[Are early dislocations still a relevant quality indicator in primary total hip arthroplasty? : An analysis from two maximum-care endoprosthetic centers].

backgroundThe dislocation rate of primary hip arthroplasty has been reduced since the 1970s to rates of 0.7-8.8%. Dislocations after primary arthroplasty are only recorded in arthroplasty registries when implant components are exchanged. In the EndoCert® certification process, dislocations in the early postoperative phase up to 3 months are additionally assessed without mandatory follow-up. Is early dislocation a significant quality indicator in primary hip arthroplasty? MATERIAL AND

methodsIn a joint database (EndoDok®), all dislocations after primary hip endoprostheses at two certified EndoProsthetics Centers of maximum care from various clinic providers were prospectively recorded over at least 3 months postoperatively using the available documents, including discharge, rehabilitation, outpatient, and physicians' reports. All patients who suffered a dislocation were analyzed in comparison to the control group without dislocation. Factors considered included gender, side, age, BMI, ASA, operation time, primary procedure, and prosthesis fixation.

resultsDuring the observation period of 9 years, elective primary total hip arthroplasty implantations were performed on a total of 3265 patients according to the same standards. The dislocation rate was low at 0.18% following elective hip arthroplasty. Risk factors such as increased BMI, prosthesis fixation, inclination angle, and operation duration were presented. The dislocation rate was not significantly influenced by training interventions. DISCUSSION: In the certification process, complications are consistently evaluated to improve processes. Under the quality-oriented conditions of the EndoCert® system, very low dislocation rates can be achieved in primary endoprosthetics. Even without follow-up examinations, consistent recording of dislocations allows for a comparable evaluation of provider quality and, in particular, provides the prerequisite for the mandatory complication analysis of all reported dislocations.