From the Research
The treatment for hip prosthesis luxation (dislocation) typically involves closed reduction followed by activity restrictions and possibly revision surgery in recurrent cases, as recommended by the most recent and highest quality study 1.
Overview of Treatment
The initial step in managing hip prosthesis luxation is closed reduction, which is usually performed under sedation or general anesthesia to realign the prosthetic components. This procedure can be done in the emergency department or operating room. Following reduction, patients are typically placed in an abduction brace or hip precaution pillow for 6-12 weeks to maintain proper positioning and prevent recurrence.
Activity Restrictions and Physical Therapy
Activity restrictions are essential during the recovery period, including avoiding hip flexion beyond 90 degrees, internal rotation, and adduction across the midline. Physical therapy focusing on strengthening the hip abductors and external rotators is usually started within 1-2 weeks after reduction. This approach helps in preventing further dislocations and improving the overall stability of the hip joint.
Surgical Intervention for Recurrent Dislocations
For recurrent dislocations (occurring more than 2-3 times), surgical intervention may be necessary, including revision arthroplasty to reposition components, use of constrained liners, or larger femoral heads to improve stability, as discussed in 2. The choice of surgical method depends on the underlying cause of the dislocation, which could be component malposition, soft tissue laxity, or impingement.
Pain Management
Pain management is an important aspect of treating hip prosthesis luxation and typically includes NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), and sometimes short-term opioids for severe pain. The goal is to minimize discomfort while allowing for early mobilization and rehabilitation.
Importance of Addressing Underlying Cause
The success of treatment depends on addressing the underlying cause of dislocation, as emphasized in 3. This involves a thorough evaluation of the patient and the prosthetic components to identify any malposition, soft tissue issues, or other factors contributing to the dislocation. By addressing these underlying causes, the risk of recurrent dislocation can be significantly reduced, improving the patient's quality of life and reducing the need for further surgical interventions.