THE MANAGEMENT OF DISLOCATING TOTAL HIP REPLACEMENTS BY BRITISH HIP SOCIETY MEMBERS

Abstract

Introduction: The management of total hip replacement (THR) dislocations is variable after closed reduction. This study was performed to look at the differences in immediate management of THR dislocations after reduction under anaesthesia.

Method: A questionnaire was sent to all members of the British Hip Society asking them about their management of THR dislocations after closed reduction.

Results: 62 orthopaedic consultants completed the questionnaire. A 34% return rate for our postal survey to the 2004 members of the British Hip Society.

For first time dislocations with a stable EUA 8% always used an abduction brace and 50% never used one. 20% were managed with a period of bed rest. For an unstable EUA, 40% always used a brace and 23% never used one. 31% were managed with a period of bed rest. When a brace was used, the majority (75%) used it for 6 weeks (range 2 to 12 weeks).

For recurrent dislocations, with a stable EUA, 65% used a brace for at least 6 weeks. For an unstable EUA 74% used a brace for at least 6 weeks and 15% managed with a brace permanently or until revision.

50% asked the patient to wear the brace 24 hours a day including whilst asleep, the only exception being for washing. The others were varying from 12 to 16 hours a day.

The commonest criteria for revision surgery were recurrent dislocation (seen as more than three), component malposition, aseptic loosening and instability at EUA. The questionnaire was answered by orthopaedic surgeons who all had experience in revision surgery, the majority having performed over 100 revision THR in the past 5 years.

Discussion: The management of dislocated THR is varied between units. There does not appear to be a pattern of management amongst BHS members. The popularity and efficacy of abduction braces remains unknown.