primary osteoarthritis [63]. Infection and dislocation are relatively common after complex reconstructions following periacetabular tumor resection [70].

Preventive Strategies and Implant Design: The use of a dual-mobility cup as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular [15]. Dual-mobility components are associated with a reduced risk of dislocation compared to standard acetabular components with 36 mm femoral heads [47]. Large-head prostheses are associated with a lower revision risk for dislocation compared to standard heads in THA for fractured femoral neck [48]. Dual-mobility prostheses have a lower rate of revision for dislocation than standard heads for the first 3 months only in THA for fractured femoral neck [48]. Elective primary or revision THA using cementless implants with dual mobility bearing surface in patients with Parkinson disease provides satisfactory long-term outcomes, although many of these patients may see a general worsening of their activities over time due to Parkinson disease [72]. A series of 384 cases at a mean follow-up of 15 years proved the good long-term behaviour of dual-articulation acetabular components in primary arthroplasty, with the absence of episodes of prosthetic instability [32]. EPSTR decreased dislocation after total hip arthroplasty performed with a posterior approach [53].

Revision and Management: The high risk of rerevision after metal-on-metal hip revision surgery for infection and dislocation is concerning [147]. The prognosis of most patients after total hip arthroplasty for long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis is expected to be excellent or good [13].

Other Considerations: Acetabular fractures with an associated dislocation have worse long-term functional outcomes with higher rates of complications and conversion to late THA compared to acetabular fractures without a dislocation [11]. Despite the advantages of THA, femoral neck fractures remain a major risk factor for long-term complications [34]. Thirty-nine percent of revisions at the institution were performed during the first 5 years after index surgery [142]. Outcomes after hip arthroplasty following previous arthrodesis were similar to those after revision rather than after primary hip arthroplasty [68].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for the resumption of desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: The provided evidence does not detail specific physiotherapy phasing, immobilisation duration, weight-bearing or range-of-motion progression schedules, or timing for sling or brace removal.

Functional milestones: Validated patient-reported outcome measure trajectories are not explicitly defined in the evidence. However, a hip fracture has a dramatic impact on patients' health-related quality of life (HRQoL), with deterioration in HRQoL sustained one year after the fracture [59]. In patients with hip dysplasia and mild osteoarthritis, recovery curves were similar to those observed in patients with severe osteoarthritis or without dysplasia [149].

Other Considerations: At one-year follow-up, no dislocation was observed in the clinical component of the study for intertrochanteric partial osteotomy for the posterior hip approach [2]. In hip-spine syndrome patients who underwent both lumbar spine fusion and total hip arthroplasty (THA), those who received lumbar spine fusion first displayed an increased risk of hip dislocation after subsequent THA [9]. The prognosis for most patients after total hip arthroplasty for long-term unreduced hip joint dislocation is expected to be excellent or good [13]. The true cumulative incidence of dislocations within two years after primary THAs performed between 2010 and 2014 in Denmark was 3.5% [16]. National implant registers define the epidemiology of primary and revision surgery and, in conjunction with individual subjective patient data and radiography, contribute to the development of evidence-based THA surgery [20]. Although there have been changes in operation methods for hip fractures and management has developed, the study does not show any effect on functional outcome over a 25-year period [29]. Clinical results at follow-up for the Dial Osteotomy in the treatment of high-grade acetabular dysplasia were 73% satisfactory and 27% unsatisfactory, with 13% of hips failing between 10–20 years [30]. In the case of significant destruction of the articular cartilage, primary total hip arthroplasty may provide the best solution for fractures of the acetabulum in elderly patients [41]. A 20-year evaluation of a hip surveillance programme shows that it is possible to prevent dislocation of the hip in children with cerebral palsy [45]. Subsequent fractures, including second hip fractures, occurred frequently and early following an index femoral neck fracture in two large global cohorts [46]. Outcomes for hip arthroplasty after previous arthrodesis were similar to those after revision rather than after primary hip arthroplasty [68]. A primary arthroplasty might be the best option for patients with displaced vertical hip fractures [130]. Traumatic hip dislocations are predominantly associated with Pipkin and acetabular rim fractures, leading to overall limitations of activities of daily living, sports, and sexual function at intermediate to long-term follow-up [148]. Lumbar degenerative disease and under-restoration of hip offset were present in a high proportion of patients with hip instability [150].

