The Fate of Hip Dislocations Within 90 Days From Primary Total Hip Arthroplasty

Background Postoperative dislocation represents a recognized complication following total hip arthroplasty (THA). Standard initial management is closed reduction, with revision arthroplasty reserved for persistent instability. This study examined current treatment patterns for early THA dislocation and evaluated preoperative patient risk factors and complications. Methods A retrospective review of 4904 consecutive primary elective THA patients treated at a single institution between May 15, 2020, and May 30, 2025, was performed. Dislocations occurring within 90 days from the primary case were identified. Patients with a diagnosis of dysplasia, cancer, conversion, or fracture were excluded. Categorical outcomes were compared with chi-squared tests. Logistic analysis assessed correlations between comorbidities and dislocation risk. Results 38 patients (0.77%) dislocated within 90 days. Patients who dislocated had a lower Risk Assessment and Prediction Tool score and Brief Resiliency Scale (BRS). The BRS was lower in those who dislocated (3.2 v 3.9, P < .001), indicating a reduced capacity for recovery. The Risk Assessment and Prediction Tool score was also lower (8.2 v 9.1, P = .021), indicative of a higher disease burden. Patients who underwent a direct anterior approach had reduced rates of dislocation compared to the posterior approach (0.43% v 0.86%), which is not statistically significant ( P = .336). Closed reduction alone was sufficient for 60.5% of dislocations. For those requiring surgical treatment, most (60%) were revised to a constrained liner. Conclusions In a large contemporary cohort, over half of early THA dislocations were managed successfully with closed reduction alone. THA dislocations are likely due to a combination of factors, but resiliency has a probable role.