What procedure is warranted after closed reduction of a luxated hip prosthesis?

From the Guidelines

After closed reduction of a luxated hip prosthesis, post-reduction imaging with radiographs is essential to confirm proper component positioning and rule out fractures or other complications, as recommended by the American College of Radiology 1. The patient should be placed on hip precautions for 6-12 weeks, which typically include avoiding hip flexion beyond 90 degrees, internal rotation past neutral, and adduction past midline. Weight-bearing status should be determined based on implant stability and surgeon preference, ranging from toe-touch to weight-bearing as tolerated. Pain management with NSAIDs (such as ibuprofen 600mg three times daily) and/or acetaminophen (1000mg four times daily) is appropriate, with opioids reserved for breakthrough pain. A physical therapy program focusing on hip abductor strengthening and gait training should be initiated. The patient should use an abduction pillow while sleeping and may require assistive devices like elevated toilet seats and reaching tools. Close follow-up at 2 weeks, 6 weeks, and 3 months is recommended to monitor stability and function, with radiographs being the imaging mainstay for following THA, as suggested by the American College of Radiology 1. These measures are crucial because recurrent dislocation rates after closed reduction range from 16-59%, with proper post-reduction protocols significantly reducing this risk by allowing soft tissue healing and promoting muscle strengthening around the prosthesis. Some key points to consider in the follow-up care include:

• Radiographs can be used to assess component position, component loosening, bone quality, osteolysis, fracture, dislocation or subluxation, femoral neck narrowing, and medial femoral calcar erosion 1
• Serial radiographs are helpful to assess subtle changes and identify potential complications early on 1
• The FDA recommends routine long-term follow-up of patients with MoM hip implants, typically to occur every 1 to 2 years, including appropriate radiographs 1

From the Research

Procedure after Closed Reduction of Luxated Hip Prosthesis

After closed reduction of a luxated hip prosthesis, the following procedures are warranted:

• Imaging-controlled repositioning is carried out with the patient under adequate analgesia and sedation 2
• Conservative therapy is carried out by immobilization with a hip joint orthesis or pelvis-leg cast for 6 weeks 2
• Check-ups are necessary to monitor the patient's condition and to detect any potential complications early on

Check-ups and Follow-up

Check-ups are essential after closed reduction of a luxated hip prosthesis to:

• Monitor the patient's condition and detect any potential complications early on
• Assess the stability of the hip joint and the prosthesis
• Check for any signs of infection or other complications

Therapy Decisions

Therapy decisions are made depending on the cause of the luxation, such as:

• Implant malpositioning
• Pelvitrochanterian insufficiency
• Impingement
• Incongruence between head and inlay
• Combinations of causes 2

Recurrent Luxation

In cases of recurrent luxation, operative therapy strategies may be necessary, such as:

• Restoration of the correct implant position
• Sufficient soft tissue tension
• Use of larger hip heads, bipolar heads, or tripolar cups to reduce the risk of dislocation 2, 3