Key Evidence

  • [L3] Preservation and repair of the hip joint capsule caused an 88% reduction of the dislocation rate in primary THA compared to standard technique with capsule resection. [1] (10.1055/s-0034-1368209)
  • [L4] At one year follow up, no dislocation was observed in the clinical component of the study. [2] (10.1016/s0020-1383(13)70180-3)
  • [L3] One in 20 patients undergoing THA for fracture will experience dislocation within a year, though most will not require revision. [3] (10.1302/0301-620x.107b10.bjj-2024-1637.r1)
  • [L4] Revision arthroplasty was successful in preventing further subluxation or dislocation in 91% of patients. [4] (10.1097/01.blo.0000218749.37860.7c)
  • [L2] Prognostic assessment of dislocation risk allows for assessment of methods to reduce dislocation in high-risk patients. [5] (10.1097/01.blo.0000218754.12311.4a)
  • [L3] Patients with preoperative acetabular morphological risk factors for dislocation might be better candidates for total hip arthroplasty. [6] (10.1016/j.arth.2023.02.042)
  • [L3] Community dislocation rates for primary THA surgery appear to be similar to those reported in academic centers. [7] (10.1097/01.blo.0000218752.22613.78)
  • [L3] Clear understanding of the cause of dislocation is essential for optimizing revision procedures and improving the rate of successful outcomes. [8] (10.1186/s12891-023-06355-4)
  • [L1] In HSS patients who underwent both LSF and THA, those who received LSF first displayed an increased risk of hip dislocation after subsequent THA. [9] (10.1186/s12891-024-07823-1)
  • [L2] The literature to date strongly indicates higher-volume surgeons and hospitals have better outcomes and, more specifically, lower dislocation rates, after total hip arthroplasty. [10] (10.1097/01.blo.0000218743.99741.f0)
  • [L3] Acetabular fractures with an associated dislocation have worse long-term functional outcomes with higher rates of complications and conversion to late THA compared to acetabular fractures without a dislocation. [11] (10.1016/j.injury.2018.07.032)
  • [L1] Total hip arthroplasty for displaced femoral neck fractures in the fit elderly may lead to higher patient-based outcomes but has higher dislocation rates compared with hemiarthroplasty. [12] (10.1007/s00264-012-1569-7)
  • [L4] The prognosis of most patients after total hip arthroplasty is expected to be excellent or good. [13] (10.1186/s12891-020-03678-4)
  • [L4] At a population level, the lifetime risk of revision hip replacement remains low at <1 in 50 people in 2017. [14] (10.2106/jbjs.20.01235)
  • [L3] The use of a DMC as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular. [15] (10.2106/jbjs.18.00614)
  • [L3] The true cumulative incidence of dislocations within 2 years after primary THAs performed between 2010 and 2014 in Denmark was 3.5%. [16] (10.2106/jbjs.19.01352)
  • [L5] The authors believe that this injury pattern merits inclusion in the existing classification system of fracture dislocation of hip for management and prediction of outcome. [17] (10.1016/s0020-1383(03)00166-9)
  • [L4] National implant registers define the epidemiology of primary and revision surgery and, in conjunction with individual subjective patient data and radiography, contribute to the development of evidence-based THA surgery. [20] (10.1097/01.blo.0000193517.19556.e4)
  • [L4] Hips at greatest risk of failure have advanced arthrosis or a combination of impingement and instability preoperatively. [21] (10.1097/01.blo.0000150307.75238.b9)
  • [L3] While early results are encouraging, long-term results are required before recommending dual-mobility acetabular systems in all primary THAs. [22] (10.1016/j.arth.2017.05.004)
  • [L3] Dislocators under 50 years old were less active preoperatively than nondislocators. [26] (10.1016/j.arth.2014.07.009)
  • [L3] Although there have been changes in operation methods for hip fractures and the management has developed, the study does not show any effect on functional outcome over a 25-year period. [29] (10.1016/j.injury.2018.10.010)
  • [L4] Clinical results at followup were 73% satisfactory and 27% unsatisfactory, with 13% of hips failing between 10–20 years. [30] (10.1097/01.blo.0000153992.17554.67)
  • [L4] The series proves the good long-term behaviour of dual-articulation acetabular components in primary arthroplasty, with an excellent survivorship rate and the absence of episodes of prosthetic instability. [32] (10.1007/s00264-008-0589-9)
  • [L2] This benefit must be balanced against continuing concerns about the additional modularity, and the new mode of failure of intraprosthetic dislocation. [33] (10.1302/0301-620x.99b1.bjj-2016-0398.r1)
  • [L3] Despite the advantages of THA, femoral neck fractures remain a major risk factor for long-term complications. [34] (10.1016/j.arth.2024.09.012)
  • [L3] Patients aged 75 years or older and those with pharmacologically treated psychiatric disease may be at increased risk of dislocations after fast-track total hip arthroplasty. [39] (10.1007/s00402-014-2051-3)
  • [L4] All injuries involved the posterior wall or posterior column, and most patients had posterior dislocation of the hip joint. [40] (10.1186/s13018-023-03515-z)
  • [L5] In the case of significant destruction of the articular cartilage, primary total hip arthroplasty (THA) may provide the best solution. [41] (10.1016/s0020-1383(13)70177-3)
  • [L3] Patients with a neurological disease who sustain a femoral neck fracture have similar rates of dislocation after undergoing hemiarthroplasty or dual-mobility total hip arthroplasty. [44] (10.1302/0301-620x.104b1.bjj-2021-0855.r1)
  • [L3] This 20-year evaluation of a hip surveillance programme shows that it is possible to prevent dislocation of the hip in children with CP. [45] (10.1302/0301-620x.96b11.34385)
  • [L2] Subsequent fractures, including second hip fractures, occurred frequently and early following an index femoral neck fracture in 2 large global cohorts. [46] (10.2106/jbjs.22.00088)
