Orthopedics-Online

Hip dislocation after TEP

definition

A Total hip replacement, also TEP Nowadays it is a frequently performed procedure, but it is not always without complications.
The hip dislocation, which leads to a dislocated joint, is a relatively common complication after total hip replacement.

If all documented complications after the operation are added together, the frequency of hip dislocation after TEP is given as approx. 20%.

A dislocation describes a displacement of the joint surfaces that are normally connected to each other (here artificial), whereby according to the definition, a hip dislocation after a total endoprosthesis is complete Articulation contact (i.e. the parts of the femoral head and acetabulum that move against each other) of the two Articulated parts has been lost.

The part of the prosthesis anchored in the thigh bone was thus pushed out of the artificial hip socket. The joint is thus "dislocated" and no longer functional.

Hip dislocation after TEP occurs in about 2% of patients in the first year after surgery.

It will be a one-time distinguished from a recurring dislocation after a hip prosthesis operation. It is important to resolve the problem quickly, as otherwise the entire result of the operation is endangered and the patient's quality of life can be severely restricted by a hip dislocation.

Illustration of a hip prosthesis

(Colored x-ray image)

Cup of the hip prosthesis
Prosthetic socket
Prosthetic head

This hip prosthesis is a so-called cementless hip prosthesis, which is initially clamped in the bone and then grows into the bone.

You can find out more about this hip prosthesis below in this topic.

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The hip joint is one of the joints that are exposed to the greatest stress.
Therefore, treatment of the hip (e.g.Hip arthrosis, hip impingement, etc.) a lot of experience.
I treat all hip diseases with a focus on conservative methods.
The aim of any treatment is treatment without surgery.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Symptoms

Hip dislocation after a total prosthesis can cause a number of different symptoms.
It is a sudden and traumatic event, so a shooting, stabbing pain typical of hip dislocation after TEP.

The Leg is shortened and movement is severely restricted as there is no longer any bony contact with the leg.
Targeted movements are no longer possible with a hip dislocation in a TEP. Likewise, a Misrotation, i.e. detect incorrect rotation of the leg.

Further symptoms are possible if structures in the area have been crushed or injured due to the misalignment of the bones and implant parts. So can Sciatic nerve when the hip prosthesis is dislocated, what symptoms such as Tingling, numbness, and leg pain can cause and impair motor skills.

Vascular injuries can occur, causing symptoms such as paleness, lack of pulse in the leg, and pain.

In the case of very severe trauma, the dislocation also Bone fragments broken out of the existing bone, causing a faint crackling and crunching when moving passively.

causes

As the cause of the Hip dislocation after TEP Different causes come into consideration, whereby the main cause may be a malfunction of the operated patient after the operation. However, problems with the actual prosthesis or the operating area can also be the reason for a dislocation.

It is important to distinguish whether an adequate trauma or a normal, everyday exercise The cause of the hip dislocation was. The risk of hip dislocation with a hip prosthesis can be reduced, but never completely eliminated. So can Blows, falls or accidentswhere high pressure is applied to the hips, cause a dislocation. Excessive movements that overwhelm the prosthesis can also lead to a dislocation, whereby, depending on the access route during the operation, certain movements are more likely to be the cause.

With the operative access of side-front is the risk of hip dislocation after a TEP strong external rotation, one Rotation of the leg around the longitudinal axis with the foot pointing outwards, or Adduction, i.e. leading the affected leg inwards, the largest.
Was the prosthesis from side-back used are mostly excessive Hip flexion and Internal rotation to be named as the cause. Movements that correspond to this pattern are sitting down or standing up or bending down deeply.

