title: Predictors and outcomes of treatment in hip hemiarthroplasty dislocation.
abstract: BACKGROUND
  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.
authors.affiliation: Nottingham University Hospitals NHS Trust, UK.
authors.forename: K M I
authors.initials: KM
authors.lastname: Salem
authors.forename: O A
authors.initials: OA
authors.lastname: Shannak
authors.forename: B E
authors.initials: BE
authors.lastname: Scammell
authors.forename: C G
authors.initials: CG
authors.lastname: Moran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006617:Hip Dislocation / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007432:Intraoperative Period; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome