Prosthetic hip dislocation: a pilot multicentre observational study

Background: Total hip arthroplasty is one of the most successful and cost-effective interventions for improving quality of life. Dislocation is a well-recognised complication with a significant health and economic burden. The aim of this study was to establish the current management practices for patients presenting with a prosthetic hip dislocation. This was measured through the primary outcome of definitive management, either in the form of revision surgery or the consideration for this through a referral pathway. The secondary outcome measured the number of dislocations per patient resulting in consideration for definitive management.

Methods: Between January and July 2019, 186 patients who sustained a prosthetic hip dislocation were identified from 13 separate institutions. Data were retrospectively collected including patient demographics, co-morbidities, details of the arthroplasty, number of dislocations, and management, both in the acute setting and after discharge.

Results: 149 patients who sustained 200 dislocations were included. The median (interquartile range) interval between primary total hip arthroplasty and first dislocation was 6 (0-13) years. An urgent reduction was achieved either in the emergency department or operating theatre in 3 (1.5%) and 188 (94%) cases, respectively, and 2 (1%) underwent urgent revision. Only 55 patients (36.9%) received definitive management, either in the form of revision surgery or consideration for this. The number of dislocations was the only independent predictor of definitive management (p = 0.001, odds ratio [OR] 1.332; 95% confidence intervals 1.130-1.570).

Conclusions: There is a lack of consensus regarding the definitive management of patients with prosthetic hip dislocation. Our study highlights the need for a standardised pathway for the management of this complication. We aim to expand this study to a national level to propose a data-driven management algorithm for prosthetic hip dislocations.