Prosthetic hip dislocations: Is relocation in the emergency department by emergency medicine staff better?

Abstract

There was no difference between EM and orthopaedics in the proportion of hips successfully relocated or complications in the ED; however, EM patients were discharged much sooner, with important resource implications. Procedures carried out in the OT were more successful than in the ED but resulted in prolonged hospital stays and were associated with more complications.

Fast-track pathway for reduction of dislocated hip arthroplasty reduces surgical delay and length of stay

“…However, sedation in the ER can lead to “oversedation” and airway obstruction, and has a lower success rate than reduction under general anesthesia in the OR ( Frymann et al 2005 ; Dela Cruz et al 2014 ). In the present study, we found a mean surgical delay of 2.5 h for fast-track cases, which is comparable to surgical delay times achieved for hip arthroplasty reduction in the ER reported by several authors ( Frymann et al 2005 ; Gagg et al 2009 ; Lawrey et al 2012 ). Surgical delay for both the fast-track pathway cases and the regular pathway cases in our study was shorter than what has been reported previously for surgical delay until reduction in the OR ( Frymann et al 2005 , Wan et al 2008 , Gagg et al 2009 ).…”

“…This is possibly due to the large variation in logistic setup between different institutions: some dislocations are reduced in the ER, while others are admitted to the hospital and reduced in the OR under general anesthesia. The LOS following the fast-track pathway for reduction of a dislocated hip arthroplasty reported in our study was shorter than the LOS reported by Lawrey et al (2012) for patients reduced in the OR, and it was similar to the LOS for dislocations reduced by orthopedic service doctors in the ER.…”

“…Even so, early reduction is recommended, to minimize the risk of neurological and vascular complications—and also pain and discomfort for the patient ( Zahar et al 2013 ). Several authors have therefore proposed immediate reduction in the ER under sedation ( Frymann et al 2005 , Gagg et al 2009 , Lawrey et al 2012 ). However, sedation in the ER can lead to “oversedation” and airway obstruction, and has a lower success rate than reduction under general anesthesia in the OR ( Frymann et al 2005 ; Dela Cruz et al 2014 ).…”

“…Similar results have been reported by Pedersen et al (2008) , who showed an optimized program for hip fracture patients to reduce both LOS and in-hospital complications postoperatively. Few studies have investigated LOS following a dislocated hip arthroplasty ( Lawrey et al 2012 , Frymann et al 2005 ). This is possibly due to the large variation in logistic setup between different institutions: some dislocations are reduced in the ER, while others are admitted to the hospital and reduced in the OR under general anesthesia.…”

“…In particular, reduced surgical delay for hip fracture patients has been a priority, as it reduces the mortality risk ( Shiga et al 2008 , Daugaard et al 2012 ). While surgical delay has been investigated for other groups of fracture patients ( Streubel et al 2011 , Menendez and Ring 2014 ), there have not been any similar investigations regarding reduction in surgical delay for dislocated arthroplasties, except comparing reduction at the emergency department to admission and reduction in theater ( Frymann et al 2005 , Gagg et al 2009 , Lawrey et al 2012 ).…”