title: Closed reduction of a dislocated constrained total hip arthroplasty using a novel technique with a PEG board.
abstract: This article describes a case of closed reduction of a dislocated total hip arthroplasty (THA) out of a constrained acetabular liner using a novel technique with a peg board secured to the operating table.A 79-year-old woman sustained multiple dislocations after a primary THA. She was converted to a constrained liner and sustained no further dislocations for 5 years. She presented after dislocating her hip while getting out of a chair. The patient was taken to the operating room, placed under general anesthesia, and laid supine on the operating table, to which a peg board had been previously securely attached. A padded perineal post was placed in the patient's groin into the peg board. Under fluoroscopy, in-line traction was applied to the right leg until the femoral head was perched on the acetabular liner. With internal rotation and pressure over the trochanter, the femoral head was reduced.This technique requires less set-up time than using a fracture table. It also securely stabilizes the patient without skilled assistants during longitudinal traction. Moreover, if closed reduction fails, the patient can be rapidly placed in the lateral decubitus position for open reduction or revision arthroplasty. Successful closed reduction of a dislocated constrained liner turns an emergent case into an elective case if revision arthroplasty is indicated. This technique can also be easily used for the more common reductions of dislocated nonconstrained THAs.
authors.affiliation: Triangle Orthopaedics Associates, Durham, North Carolina 27704, USA. jflint@triangleortho.com
authors.forename: John H
authors.initials: JH
authors.lastname: Flint
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007103:Immobilization / Q000295:instrumentation* / Q000379:methods*; D011475:Prosthesis Failure; D011859:Radiography; D014143:Traction / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome