JOA - 2026-07-20 - Journal Article
"Two Strikes, You're Out": Contemporary Revision Patterns Following Instability after Posterior and Anterior Approach Total Hip Arthroplasty.
Driscoll DA, Burgio C, Viggiano M, Yared T, Trenchfield D, Sokrab R, El-Hassan M, Vigdorchik J, Sculco PK
Topics
Key Takeaway
After a second THA dislocation, revision risk reaches 93.9% (OR 7.70 vs. one dislocation), and late dislocations (>90 days) carry 97.0% revision risk—challenging the historical three-dislocation threshold for surgical intervention.
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Summary
This study examined the relationship between dislocation recurrence, timing, and revision risk in a contemporary primary THA cohort (2016–2024). Of 285 patients (0.7%) who dislocated, 84.9% ultimately underwent revision; revision risk rose from 69.1% after one dislocation to 93.9% after two (OR 7.70, 95% CI 3.28–20.49) with no statistically significant incremental increase beyond the second event. Late dislocations (>90 days) were independently associated with revision at 97.0% vs. 74.9% for early events (OR 7.76, 95% CI 2.46–35.10), and findings were consistent across posterior and anterior approaches.
Key Limitation
Single-institution data with a high baseline revision rate (84.9%) likely reflects referral and surgeon-specific practice patterns, limiting generalizability of the absolute revision thresholds to lower-volume or community settings.
Original Abstract
INTRODUCTION
Dislocation remains one of the most challenging complications after total hip arthroplasty (THA). Previous studies suggested that three or more dislocations were a threshold for revision; however, these data predate contemporary implants and modern surgical approaches. We used a contemporary cohort of primary THA patients to evaluate the relationship between dislocation recurrence, timing of instability, and subsequent revision for instability.
METHODS
There were 40,315 patients who underwent primary THA at our institution from 2016 to 2024. Among these patients, those who sustained a dislocation event were included. Keyword and diagnosis code search was performed to identify patients, and charts were reviewed to confirm dislocation. A total of 285 patients (0.7%) were included at a mean 5.7-year follow-up, of whom 242 (84.9%) ultimately underwent revision for instability. Instability was categorized by recurrence (one, two, or ≥ three dislocations) and timing (early ≤ 90) versus late (greater than 90 days)). Multivariable logistic regressions were performed to identify factors independently associated with risk of revision.
RESULTS
Revision risk increased sharply with recurrence, rising from 69.1% after one dislocation to 93.9% after two and 98.5% after three or more. Patients who had two dislocations had significantly greater odds of revision than those who had one (odds ratio (OR) 7.70, 95% confidence interval (CI) 3.28 to 20.49, P < 0.001), while risk did not significantly increase beyond the second dislocation. Late dislocations were more likely to result in revision than early events (97.0 versus 74.9%, P < 0.001) and remained independently associated with revision (OR 7.76, 95% CI 2.46 to 35.10, P = 0.002). The association between recurrence, timing, and revision risk was consistent across both approaches.
CONCLUSIONS
In contemporary THA practice, revision frequently occurred after a second dislocation, and late dislocations were more likely to require revision than early events. Future multicenter studies are needed to further refine instability management strategies.