From the Research
No, a patient should not be discharged immediately after reduction of a hip prosthesis luxation. After successful reduction, the patient should be observed in the hospital for at least 24 hours to monitor for complications, ensure pain control, and confirm stability of the reduction with post-reduction imaging 1. During this observation period, the patient should receive appropriate pain management with medications such as acetaminophen, NSAIDs (if not contraindicated), and possibly opioids for breakthrough pain.
Some key points to consider in the management of hip prosthesis luxation include:
- The success rate of reduction in the emergency department is high, with one study reporting a success rate of 92% 1
- However, the risk of recurrent dislocation is significant, especially within the first 24-48 hours after reduction 2
- The reduction procedure itself can sometimes cause complications such as neurovascular injury, fracture, or damage to the prosthetic components that may not be immediately apparent but could require urgent intervention 2
- Physical therapy evaluation should be initiated prior to discharge to assess mobility and provide guidance on hip precautions, which typically include avoiding hip flexion beyond 90 degrees, internal rotation, and adduction across the midline 3
- Post-discharge follow-up should be arranged within 1-2 weeks with the orthopedic surgeon to monitor for any potential complications or recurrent dislocation 4
The most recent and highest quality study on this topic, published in 2022, found that a modified lateral position reduction maneuver can effectively increase the reduction success rate and satisfaction without increasing the risk of complications compared with the traditional Allis supine reduction maneuver 5. However, this study does not address the question of whether a patient can be discharged immediately after reduction, and therefore the cautious approach of observing the patient in the hospital for at least 24 hours remains the recommended course of action.