Bracing after late THA dislocation
Date First Published:
November 29, 2025
Last Updated:
November 29, 2025
Report by:
Samuel Joy McGreal, RMO (Fiona Stanley Hospital, Perth)
Search checked by:
., .
Three-Part Question:
In adults with late dislocation (≥1 year post-THA) does post-reduction bracing (e.g., abduction brace, knee immobiliser) compared with no brace reduce the risk of re-dislocation?
Clinical Scenario:
A 72-year-old presents with a late dislocation of a primary total hip arthroplasty (THA) (≥1 year after index surgery). After closed reduction, the team is considering post-reduction bracing (hip abduction brace or immobilisation such as a knee immobiliser/cricket splint) to prevent recurrence.
Search Strategy:
(total hip arthroplasty[Title/Abstract] OR THA[Title/Abstract]) AND dislocation[Title/Abstract] AND (abduction brace OR bracing OR immobilization OR immobilisation OR knee immobilizer)
("hip dislocation"[MeSH Terms]) AND ("arthroplasty, replacement, hip"[MeSH Terms]) AND (brace OR bracing)
Definitions
• Early dislocation: typically ≤3–6 months after THA.
• Late dislocation: ≥1 year after THA; some series further label ≥5 years as “very late.”
("hip dislocation"[MeSH Terms]) AND ("arthroplasty, replacement, hip"[MeSH Terms]) AND (brace OR bracing)
Definitions
• Early dislocation: typically ≤3–6 months after THA.
• Late dislocation: ≥1 year after THA; some series further label ≥5 years as “very late.”
Search Details:
MEDLINE via PubMed (NCBI)
Outcome:
Identified and screened by title/abstract: 11 studies. Full text assessed: 5 studies . Included for BET table: 3 studies. Back-up context used in narrative: 2 studies.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Efficacy of abduction bracing in the management of total hip arthroplasty dislocation Hargovind Dewal, Stephen L Maurer, Peter Tsai, Edward Su, Rudi Hiebert, Paul E Di Cesare 19/09/2004 | 149 THA dislocations (91 first-time; 58 recurrent), mixed early/late | Abduction brace vs no brace after closed reduction | 61% vs 64% (first-time); 55% vs 56% (recurrent) | No benefit of bracing in preventing re-dislocation | |
| Identification of risk factors for treatment failure of closed reduction and abduction bracing after first-time total hip arthroplasty dislocation Viktor Janz, Georgi I Wassilew, Michael Putzier, Geraldine Kath, Carsten F Perka 08/01/2021 | 87 first-time THA dislocations; median 28 months post-op | 6-week abduction brace (no no-brace arm) | 67% re-dislocation | High failure despite brace; risk factors: early dislocation, BMI ≥25, low cup anteversion | |
| Late dislocation after total hip arthroplasty Marius von Knoch, Daniel J Berry, W Scott Harmsen, Bernard F Morrey 01/11/2002 | Large series; many ≥5 years post-THA (late/very late) | Observational (no brace comparator arm) | ~55% recurrence | Late recurrence driven by wear, malposition, loosening; often surgical solutions |
Author Commentary:
• Best direct evidence (brace vs no-brace) is Dewal 2004, showing no reduction in redislocation with abduction bracing after closed reduction.
• Modern braced cohort (Janz) confirms high failure rates and clarifies who fails bracing (early dislocators, BMI ≥25, low cup anteversion).
• Large datasets (von Knoch) show late events are usually mechanical (wear, malposition, loosening) with ~55% recurrence, making bracing biologically implausible as a durable fix.
• Compliance/effectiveness: Biomechanical work indicates braces often do not restrict motion as much as intended unless set more restrictively than labelled.
• Modern braced cohort (Janz) confirms high failure rates and clarifies who fails bracing (early dislocators, BMI ≥25, low cup anteversion).
• Large datasets (von Knoch) show late events are usually mechanical (wear, malposition, loosening) with ~55% recurrence, making bracing biologically implausible as a durable fix.
• Compliance/effectiveness: Biomechanical work indicates braces often do not restrict motion as much as intended unless set more restrictively than labelled.
Bottom Line:
For late THA dislocation (≥1 year post-op), post-reduction bracing (abduction brace or knee immobiliser/cricket splint) has not been shown to reduce re-dislocation compared with no brace. Re-dislocation rates remain high despite bracing, and late events are frequently due to mechanical causes (wear, malposition, loosening, spinopelvic issues) that require diagnostic work-up (standing/sitting lateral spinopelvic radiographs; CT for component position/wear) and often definitive surgical solutions. Routine bracing is not supported for late dislocators.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Hargovind Dewal, Stephen L Maurer, Peter Tsai, Edward Su, Rudi Hiebert, Paul E Di Cesare. Efficacy of abduction bracing in the management of total hip arthroplasty dislocation
- Viktor Janz, Georgi I Wassilew, Michael Putzier, Geraldine Kath, Carsten F Perka. Identification of risk factors for treatment failure of closed reduction and abduction bracing after first-time total hip arthroplasty dislocation
- Marius von Knoch, Daniel J Berry, W Scott Harmsen, Bernard F Morrey. Late dislocation after total hip arthroplasty