In-patient management of dislocation after total hip arthroplasty: a multicentre study from UK hospitals

This retrospective multicentre study, involving 38 UK hospital trusts, aimed to characterise the demographic features, inpatient management, and referral patterns of patients with prosthetic hip dislocations. The primary focus was to identify factors influencing a definitive management plan following acute total hip arthroplasty (THA) dislocation, and to assess differences in the management of primary versus revision THA dislocations.

Data from 645 patients who sustained acute prosthetic hip dislocations between 01 January 2019 and 31 July 2019, were collected from electronic medical records. Patients were divided into Primary and Revision THA groups. Statistical analyses were used to explore demographic patterns, comparative analyses, and factors influencing referral decisions, with significance set at p < 0.05.

The mean age of patients was 76.2 years, with a predominance of females (65.7%) and posterior dislocations (72.7%). Of the patients, 37.8% underwent reduction in the Emergency Department (ED), with a success rate of 69.7%, while 72.9% required reduction in theatre, achieving a success rate of 90.6%. Inpatient mortality was 1.2%. Only 32.5% of patients had a definitive management plan following their dislocation. Primary THA patients (n = 504) were predominantly female (69.6%) compared to Revision THA patients (n = 141, 48.9%, p < 0.001). Anterior dislocations were more common in the Revision THA group (26.2% vs. 17.3%, p = 0.017). The primary THA group had a higher success rate in closed reduction (92.9% vs. 82.9%, p = 0.002). Revision THA patients were more likely to have a definitive management plan (52.9% vs. 26.9%, p < 0.001).

This study highlights significant variability in the management of THA dislocations, particularly in the lack of standardised protocols for inpatient management and onward referral to revision arthroplasty surgeons. Standardisation of care pathways is needed to optimise outcomes for patients with prosthetic hip dislocations.