| Keywords [eng] |
total hip arthroplasty, THA, surgical approach, posterior approach, direct lateral approach, direct anterior approach, dislocation, dislocation prevention, cause of dislocation, postoperative complications, dislocation rate |
| Abstract [eng] |
Total hip arthroplasty (THA) is a often performed and effective procedure for managing hip pathology. However, postoperative dislocation is one of the leading complications and cause for revision surgery, showing the importance of working prevention strategies. This research explores different surgical approaches and techniques aimed at minimizing dislocation risk, based on a good understanding of hip joint anatomy, biomechanics and surgical steps. The objective of this study is to examine key surgical factors that influence postoperative stability and assess how different approaches and techniques contribute to reducing dislocation rates. A narrative review methodology was performed, evaluating current literature on surgical approaches (anterior, posterior, and lateral), capsular and soft tissue management, implant selection (head size, dual mobility systems), the influence of leg length and offset changes and the role of technological aids, like robotic-assisted surgery in decreasing dislocation rate. Findings in literature show, that successful prevention begins with taking careful attention to the stabilizing structures of the hip. Techniques that preserve or reconstruct the joint capsule, ligaments, and periarticular musculature are consistently associated with lower dislocation rates. The direct anterior approach, which limits soft tissue disruption, and posterior approach followed by a capsular repair, both show lower dislocation rates. Additionally, implant design has a drastic impact on stability. Larger femoral heads and dual mobility implants provide more stability through improved biomechanics lowering therefore successfully dislocation rates after (THA). Surgeon experience and the integration of modern robotic-assisted techniques further help in correct component positioning, and therefore reduction of dislocation. While restoration of leg length and femoral offset is important for functional outcomes, their role in dislocation prevention is considered supportive rather than primary. In conclusion, the prevention of dislocation after total hip arthroplasty is a complex, multifactorial challenge. The best results are achieved through a combination of well-defined surgical techniques, soft tissue handling, appropriate implant choice, and the use of modern technologies. Therefore, an approach that considers also patient-specific risk factors and surgical expertise is the way to provide long-term stability hence lower dislocation rates and an overall improved quality of life for the patient following (THA). |
