Biomechanical aspects of the development of hip dislocation after hip arthroplasty

S.O. Maslennikov, M.L. Golovaha

Abstract


Based on a review of the literature of domestic and foreign authors, an analysis of the biomechanical aspects of the development of a dislocation of the femur endoprosthesis was made, an assessment was made of the dependence of the possibility of the development of a dislocation on the condition of the surrounding soft tissues and the capsular-ligament apparatus after endoprosthetics. The risk factors for dislocation of the hip endoprosthesis are numerous and varied. Many risk factors are associated with surgical technique, geometric design of the implant, and with orientation of both the femoral and acetabular components during their installation. Nevertheless, one factor unanimously agreed by orthopedists is that a violation of the integrity of the soft tissues of the hip joint clearly predisposes to the risk of dislocation of the femoral component of the endoprosthesis. It was found that for the thinnest capsule (1 mm) the peak resistance to dislocations reached only 53 % of that at a capsule thickness of 3.5 mm and reached only 31 % of the maximum capsule thickness of 6 mm, in addition, the localization of the defect is important: in the back And the posterolateral region, both from the side of the ace-tabular and from the femoral component, there is a significant decrease in the force of action causing the dislocation, by more than 50 % relative to the level of the intact capsule. The recovery of such defects returns the peak values of the resistance moment within 10–20 % of the baseline. Thus, an obvious dependence on the safety of the soft tissues of the joint is defined as a factor that affects instability and causes a complication in the form of a dislocation of the hip endoprosthesis. Particular attention should be paid to identifying the most effective strategies for surgical repair of capsule defects and surrounding soft tissues of the joint, which implies the need to carefully restore the posterior capsular structures as much as possible, both in primary and revision surgery.

Keywords


endoprosthesis; hip joint; prosthesis dislocation; biomechanics

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DOI: https://doi.org/10.22141/1608-1706.6.18.2017.121178

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