  • [L2] Dual-mobility components are associated with a reduced risk of dislocation and with no significant difference in the risk of revision for any cause within two years of THA when compared to standard acetabular components with 36 mm femoral heads. [47] (10.1302/0301-620x.107b1.bjj-2024-0611.r1)
  • [L3] Dislocation is the most common cause of revision, with large-head prostheses associated with a lower revision risk for dislocation and DM prostheses having a lower rate of revision for dislocation than standard heads for the first 3 months only. [48] (10.1097/corr.0000000000001447)
  • [L2] In patients with a hybrid THA and a 28-mm head, there was a 2 times greater risk of dislocation among those with a larger cup diameter (≥56 mm). [52] (10.1016/j.arth.2010.11.015)
  • [L3] EPSTR decreased dislocation after total hip arthroplasty performed with a posterior approach. [53] (10.1097/01.blo.0000218750.14989.ef)
  • [L3] [55] (10.1007/s11999-015-4230-0)
  • [L5] The study helps to establish a baseline that can be used for further refinement and clarification of hip pathoanatomy, potentially allowing range of motion and provocative testing to be used as screening tests to develop preventative strategies and reduce the need for imaging studies. [56] (10.2106/jbjs.o.00966)
  • [L3] A computer-assisted analysis of young adult hip radiographs generally demonstrates substantial to excellent levels of interobserver reliability for most parameters. [57] (10.1177/0363546514542797)
  • [L4] Gradual distraction with an external fixator is a viable option for the treatment of chronic dislocation following total hip arthroplasty, restoring a much higher level of function and equal limb lengths while avoiding an open procedure. [58] (10.2106/jbjs.e.00529)
  • [L3] A hip fracture has a dramatic impact on the patients' HRQoL, and the deterioration in HRQoL sustained also one year after the fracture. [59] (10.1186/s12891-016-1111-y)
  • [L5] [63] (10.5435/jaaos-d-17-00775)
  • [L3] Morphological factors related to hip dysplasia and a shallow acetabulum, which can be assessed with a radiograph alone, were found to be predictors of instability following HA in the elderly. [64] (10.1016/j.arth.2023.09.030)
  • [L4] Our outcomes were similar to those after revision rather than after primary hip arthroplasty. [68] (10.1007/s11999-009-1027-z)
  • [L1] Treatment of THA for elderly displaced femoral neck fracture could provide better results of reduced reoperation rate and pain relief; however, HA yielded a lower incidence of postoperative dislocation. [69] (10.1016/j.arth.2011.07.009)
  • [L4] Still, infection and dislocation are relatively common after these complex reconstructions. [70] (10.1007/s11999-016-4805-4)
  • [L3] This large registry study demonstrated that bearing surface had little association with the incidence of late dislocation. [71] (10.1007/s11999-015-4395-6)
  • [L4] Elective primary or revision THA using cementless implants with dual mobility bearing surface in patients with PD provides satisfactory long-term outcomes, although many of these patients may see a general worsening of their activities over time due to PD. [72] (10.1016/j.arth.2017.11.062)
  • [L3] Surgeons should approach conversion THA as a challenging procedure, and patients undergoing this procedure should be counseled about the elevated risks. [105] (10.1097/corr.0000000000000702)
  • [L5] Trends in acetabular loading characteristics showed peak pressures within the joint were increased and concentrated into a smaller area with increases in ante- and retroversion, potentially leading to chondrolabral injury. [106] (10.1016/j.arthro.2018.10.062)
  • [L4] Acetabular component overhang is more severe when the pelvis tilts posteriorly. [111] (10.1097/corr.0000000000000830)
  • [L2] [116] (10.1007/s11999-014-3641-7)
  • [L4] [122] (10.1016/j.otsr.2010.03.020)
  • [L4] [129] (10.2106/jbjs.o.00526)
  • [L3] A primary arthroplasty might be the best option for patients with displaced fractures. [130] (10.1186/1471-2474-13-171)
  • [L2] Patients with Parkinson's disease had a longer mean length of hospital stay and an increased risk of hip dislocation during the first post-operative year. [132] (10.1302/0301-620x.96b4.33422)
  • [L4] [137] (10.1097/01.blo.0000144861.11193.17)
  • [L2] Cementless acetabular components, particularly when combined with smaller femoral heads, have a significantly higher rate of revision for dislocation compared to cemented acetabular components. [140] (10.1016/j.arth.2007.07.009)
  • [L3] Thirty-nine percent of revisions at the institution were performed during the first 5 years after index surgery. [142] (10.1097/01.blo.0000203484.90711.52)
  • [L3] Patients with acetabular dysplasia have an increased frequency of spinal anomalies seen on standard hip radiographs. [143] (10.1302/0301-620x.103b8.bjj-2020-2481.r1)
  • [L3] Great variability in post-operative radiographic cup orientation is caused equally by variability in the orientation at which the cup is implanted and the change in pelvic position between impaction and post-operative radiograph. [144] (10.1302/0301-620x.96b10.34100)
  • [L3] The high risk of rerevision after MoMHR revision for infection and dislocation is concerning. [147] (10.1007/s11999.0000000000000029)
  • [L4] Traumatic hip dislocations are predominantly associated with Pipkin and acetabular rim fractures, leading to overall limitations of activities of daily living, sports, and sexual function at intermediate to long-term follow-up. [148] (10.2106/jbjs.23.00660)
  • [L3] Patients who had hip dysplasia and mild OA had similar recovery curves compared to those who had severe OA or who did not have dysplasia. [149] (10.1016/j.arth.2024.04.060)
  • [L3] Lumbar degenerative disease and under-restoration of hip offset were present in a high proportion of patients with hip instability. [150] (10.1016/j.arth.2022.02.028)

