Abstract
Background
Total hip arthroplasty (THA) is one of the most successful operations in all of medicine
in improving patient pain and restoring function. However, complications do arise
after primary and revision THA. Dislocation of a THA, also known as instability, occurs
in 1–2% of primary THAs and up to 30% of revision THAs. Most dislocations in the United
States are initially managed with closed reduction under procedural sedation in emergency
departments (EDs) by on-call orthopedists or emergency medicine specialists.
Objective
In this review the characteristics of the articulations that may require closed reduction
in the ED are described, as well as their radiographic findings prior to reduction.
Finally, we present subtle radiographic findings associated with failed closed reductions.
Discussion
Due to the different types of implants that have been introduced, closed reduction
can be challenging in certain cases. Iatrogenic intraprosthetic dislocations are becoming
more common with the increased use of dual-mobility liners. There are also dislocations
after staged revision THA cases with the use of spacers. In spacers with semi-constrained
articulation, there is the possibility of partial reduction of the spacer.
Conclusions
Dislocation is one of the most common mechanical complications after primary and revision
THA. In the majority of the cases, acute closed reduction can be achieved successfully
in the ED setting. However, there are specific dislocation types that present unique
challenges to acute reduction.
Keywords
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Article info
Publication history
Published online: January 12, 2021
Accepted:
November 22,
2020
Received in revised form:
October 28,
2020
Received:
July 9,
2020
Footnotes
Dr Sculco is a paid consultant for EOS Imaging Intellijoint Surgical, Lima Corporate and Depuy Synthes and has research support from Intellijoint Surgical.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
