Surgical Management of Primary Hip Arthroplasty Dislocation

The occurrence of dislocation after implantation of a total hip arthroplasy raises the difficult problem of its management. The classification of the dislocation will be in its direction, its character occurred (traumatic or positional), its recurrence, its time of onset (early or late)... If the management of the first dislocation poses little problem, it does is not the same for that of its recurrence. Thus, after the initial management of the first instability, we must undertake the etiological exam to clarify the origin of this complication. A careful clinical examination should definitely look muscular weakness, leg length, axial piston... A complete radiological exam must understand the position of the implants. It is frequently difficult to determine the anteroposterior orientation of the cup which requires a CTscan whose terms of achievement must be observed. The therapeutic arsenal is very large: uni or bipolar surgical revision retension soft tissues, removal of the factors favoring the cam effect plasty capsular advancement osteotomy of the greater trochanter, device implantation preventing recidivism (dual mobility, anti-dislocation device, ftripolar insert).