See Also

References

[1] Der Einfluss der Kapselrekonstruktion auf die Luxationsrate nach primärer Hüftendoprothetik: eine retrospektive Analyse von 1972 Fällen. Zeitschrift für Orthopädie und Unfallchirurgie. 2014. DOI: 10.1055/s-0034-1368209

[2] Intertrochanteric partial osteotomy for posterior hip approach. Injury. 2012. DOI: 10.1016/s0020-1383(13)70180-3

[3] The cumulative incidence of dislocation and revision surgery following total hip arthroplasty for hip fracture in New South Wales. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b10.bjj-2024-1637.r1

[4] Recurrent Instability after Total Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000218749.37860.7c

[5] Epidemiology of Dislocation after Total Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000218754.12311.4a

[6] Acetabular Morphology Predicts the Risk of Dislocation Following Hemiarthroplasty for Femoral Neck Fractures in the Elderly. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.02.042

[7] An Analysis of the Risk of Hip Dislocation with a Contemporary Total Joint Registry. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000218752.22613.78

[8] Treatment strategies for recurrent dislocation following total hip arthroplasty: relationship between cause of dislocation and type of revision surgery. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06355-4

[9] Previous lumbar spine fusion increases the risk of dislocation following total hip arthroplasty in patients with hip-spine syndrome: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07823-1

[10] Increased Surgical Volume Is Associated with Lower THA Dislocation Rates. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000218743.99741.f0