However, if these were everyday and controlled movements, one would come not optimally seated or e.g. in case of infection, loosened prosthesis as a cause of hip dislocation after TEP surgery, which must be corrected surgically.
In conclusion, even a poorly trained and weak muscles of the patient lead to excessive mobility in the joint and thus be the cause of a dislocation in a total endoprosthesis. Material defects are also less common.

diagnosis

When treating a hip dislocation after a hip prosthesis, the history, inspection and technical methods lead to the diagnosis. First of all, ask about a triggering factor, such as trauma or previous movement.
Proceed to diagnosis with an inspection Shortened leg that is incorrectly rotated outwards or inwards notices.

An x-ray of the hip is important for the diagnosis front and side levelto assess the extent of hip dislocation after TEP surgery and a Loosening or a Misfit to be able to exclude the prosthesis. If this is not enough, computed tomography can provide more accurate images and a reliable assessment of the hip dislocation.

It is then also decided whether a renewed operation is necessary or not. If no abnormalities can be seen, the movement sequence and possibly the dislocation mechanism can be reproduced using moving x-ray images in an image converter. In this way, the diagnosis of dislocation in a hip prosthesis is objectified.
Furthermore should Inflammation parameters be measured in the blood to rule out infection (see: Complication of hip replacement surgery)

therapy

The Reduction is the most important measure in hip dislocation after TEP to avoid permanent damage Vascular or nerve compressions to avoid.

As a reduction, this is Adjust the joint partners involved (here the femoral head and the hip socket) in the physiological position.
In the case of a dislocation in an artificial hip joint, this means that you want to lead the artificial femoral head that sits in the thigh bone back into the artificial hip socket.

It is between a closed and one open or operative reduction distinguished.
With closed reduction, the Reduction according to Böhler carried out, in which the femoral head is to be brought back to the right place after the patient has been fixed with targeted pulling and rotating movements. Due to the mostly strong hip muscles, this is sometimes done under anesthesia.

If the closed reduction is not possible or if there are accompanying injuries such as a fracture, the reduction is open, i.e. surgically. You can do this at the same time Accompanying injuries be treated. Also here is a detailed assessment of the prosthesis possible, which can possibly be adjusted or swapped in the same session.

After every reduction after a hip dislocation, the result must be seen X-ray or CT images to be controlled.

Aftercare

After the acute therapy of a hip dislocation after a TEP, a follow-up treatment follows. This depends on the measures taken previously. If a simple repositioning was carried out without complications, strengthening exercises in the context of physical or occupational therapy are mainly used for follow-up treatment.

If, on the other hand, it is not the first but the second or third hip dislocation in an artificial hip joint, the prosthesis usually has to be replaced and the result of the operation corrected. In the case of a hip dislocation of the TEP, it is important to check the position of the inserted parts at regular intervals, especially immediately after the event.
In addition, patient training can be used to once again point out how to use the prosthesis correctly and thus prevent the risk of renewed dislocation.

After another operation, the follow-up treatment consists of slowly approaching the maximum possible load as part of a controlled rehab treatment.

Read more about this at: Rehabilitation after installing a hip prosthesis

How can you avoid hip dislocation after TEP?

Even if a hip dislocation cannot always be avoided in a TEP, there are a few rules that patients should follow and measures that can reduce the risk.

The most important thing is to keep movements in the operated hip fundamentally controlled and at rest perform. A hip dislocation of the prosthesis is often caused by abrupt movements, which should be avoided. Especially through getting up and sitting down slowly one can avoid a dislocation with an artificial hip joint.

In the first few weeks after the operation, it is better to walk and lie down than to sit and stand.
In order to avoid hip dislocation, certain movements in which the hip is bent and the leg is rotated at the same time should only be performed to a small extent, e.g. a flexion in the hip joint of more than 90 ° is not recommended.
To make this easier to implement in everyday life, there are corresponding cushions in wedge shape, which are used so that the leg is not brought into unwanted positions.
When walking longer distances, a crutch can help prevent hip dislocation in an artificial hip joint.

In addition to these measures, provides good physical therapy with targeted muscle building another important pillar.
By a well-developed hip muscles the joint can also be stabilized and thus the risk of hip dislocation after TEP can be reduced.