Does a patient with a dislocated femoral head component after hip replacement surgery at rehab need to be sent to the hospital?

Management of Dislocated Femoral Head Component After Hip Replacement

A patient with a dislocated femoral head component after hip replacement surgery should be immediately transferred from rehabilitation to the hospital for urgent evaluation and management. 1

Rationale for Hospital Transfer

• Immediate Complications: A dislocated prosthesis represents an orthopedic emergency that requires prompt reduction to:

  • Prevent neurovascular compromise
  • Minimize soft tissue damage
  • Reduce the risk of avascular necrosis
  • Prevent chronic dislocation which can lead to severe complications including prosthetic protrusion 2

• Need for Specialized Care: Rehabilitation facilities typically lack:

  • Appropriate imaging capabilities (radiographs, CT scans)
  • Orthopedic specialists for evaluation and reduction
  • Operating rooms for potential surgical intervention
  • Anesthesia services required for closed or open reduction

Management Protocol

1. Initial Assessment at Hospital:

   • Obtain radiographs to confirm dislocation and assess component positioning
   • CT scan may be needed to evaluate component positioning (cup and femoral anteversion) 1
   • Assess for excessive anteversion which is commonly associated with anterior dislocations (approximately 10° excessive femoral and acetabular anteversion) 3

2. Reduction Procedure:

   • Closed reduction under anesthesia is the first-line treatment
   • Post-reduction radiographs to confirm proper positioning
   • If closed reduction fails, surgical intervention may be necessary

3. Post-Reduction Care:

   • Administer supplemental oxygen for at least 24 hours to prevent hypoxia 4, 1
   • Implement active warming strategies to prevent hypothermia 1
   • Remove urinary catheters as soon as possible to reduce infection risk 4, 1
   • Monitor for signs of bone cement implantation syndrome if revision surgery is needed 1

4. Thromboprophylaxis:

   • Venous thromboembolism prophylaxis should be used and continued for 4 weeks postoperatively 4, 1
   • Options include low molecular weight heparin (e.g., enoxaparin) or direct oral anticoagulants 1

5. Post-Reduction Stabilization:

   • For anterior dislocations, immobilization in a "deck chair position" (45° flexion, 10-20° abduction, neutral rotation) for approximately 2 weeks may prevent recurrence 3
   • Weight-bearing status should be determined based on stability assessment

Risk Factors for Redislocation

• Surgical approach (posterior approach has 6-fold higher risk) 5
• Suboptimal component positioning 5
• Smaller femoral head sizes 5
• Femoral head depression fractures (similar to Hill-Sachs lesions in shoulder dislocations) 6

Rehabilitation Considerations

• The rehabilitation process constitutes the majority of a patient's inpatient stay after hip fracture and continues after discharge 4
• Patients should be allowed to weightbear as tolerated after successful reduction and stabilization, unless otherwise specified 4
• Patients with subluxation or dislocation report significantly more concern about instability and have lower functional scores 7

Follow-up Care

• Regular clinical follow-up to assess stability and function
• If recurrent dislocations occur, revision surgery may be necessary
• Total hip replacement should be considered for cases with femoral head depression fractures or recurrent instability 6

Remember that dislocations represent a significant complication with potential for increased morbidity and mortality if not addressed promptly. Rehabilitation facilities are not equipped to manage this condition, making immediate hospital transfer essential.