Dislocation of a total hip arthroplasty: acute management in the ED

Am J Emerg Med. 2014 Dec;32(12):1554.e1-3. doi: 10.1016/j.ajem.2014.04.045. Epub 2014 Apr 26.

Abstract

Dislocation is one of the most common complications of total hip arthroplasty (THA). Because of the growing number of patients undergoing THA annually and the immense number of patients who have previously undergone the procedure, familiarity with the diagnosis and treatment of this complication is critical. Although the most common direction of dislocation is posterior, anterior dislocations do occur, and correctly identifying the direction of dislocation is important before attempted closed reduction as both the reduction maneuvers used and the postoperative instructions afterward are distinct for an anterior as opposed to a posterior dislocation. We present the current case of an anterior hip dislocation that was unable to be closed reduced as the direction of dislocation was presumed to be posterior. Although a shoot through lateral is recommended in all cases to confirm the direction of dislocation, we highlight how the physician can differentiate the direction of dislocation based on the position of the foot and location of the lesser trochanter on the anteroposterior radiograph.

Publication types

  • Case Reports

MeSH terms

  • Arthroplasty, Replacement, Hip / adverse effects*
  • Emergency Service, Hospital
  • Female
  • Hip Dislocation / diagnostic imaging
  • Hip Dislocation / etiology*
  • Hip Dislocation / therapy
  • Hip Prosthesis / adverse effects
  • Humans
  • Middle Aged
  • Prosthesis Failure
  • Radiography