Outcomes of the dislocated hip hemiarthroplasty: a multi-centre study

Abstract

Introduction: Hip hemiarthroplasties are performed in medically frail and/or comorbid patients who sustain a displaced intracapsular hip fracture. Dislocations occur in approximately 0.6-5.0% patients and are associated with worse outcomes, including mortality when compared against a similar cohort of patients who do not suffer a dislocation of their hemiarthroplasty.This study aimed to quantify the outcomes from the management of dislocated hip hemiarthroplasties in a cohort of contemporaneously used implants and the associated 1-year mortality.

Methods: A retrospective review of a prospectively collected database of 4116 consecutive patients treated with a cemented hip hemiarthroplasty, in which 63 dislocations were identified was performed.The outcomes of the management of each dislocation were quantified, including the number of dislocations sustained after a preceding successful closed reduction. 1-year mortality was ascertained and stratified for each treatment option.

Results: 63 patients with a dislocation of a cemented hip hemiarthroplasty performed for an intracapsular hip fracture were included. Closed reduction was unsuccessful in 72% of (31/43) patients who had a closed reduction of their first dislocation. Failure rates of a second closed reduction increased to 76.9% and 100.0% with a third closed reduction.1-year mortality rate after a dislocation was 46.0% for all patients and lowest in the cohort of patients who were treated with a revision arthroplasty (27.3%).

Conclusions: Closed reduction of dislocated hip hemiarthroplasty is associated with a high failure rate, especially after a second dislocation. Consideration should be made to perform a revision procedure after a second dislocation with a high suspicion for soft tissue repair failure and/or infection.

Keywords: Dislocation; hemiarthroplasty; hip fracture; mortality; outcome.