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<< Managing Dislocations of the Hip, Knee, and Ankle in the Emergency Department (Trauma CME)

Special Circumstances

Hip Dislocation Following Total Hip Arthroplasty

Special consideration is necessary for patients presenting with dislocation of a prior total hip arthroplasty (THA). Approximately 2% of individuals who have undergone THA will present with hip dislocation, which typically results from minimal traumatic force.69 These are usually due to activities such as bending over to pick something up off the floor, putting on shoes and socks, and getting into and out of bed.70 Approximately 60% of dislocations following THA occur within the first 3 months, and 77% occur within the first year.71

Reduction techniques are similar to those described in the "Reduction of Hip Dislocation" section on page 13; however, the urgency of reduction is not as pressing, since there is no risk of avascular necrosis, since the femoral head has been replaced. Prompt reduction is still encouraged however, due to patient discomfort as well as the risk of sciatic nerve injury. Of note, forceful reduction of a dislocated hip prosthesis may dislodge the acetabular cup, fracture underlying osteoporotic bone, or loosen the prosthesis. If reduction is unsuccessful after multiple attempts, orthopedic surgery should be consulted for reduction in the operating room.

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