JBJS -- Letters to the Editor for Berry et al., 87 (11) 2456-2463

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Letters to the Editor to:

Scientific Articles:
Daniel J. Berry, Marius von Knoch, Cathy D. Schleck, and William S. Harmsen
Effect of Femoral Head Diameter and Operative Approach on Risk of Dislocation After Primary Total Hip Arthroplasty
J Bone Joint Surg Am 2005; 87: 2456-2463 [Abstract] [Full text] [PDF]

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Electronic letters published:

Hip Dislocation Following Total Hip Arthroplasty: Himanshu Sharma (17 January 2006)

Hip Dislocation Following Total Hip Arthroplasty 17 January 2006

Himanshu Sharma,
Specialist Registrar in Trauma & Orthopaedics
Royal Alexandra Hospital, Paisley, SCOTLAND, PA2 9PN, UK
Send letter to journal:
Re: Hip Dislocation Following Total Hip Arthroplasty

hksharma1{at}aol.com Himanshu Sharma

To The Editor:
We read with interest the article by Berry, et al,(1). We would like to congratulate the authors for reviewing a very large cohort series with a quite long follow- up. However, because this was a computer database analysis, the study suffers from lack of a detailed clinical and radiologic data analysis, which leads us to raise some questions about the completeness of the study.
There were too many variables and confounding factors including a wide range of patient ages, several operating surgeons, and many implants used over many years. Nevertheless, we believe the authors effectively confirmed the anecdotal hypotheses about the effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. (2,3,4)
Dislocations that occurred in patients with well positioned components could have been compared with dislocations that occurred in patients with mal- positioned components to determine whether good radiographic appearances were associated with better clinical outcomes, the number of recurrent dislocations,and other complications.
Septic dislocations are a real orthopaedic challenge, which was not looked into further. We would also be interested to know whether an early versus a late dislocation had a higher recurrence rate.
Furthermore, what was the relationship of an operating surgeon's experience and the rate of dislocation? Patient related factors, complexity of the hip, and any particular implant as a common denominator should also be identified, as it might help us in pinpointing implant specific problems in causation of recurrent dislocation.
References:
1. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am. 2005 Nov;87(11):2456-63.
2. Kelley SS, Lachiewicz PF, Hickman JM, Paterno SM. Relationship of femoral head and acetabular size to the prevalence of dislocation. Clin Orthop Relat Res. 1998 Oct;355:163-70.
3. Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002 Dec;405:46 -53.
4. Bartz RL, Nobel PC, Kadakia NR, Tullos HS. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg Am. 2000 Sep;82(9):1300-7.