Instability

Postoperative hip dislocation is directly related to soft tissue integrity, approach, component position, and implant choice. The need to achieve a stable, impingement-free range of motion is even more crucial in the potential athlete. Maintenance of the soft tissue envelope decreases the risk of dislocation. Preserving the integrity of the posterior soft tissue provides the most stability, and is achieved either by maintaining tendinous attachments through an anterior or lateral approach [12], or by repairing capsular tissues and the short external rotators [13].

Intraoperatively, surgeons should ensure that hip does not demonstrate prosthetic or bony impingement. Prosthetic impingement in athletes can be minimized with larger head sizes, and even eliminated with head sizes greater than 36 mm [14]. Larger head sizes also increase the "drop distance" before potential dislocation, and the use of modified neck tapers maximizes head-to-neck ratios. Bony impingement is minimized with restoration of leg length and offset and the debridement of osteophytes. Optimal component position in the position of safety may also be enhanced with image guidance or computer navigation [15].

0 0

Post a comment