A detailed review of hip reduction maneuvers: a focus on physician safety and introduction of the Waddell technique

Abstract

Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip arthroplasty. Bigelow first described closed treatment of a dislocated hip in 1870, and in the last decade many reduction techniques have been proposed. In this article, we review all described techniques for the reduction of hip dislocation while focusing on physician safety. Furthermore, we introduce a modified technique for the reduction of posterior hip dislocation that allows the physician to adhere to the back safety principles set for by the Occupational Safety and Health Administration.

Dislocation of the Hip: A Review of Types, Causes, and Treatment

“…Anterior hip dislocations are classified as either superior-anterior (pubic) or inferior-anterior (obturator). 7,23,24 Pubic-type dislocations result from abduction, extension, and external rotation of the hip. Obturator-type dislocations result from abduction, flexion, and external rotation of the hip.…”

“…Obturator-type dislocations result from abduction, flexion, and external rotation of the hip. 4,7,25 Patients with anterior dislocations may have a palpable femoral head in the femoral triangle in contrast to a palpable femoral head in the gluteal area with posterior dislocations. 2…”

“…39 On the other hand, administration of intravenous, general, or regional sedation has been proven to reduce complications and ease the modes of reduction in numerous studies. 2,4,7,8,34,39 In postoperative total hip replacement dislocations, if the prosthetic components are adequately positioned, most patients (67%) who undergo successful closed reduction will not experience another dislocation. 8 Adequate sedation is required to properly relax the muscles and reduce the risk of injuring the patient or physician.…”

“…8 Adequate sedation is required to properly relax the muscles and reduce the risk of injuring the patient or physician. 7,34 Adequate sedation also reduces the risk of repeated attempts at closed reduction that can damage the prosthesis or injure the patient. 3 Bigelow first described closed treatment of a dislocated hip in 1870, and many reduction techniques have been proposed since then.…”

“…3 Bigelow first described closed treatment of a dislocated hip in 1870, and many reduction techniques have been proposed since then. 7 Because closed reduction techniques require placing the patient in different positions (eg, prone, supine, lateral decubitus), the choice of technique should minimize further injury at the time of presentation. Although mastery of each technique is not mandatory, becoming proficient in a few techniques will aide in the flexibility of treatment when one approach fails to work.…”