title: Dislocation of a total hip arthroplasty: acute management in the ED.
abstract: Dislocation is one of the most common complications of total hip arthroplasty (THA). Because of the growing number of patients undergoing THA annually and the immense number of patients who have previously undergone the procedure, familiarity with the diagnosis and treatment of this complication is critical. Although the most common direction of dislocation is posterior, anterior dislocations do occur, and correctly identifying the direction of dislocation is important before attempted closed reduction as both the reduction maneuvers used and the postoperative instructions afterward are distinct for an anterior as opposed to a posterior dislocation. We present the current case of an anterior hip dislocation that was unable to be closed reduced as the direction of dislocation was presumed to be posterior. Although a shoot through lateral is recommended in all cases to confirm the direction of dislocation, we highlight how the physician can differentiate the direction of dislocation based on the position of the foot and location of the lesser trochanter on the anteroposterior radiograph.
authors.affiliation: Division of Adult Reconstruction, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL 60611. Electronic address: yale.fillingham@gmail.com.
authors.forename: Yale A
authors.initials: YA
authors.lastname: Fillingham
authors.affiliation: Division of Adult Reconstruction, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL 60611.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Division of Adult Reconstruction, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL 60611.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Cvetanovich
authors.affiliation: Division of Adult Reconstruction, Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 W Harrison St Suite 300, Chicago, IL 60611.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Della Valle
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D005260:Female; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography