Management of Dislocated Femoral Component After Left Hip Arthroplasty
The management of a dislocated femoral component after hip arthroplasty requires prompt closed reduction under appropriate anesthesia, followed by immobilization in the "deck chair position" (45° flexion, 10-20° abduction, and neutral rotation) for approximately 2 weeks to prevent recurrence.
Initial Assessment and Management
Immediate Actions
- Obtain urgent AP pelvis and lateral hip radiographs to confirm dislocation and assess component positioning
- Assess neurovascular status of the affected limb
- Provide appropriate analgesia using a multimodal approach:
- Regular acetaminophen (paracetamol) as first-line treatment
- NSAIDs if no contraindications exist (renal impairment, bleeding risk)
- Opioids at lowest effective dose only for breakthrough pain
Closed Reduction
- Perform closed reduction under appropriate anesthesia (general or procedural sedation)
- For anterior dislocations (less common):
- Apply inline traction with external rotation
- Assistant may push on femoral head or pull femur laterally to assist reduction 1
- For posterior dislocations (more common):
- Apply longitudinal traction with internal rotation on the hip 1
Post-Reduction Management
Immobilization
- Immobilize the hip in the "deck chair position" for approximately 2 weeks:
- 45° flexion
- 10-20° abduction
- Neutral rotation 2
- This position has shown excellent medium-term functional results and effectively prevents recurrence 2
Monitoring and Care
- Administer supplemental oxygen for at least 24 hours post-procedure to prevent hypoxia 3
- Implement active warming strategies to prevent hypothermia 3
- Remove urinary catheters as soon as possible to reduce infection risk 3
- Monitor for signs of bone cement implantation syndrome if revision surgery is needed 3
Thromboprophylaxis
- Venous thromboembolism prophylaxis is strongly recommended:
Rehabilitation Protocol
Early Phase (0-2 weeks)
- Pain management with multimodal analgesia
- Protected weight-bearing as tolerated unless contraindicated
- Gentle mobilization as soon as pain allows
- Avoid activities that exacerbate symptoms (stairs, inclines)
Intermediate Phase (2-6 weeks)
- Progressive strengthening exercises focusing on hip abductors
- Core and hip stabilization exercises to improve biomechanics
- Gradual return to normal activities
Advanced Phase (6+ weeks)
- Functional exercises
- Return to full activities as tolerated
Surgical Considerations for Recurrent Dislocations
- If closed reduction fails or dislocations recur despite conservative management, surgical intervention may be necessary
- Surgical options include:
Common Pitfalls and Complications
- Delayed treatment increases risk of complications including pressure ulcers, pneumonia, and venous thromboembolism
- Chronic dislocation can lead to severe complications in debilitated patients, including pressure sores and infection 5
- Inadequate rehabilitation focusing only on pain relief without addressing underlying muscle weakness can lead to recurrence
- Overreliance on opioids can cause sedation, delirium, and respiratory depression, particularly in elderly patients
Monitoring for Recurrence
- Post-reduction radiographs to confirm proper positioning
- Regular clinical follow-up to assess stability and function
- CT scan may be needed to evaluate component positioning (cup and femoral anteversion) if recurrent dislocations occur 2
By following this management protocol, most patients with dislocated hip arthroplasty can achieve good functional outcomes without requiring revision surgery.