Total Hip Arthroplasty in Patients with Spasticity: A Critical Analysis Review.

Patients with neuromuscular spasticity about the hip with concomitant painful hip arthritis can be effectively treated with total hip arthroplasty, with excellent clinical outcomes and durable implant survivorship. Certain subsets of patients in this population are at increased risk of dislocation, component loosening, and heterotopic ossification and are also prone to postoperative medical complications. Strategies that may mitigate the risk of dislocation include using large femoral heads or dual-mobility articulations with cautious use of constrained liners, careful repairing of soft-tissue structures at the conclusion of the surgical procedure, and performing concomitant adductor and flexor tenotomies. In addition, the other common complications can be reduced by coordinating perioperative care with neurological and medical specialists and administering perioperative heterotopic ossification prophylaxis, most commonly in the form of nonsteroidal anti-inflammatory medications, if tolerated.