[11] Native hip dislocation at acetabular fracture predicts poor long-term outcome. Injury. 2018. DOI: 10.1016/j.injury.2018.07.032

[12] Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. International Orthopaedics. 2012. DOI: 10.1007/s00264-012-1569-7

[13] Diagnosis, preoperative evaluation, classification and total hip arthroplasty in patients with long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03678-4

[14] Lifetime Risk of Revision Hip Replacement Surgery in Australia Remains Low. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.01235

[15] Reduced Revision Risk for Dual-Mobility Cup in Total Hip Replacement Due to Hip Fracture. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.18.00614

[16] “True” Cumulative Incidence of and Risk Factors for Hip Dislocation within 2 Years After Primary Total Hip Arthroplasty Due to Osteoarthritis. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.19.01352

[17] Three part posterior fracture dislocation of the hip without fracture of the femoral head: review of literature and a case report. Injury. 2004. DOI: 10.1016/s0020-1383(03)00166-9

[20] PRESIDENTIAL GUEST ADDRESS: The Swedish Hip Registry. Clinical Orthopaedics and Related Research. 2005. DOI: 10.1097/01.blo.0000193517.19556.e4

[21] Debridement of the Adult Hip for Femoroacetabular Impingement. Clinical Orthopaedics and Related Research. 2004. DOI: 10.1097/01.blo.0000150307.75238.b9

[22] Dual-Mobility vs Fixed-Bearing Total Hip Arthroplasty in Patients Under 55 Years of Age: A Single-Institution, Matched-Cohort Analysis. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2017.05.004

[26] Cup Position Alone Does Not Predict Risk of Dislocation After Hip Arthroplasty. The Journal of Arthroplasty. 2015. DOI: 10.1016/j.arth.2014.07.009

[29] Hip fractures – Treatment and functional outcome. The development over 25 years. Injury. 2018. DOI: 10.1016/j.injury.2018.10.010

[30] Long-term Results of the Dial Osteotomy in the Treatment of High-grade Acetabular Dysplasia. Clinical Orthopaedics and Related Research. 2005. DOI: 10.1097/01.blo.0000153992.17554.67

[32] The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. International Orthopaedics. 2008. DOI: 10.1007/s00264-008-0589-9

[33] Dislocation following total hip arthroplasty using dual mobility acetabular components. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b1.bjj-2016-0398.r1

[34] Increased Risk of 10-Year Revision Following Total Hip Arthroplasty for Femoral Neck Fracture. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.09.012

[39] Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors. Archives of Orthopaedic and Trauma Surgery. 2014. DOI: 10.1007/s00402-014-2051-3

[40] Incidence of traumatic sciatic nerve injury in patients with acetabular fractures and factors affecting recovery: a retrospective study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03515-z

[41] Fractures of the acetabulum in elderly patients: An update. Injury. 2012. DOI: 10.1016/s0020-1383(13)70177-3

[44] Total, hemi, or dual-mobility arthroplasty for the treatment of femoral neck fractures in patients with neurological disease. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b1.bjj-2021-0855.r1

[45] Prevention of dislocation of the hip in children with cerebral palsy. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b11.34385

[46] High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.22.00088

[47] The risk of dislocation in dual-mobility versus 36 mm heads in primary total hip arthroplasty for osteoarthritis. The Bone & Joint Journal. 2025. DOI: 10.1302/0301-620x.107b1.bjj-2024-0611.r1

[48] THA for a Fractured Femoral Neck: Comparing the Revision and Dislocation Rates of Standard-head, Large-head, Dual-mobility, and Constrained Liners. Clinical Orthopaedics & Related Research. 2020. DOI: 10.1097/corr.0000000000001447

[49] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Summary.

[50] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Radiography.

[52] Cup Size and Risk of Dislocation After Primary Total Hip Arthroplasty. The Journal of Arthroplasty. 2011. DOI: 10.1016/j.arth.2010.11.015

[53] The Effect of EPSTR and Minimal Incision Surgery on Dislocation after THA. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000218750.14989.ef

[55] Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-015-4230-0

[56] Why Examine a Hip?. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.o.00966

[57] Interobserver and Intraobserver Reliability of the Radiographic Analysis of Femoroacetabular Impingement and Dysplasia Using Computer-Assisted Measurements. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514542797

[58] Use of an Ilizarov Apparatus to Perform Closed Reduction of a Chronic Proximal Dislocation Following Total Hip Arthroplasty. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00529

