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.

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.