Results of Reduction of Dislocated Prosthetic Hips in the Emergency Department

Background: Dislocation of total hip arthroplasty (dTHA) is a commonly encountered complication in the emergency department (ED). Several studies have been conducted that describe the overall success rate after reduction in the ED, however, all were small in sample size.

Objectives: The aim of the study was to assess the success rate of reduction of dTHA by emergency physicians in the ED under procedural sedation (PSA).

Methods: Patients who presented to the ED with a dislocated prosthetic hip were eligible for inclusion. We performed a retrospective cohort study assessing success rate. Secondary parameters included time to reduction, discharge rate from the ED, and complication rate.

Results: There were 305 patients analyzed. Of these, 31 were excluded due to hemi-arthroplasty and 25 because they went primarily for reduction in the operating room. In total, 249 patients were included. Of 249 attempted reductions in the ED, 230 (92%, 95% confidence interval [CI] 89-96%) were successful. Seventy-one cases (28.5%, 95% CI 22.9-34.2%) were discharged from the ED after successful reduction. Six cases (2.4%, 95% CI 0.2-2.6%) experienced complications related to PSA and three cases (1.2%, 95% CI 0.5-4.3%) experienced complications related to reduction.

Conclusion: Reduction of a dTHA can be performed safely in the ED under PSA by emergency physicians with a high rate of success.