[59] Quality of life following hip fractures: results from the Norwegian hip fracture register. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1111-y

[63] Total Hip Arthroplasty for Posttraumatic Conditions. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00775

[64] Predicting Instability Risk Following Hemiarthroplasty for Femoral Neck Hip Fractures in Geriatric Patients. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.09.030

[68] Hip Arthroplasty after Previous Arthrodesis. Clinical Orthopaedics & Related Research. 2009. DOI: 10.1007/s11999-009-1027-z

[69] Hemiarthroplasty vs Primary Total Hip Arthroplasty For Displaced Fractures of the Femoral Neck in the Elderly. The Journal of Arthroplasty. 2012. DOI: 10.1016/j.arth.2011.07.009

[70] LUMiC® Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results. Clinical Orthopaedics & Related Research. 2017. DOI: 10.1007/s11999-016-4805-4

[71] Are Ceramic-on-ceramic Bearings in Total Hip Arthroplasty Associated With Reduced Revision Risk for Late Dislocation?. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-015-4395-6

[72] Total Hip Arthroplasty in Patients With Parkinson Disease: Improved Outcomes With Dual Mobility Implants and Cementless Fixation. The Journal of Arthroplasty. 2018. DOI: 10.1016/j.arth.2017.11.062

[74] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > 2. Arthrology > Hip (Fig. 2.49).

[77] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Osseous and Ligamentous Anatomy.

[78] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > IV. Hip Capsule and Ligaments.

[79] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Introduction.

[83] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > LOWER EXTREMITY.

[85] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > V. Hip Joint Muscles.

[87] Aaos Comprehensive Orthopaedic Review 3. Fractures of the Hip > I. General Considerations.

[90] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > VI. Neurovascular Structures Surrounding the Hip.

[94] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Imaging.

[105] Conversion of Hemiarthroplasty to THA Carries an Increased Risk of Reoperation Compared With Primary and Revision THA. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000702

[106] The Effect of Femoral Version on Acetabular Loading Characteristics: a Biomechanical Study. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.10.062

[111] Tilt-adjusted Cup Anteversion in Patients with Severe Backward Pelvic Tilt is Associated with the Risk of Iliopsoas Impingement: A Three-dimensional Implantation Simulation. Clinical Orthopaedics & Related Research. 2019. DOI: 10.1097/corr.0000000000000830

[116] High Early Failure Rate After Cementless Hip Replacement in the Octogenarian. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-014-3641-7

[122] Is femoral head fracture-dislocation management improvable: A retrospective study in 110 cases. Orthopaedics & Traumatology: Surgery & Research. 2010. DOI: 10.1016/j.otsr.2010.03.020

[129] What’s New in Hip Replacement. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.o.00526

[130] The vertical hip fracture – a treatment challenge. A cohort study with an up to 9 year follow-up of 137 consecutive hips treated with sliding hip screw and antirotation screw. BMC Musculoskeletal Disorders. 2012. DOI: 10.1186/1471-2474-13-171

[132] Surgical outcomes of primary hip and knee replacements in patients with Parkinson’s disease. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b4.33422

[137] Histopathologic Features of the Acetabular Labrum in Femoroacetabular Impingement. Clinical Orthopaedics and Related Research. 2004. DOI: 10.1097/01.blo.0000144861.11193.17

[140] Risk Factors for Revision for Early Dislocation in Total Hip Arthroplasty. The Journal of Arthroplasty. 2008. DOI: 10.1016/j.arth.2007.07.009

[142] Early Failure in Total Hip Arthroplasty. Clinical Orthopaedics & Related Research. 2006. DOI: 10.1097/01.blo.0000203484.90711.52

[143] The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b8.bjj-2020-2481.r1

[144] The relationship between operative and radiographic acetabular component orientation. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b10.34100

[147] Outcomes After Metal-on-metal Hip Revision Surgery Depend on the Reason for Failure: A Propensity Score-matched Study. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1007/s11999.0000000000000029

[148] Intermediate to Long-Term Results Following Traumatic Hip Dislocation. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.23.00660

[149] Dysplastic Hips That Are Too Late for Periacetabular Osteotomy Are Not Too Early for Total Hip Arthroplasty. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2024.04.060

[150] The Effect of Hip Offset and Spinopelvic Abnormalities on the Risk of Dislocation Following Total Hip Arthroplasty. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2022.02.028

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.