Failure of Closed Reduction After Dislocation of Austin Moore Hemiarthroplasty: An Analysis of Risk Factors A 6-Year Follow-Up Study

Department of Orthopedics Ysbyty Gwynedd, Bangor North Wales, United Kingdom.
The Journal of arthroplasty (Impact Factor: 2.67). 08/2009; 25(5):781-4. DOI: 10.1016/j.arth.2009.04.035
Source: PubMed


The aim of this study was to determine the factors associated with failure of closed reduction of dislocated Austin Moore hemiarthroplasty for subcapital neck of femur fracture. There were 44 (1.8%) cases of dislocation for a 6-year period. There were 28 females and 12 males, and mean age was 85.6 years. Thirty-two patients (80%) had redislocations, and 13 patients (40%) required 2 or more closed reductions. Twenty-eight patients subsequently had a Girdlestone arthroplasty. Dementia and a previous failed closed reduction were associated with a higher failure rate (P = .03 and .04, respectively). Failed close reduction patients also had a higher 6-month mortality rate (P = .04). Closed reduction after Austin Moore hip dislocation has a higher failure rate significantly in patients with dementia and are associated with a higher mortality rate. We believe closed reduction should be avoided in these groups of patients, and Girdlestone procedure was considered after initial first dislocation.

9 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dislocation is a frequent and costly complication of hip arthroplasty. The purpose of this study was to assess the financial impact on the treating institution of this complication in patients with primary hemiarthroplasty (HA), total hip arthroplasty (THA) and revision surgery (RTHA). Between October 2001 and August 2009, 2014 consecutive hip arthroplasties were performed at our institution, of which 87 (18 HA, 44 THA and 25 RTHA) dislocated within 6 weeks of the primary operation. The average cost of treating implant dislocation by closed reduction, open reduction or revision was assessed and expressed as a percentage cost increase compared to an uncomplicated procedure. Of the 87 dislocated implants all needed one or more closed reductions and 52 eventually required revision surgery. An early dislocation increased the cost of HA, THA and RTHA by 472%, 342% and 352%, respectively.
    No preview · Article · Feb 2012 · Hip international: the journal of clinical and experimental research on hip pathology and therapy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Dislocation following hip hemiarthroplasty (HHA), its incidence, predictors, treatment outcomes and mortality were investigated in a single centre series. Methods: The prospectively collected data on neck of femur fracture admissions compiled over 11 years were reviewed. Place of residence, place of fall, past medical history, intraoperative factors (grade of surgeon, delay in surgery, type of implant and operative time), postoperative complications and mortality were compared between patients who suffered a dislocation and those who did not. In the dislocation group, the mean number of dislocations, reduction method, type and fate of implant, and mortality were investigated. Results: Prospective data on 8,631 admissions were collected; 41% of these were managed with a HHA. The dislocation rate was 0.76%. A delay in surgery of >24 hours was associated with a fourfold increase in the dislocation risk. The majority (81%) of dislocations occurred in the first six weeks and closed manipulation was the definitive treatment in only 23% of the cases. The mortality rate was not increased following HHA dislocation. Conclusions: The delay in surgery was the most important predictor of HHA dislocation. Closed reduction was associated with a high failure rate. While an initial attempt at closed reduction for a first dislocation is recommended, for redislocators, we recommend early exploration/revision as an alternative to repeat manipulations.
    Full-text · Article · Sep 2014 · Annals of The Royal College of Surgeons of England
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Dislocating hip prosthesis remains a substantial clinical problem. The aim of this study is to describe the risk of recurrent instability after a primary dislocation of primary hip arthroplasty performed for osteoarthritis (OA) or femoral neck fracture (FNF). Methods: Seventy patients (male/females: 25/45; mean age 77 [range 46-94]) with dislocating hip arthroplasties were included in a prospective cohort study and followed for four years. Radiographs and all surgical records were reviewed. We compared stable hips to those who either continued to dislocate or were revised due to recurrent instability (unstable group). Results: Forty-two hips (60 %) had episodes of recurrent instability leading to repeated closed reductions or major revision surgery and were classified as unstable. A diagnosis of FNF and cognitive dysfunction (OR 9.3 [95 % CI 1.4-64.1]) or postoperative radiological discrepancies such as leg-lengthening and offset reduction increased the risk of further instability (OR 13.5 [95 % CI 1.3-148.1]). The surgical approach at primary surgery and ASA class did not significantly influence the risk of continued instability. Conclusions: Patients with a FNF and cognitive dysfunction or with sub-optimal postoperative radiographs after hip arthroplasty surgery are at high risk of recurrent instability after a primary dislocation. For hip fracture patients, all efforts should be made to avoid the first dislocation.
    Full-text · Article · Nov 2014 · International Orthopaedics