Prosthetic hip dislocations: Is relocation in the emergency department by emergency medicine staff better
Emergency Medicine Australasia, 04/25/2012
Lawrey E et al. – 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 operating theatre (OT) were more successful than in the ED but resulted in prolonged hospital stays and were associated with more complications.
- Retrospective cohort study of patients presenting to Auckland City Hospital Adult Emergency Department with prosthetic hip dislocations between 1 January 2003 and 14 April 2008.
- Primary outcomes were proportion of successful relocation attempts and length of hospital stay.
- Secondary outcomes were: time to relocation, complications, post-procedural advice, representation rate and long-term outcomes for first-time dislocations.
- There were 410 eligible presentations during the study period.
- Emergency medicine (EM) was successful in 254/323 attempts (79%, 95% confidence interval [CI] 74-83).
- Orthopaedics were successful in 25/35 reductions in the ED (71%, 95% CI 55-84) and 49/51 OT attempts (96%, 95% CI 86-100), P=0.004 for location OT versus ED.
- Median times to discharge were 8.8h for EM, 28.3h for orthopaedics in the ED and 81h for orthopaedics in the OT, P<0.001 for EM versus orthopaedics.
- Mechanical complications of procedures and early redislocations were infrequent.
- Complication of sedation were more often seen in OT compared to ED (23/47 [49%, 95% CI 35-63]vs 37/318 [12%, 95% CI 9-16]).