International Orthopaedics

, Volume 42, Issue 9, pp 2059–2065 | Cite as

Soft tissue tension is four times lower in the unstable primary total hip arthroplasty

  • Takeshi Ogawa
  • Masaki Takao
  • Hidetoshi Hamada
  • Takashi Sakai
  • Nobuhiko Sugano
Original Paper



The aim was to compare patients who suffered recurrent dislocation following total hip arthroplasty (THA) with those who did not to clarify the degree of soft tissue tension in dislocation patients.


The subjects were 18 hips with recurrent dislocation (unstable THA group) and 37 hips without dislocation (stable THA group). To evaluate soft tissue tension, radiographs were taken while applying distal traction at traction forces of 40, 30, and 20% of the body weight (BW) and femoral head displacement was measured. Acetabular offset, femoral offset, limb offset, and leg length discrepancy were measured in patients with a normal contralateral hip joint.


The mean femoral head displacement in the unstable THA group was 5.6 mm at 40% of the BW, 4.6 mm at 30% of the BW, and 3.5 mm at 20% of the BW. In the stable THA group, the mean femoral head displacement was 1.4 mm at 40% of the BW, 1.1 mm at 30% of the BW, and 0.9 mm at 20% of the BW. Significant differences were seen between the groups at all traction forces. Furthermore, on comparing the unstable and stable THA groups, femoral offset was found to significantly be smaller in the affected side than in the healthy side in the unstable THA group.


We found that soft tissue tension is approximately fourfold lower in patients exhibiting recurrent dislocations following THA than in patients exhibiting no dislocations and that femoral offset was related to decreased soft tissue tension.


Dislocation Soft tissue tension Hip joint Instability Total hip arthroplasty 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Patel PD, Potts A, Froimson MI (2007) The dislocating hip arthroplasty: prevention and treatment. J Arthroplast 22:86–90CrossRefGoogle Scholar
  2. 2.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91:128–133. CrossRefPubMedGoogle Scholar
  3. 3.
    Berry DJ, von Knoch M, Schleck CD, Harmsen WS (2004) The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 86:9–14CrossRefPubMedGoogle Scholar
  4. 4.
    Malkani AL, Ong KL, Lau E, Kurtz SM, Justice BJ, Manley MT (2010) Early- and late-term dislocation risk after primary hip arthroplasty in the Medicare population. J Arthroplast 25:21–25. CrossRefGoogle Scholar
  5. 5.
    Parvizi J, Kim KI, Goldberg G, Mallo G, Hozack WJ (2006) Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning. Clin Orthop Relat Res 447:60–65CrossRefPubMedGoogle Scholar
  6. 6.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220CrossRefPubMedGoogle Scholar
  7. 7.
    Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22:815–821CrossRefPubMedGoogle Scholar
  8. 8.
    Sugano N, Tsuda K, Miki H, Takao M, Suzuki N, Nakamura N (2012) Dynamic measurements of hip movement in deep bending activities after total hip arthroplasty using a 4-dimensional motion analysis system. J Arthroplast 27:1562–1568. CrossRefGoogle Scholar
  9. 9.
    Takao M, Nishii T, Sakai T, Sugano N (2016) Postoperative limb-offset discrepancy notably affects soft-tissue tension in total hip arthroplasty. J Bone Joint Surg Am 98:1548–1554. CrossRefPubMedGoogle Scholar
  10. 10.
    Nishihara S, Sugano N, Nishii T, Ohzono K, Yoshikawa H (2003) Measurements of pelvic flexion angle using three-dimensional computed tomography. Clin Orthop Relat Res 411:140–151CrossRefGoogle Scholar
  11. 11.
    Kingsley PC, Olmsted KL (1948) A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg Am 30:745–751CrossRefGoogle Scholar
  12. 12.
    Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75:228–232CrossRefPubMedGoogle Scholar
  13. 13.
    Sheth NP, Melnic CM, Paprosky WG (2016) Evaluation and management of chronic total hip instability. Bone Joint J 98:44–49. CrossRefPubMedGoogle Scholar
  14. 14.
    Marchetti E, Krantz N, Berton C, Bocquet D, Fouilleron N, Migaud H, Girard J (2011) Component impingement in total hip arthroplasty: frequency and risk factors. A continuous retrieval analysis series of 416 cups. Orthop Traumatol Surg Res 97(2):127–133. CrossRefPubMedGoogle Scholar
  15. 15.
    Miki H, Sugano N, Yonenobu K, Tsuda K, Hattori M, Suzuki N (2013) Detecting cause of dislocation after total hip arthroplasty by patient-specific four-dimensional motion analysis. Clin Biomech (Bristol, Avon) 28:182–186. CrossRefGoogle Scholar
  16. 16.
    Shon WY, Baldini T, Peterson MG, Wright TM, Salvati EA (2005) Impingement in total hip arthroplasty a study of retrieved acetabular components. J Arthroplast 20:427–435CrossRefGoogle Scholar
  17. 17.
    Ranawat CS, Maynard MJ (1991) Modern techniques of cemented total hip arthroplasty. Tech Orthop 6:17–25CrossRefGoogle Scholar
  18. 18.
    Dorr LD, Malik A, Dastane M, Wan Z (2009) Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res 467:119–127. CrossRefPubMedGoogle Scholar
  19. 19.
    Nakashima Y, Hirata M, Akiyama M, Itokawa T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Iwamoto Y (2014) Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty. Int Orthop 38:27–32. CrossRefPubMedGoogle Scholar
  20. 20.
    Berry DJ, von Knoch M, Schleck CD, Harmsen WS (2005) Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 87:2456–2463CrossRefPubMedGoogle Scholar
  21. 21.
    Howie DW, Holubowycz OT, Middleton R, Large Articulation Study Group (2012) Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 94(12):1095–1102. CrossRefPubMedGoogle Scholar
  22. 22.
    Allen CL, Hooper GJ, Frampton CM (2014) Do larger femoral heads improve the functional outcome in total hip arthroplasty? J Arthroplast 29(2):401–404. CrossRefGoogle Scholar
  23. 23.
    Hummel MT, Malkani AL, Yakkanti MR, Baker DL (2009) Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplast 24(6 Suppl):73–76. CrossRefGoogle Scholar
  24. 24.
    Takao M, Otake Y, Fukuda N, Sato Y, Armand M, Sugano N (2018) The posterior capsular ligamentous complex contributes to hip joint stability in distraction. J Arthroplast 33(3):919–924. CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Takeshi Ogawa
    • 1
  • Masaki Takao
    • 1
  • Hidetoshi Hamada
    • 2
  • Takashi Sakai
    • 2
  • Nobuhiko Sugano
    • 1
  1. 1.Department of Orthopaedic Medical EngineeringOsaka University Graduate School of MedicineSuitaJapan
  2. 2.Department of Orthopaedic SurgeryOsaka University Graduate School of MedicineSuitaJapan

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