Closed reduction of dislocated hip arthroplasty: A teaching institution's experience

Background: Dislocation is a common complication of hip arthroplasty and is typically treated initially by closed reduction under sedation in the emergency department (ED). Although closed reduction has a very high success rate, information on the risk factors for difficult or failed procedures is scarce. Methods: The authors retrospectively reviewed the 5-year experience of treating patients for dislocated hip arthroplasty at a single center to determine the specific variables related to difficult or failed closed reductions. Results: Of 112 hip arthroplasty dislocations studied, 25 (22%) closed reductions were difficult, 20 attempted closed reductions (18%) failed, and six (6%) patients had complications (two skin lacerations, two periprosthetic fractures, one incongruent reduction, and one component loosening). Significant predictors for a difficult reduction were age, prior dislocation, time to reduction, and time from surgery. The level of anesthesia approached significance. Among the 20 hip arthroplasty dislocations in which initial closed reduction attempts in the ED failed, 12 (60%) were subsequently successful under deeper levels of sedation outside of the ED, six (30%) required an open reduction, and two (10%) required revision hip arthroplasty because of complications. Hip arthroplasty dislocations in older patients typically occurred shortly after the last surgery and were at increased risk for a difficult closed reduction or complications if dislocated for longer than 24 hr. Conclusions: In older patients, patients in the early postoperative period, first-time hip arthroplasty dislocations, or hip arthroplasty dislocations >24 hr old, clinicians should consider performing closed-hip arthroplasty reduction in an environment that offers more flexibility than the ED.