From the Research
The best reduction technique for hip prosthesis luxation is closed reduction under adequate sedation or anesthesia, specifically using propofol, as it has been shown to be significantly more effective than combination fentanyl/midazolam in achieving successful reduction 1.
Key Considerations
- Closed reduction should be performed in the emergency department or operating room, with the patient under adequate sedation or anesthesia.
- Longitudinal traction along the femoral axis, with an assistant stabilizing the pelvis, followed by gentle internal rotation and adduction, is the recommended technique.
- Prior to attempting reduction, imaging studies including radiographs should be obtained to confirm the direction of dislocation and rule out periprosthetic fractures.
- Post-reduction radiographs are necessary to confirm proper component positioning, and the patient should be placed in a hip abduction brace or pillow to maintain stability.
Sedation Options
- Propofol is the recommended sedative agent due to its higher success rate and shorter time to reduction compared to combination fentanyl/midazolam 1.
- Combination fentanyl/midazolam is not recommended due to its high risk of failure and longer time to reduction.
Important Notes
- If closed reduction fails after 1-2 attempts, or if there is component malposition or mechanical blockage, open reduction may be necessary.
- The goal of reduction is to restore normal hip biomechanics and avoid the risks associated with open surgical reduction.