The devastating impact of hip dislocations on quality of life after total hip arthroplasty: patient priorities in implant choice, such as dual mobility or constrained liners, differ from those of surgeons.
Philippe Hernigou, Sami Karam, Charles-Henri Flouzat-Lachaniette
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Abstract
Purpose: Recurrent hip dislocation after total hip arthroplasty is among the most distressing complications for patients, often reshaping their everyday lives. Beyond the immediate physical consequences, repeated instability generates fear of movement, social withdrawal, and emotional strain. Yet, the extent of this burden has rarely been quantified using patient-centered methods.
Methods: We evaluated 170 patients who had experienced at least three dislocations and were scheduled for revision surgery. To capture the impact on health-related quality of life (HRQoL), patients completed a Time Trade-Off (TTO) assessment, estimating how many years of life they would exchange for a dislocation-free state. A parallel measure, the Survival Implant TTO, explored whether patients would sacrifice implant longevity in favor of greater stability. Their preferences were compared with surgeons' attitudes toward balancing implant durability and stability.
Results: Patients consistently described instability as a devastating experience, with many reporting restrictions in daily activities and a loss of independence. On average, patients were prepared to exchange nearly one quarter of their remaining life expectancy for stability and were also willing to shorten projected implant survival if this reduced the likelihood of further dislocations. In contrast, surgeons-particularly when treating younger patients-often emphasized implant durability over stability.
Conclusions: Recurrent hip dislocation has a far-reaching impact on quality of life, comparable to or exceeding that of chronic systemic diseases. Importantly, patient priorities differ from those of surgeons: stability is consistently valued over implant longevity. Incorporating these perspectives into revision planning is essential for truly patient-centered care.
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
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The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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