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Invagination of elevated lip liner preventing reduction of dislocated total hip.

ABSTRACT: Instability is the most common indication for revision total hip arthroplasty in the United States. Elevated-rim acetabular liners were introduced to minimize the risk of posterior instability. We describe a patient with multiple total hip arthroplasty dislocations secondary to component subsidence leading to instability. As the patient initially refused revision of his femoral component, he was treated with an elevated-rim acetabular liner. When this too dislocated, the hip could not be reduced concentrically. During operative exposure for a stem revision, the lipped aspect of the liner was found to have folded into the acetabulum thus preventing concentric reduction of the head. We conclude that invagination of the elevated lip of a polyethylene liner should be considered when concentric reduction of a dislocated hip proves difficult.

SUBMITTER: Ordaz A

PROVIDER: S-EPMC7083719 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Invagination of elevated lip liner preventing reduction of dislocated total hip.

Ordaz Angel A Schirmers Joseph J Bini Stefano S

Arthroplasty today 20200107 1

Instability is the most common indication for revision total hip arthroplasty in the United States. Elevated-rim acetabular liners were introduced to minimize the risk of posterior instability. We describe a patient with multiple total hip arthroplasty dislocations secondary to component subsidence leading to instability. As the patient initially refused revision of his femoral component, he was treated with an elevated-rim acetabular liner. When this too dislocated, the hip could not be reduced ...[more]

PMID: 32211469

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Project description:Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an opiate/benzodiazepine combination has been employed. The use of other pharmacologic agents, such as etomidate and propofol, have more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes, including recovery times, of these 3 sedation agents.We performed a retrospective chart review examining 198 patients who presented with dislocated total hip arthroplasty at 2 academic affiliated medical centers. The patients were grouped according to the type of sedation agent. We calculated percentages of reduction and sedation complications along with recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. We then compared the data for each sedation agent.We found reduction complications rates of 8.7% in the propofol, 24.7% in the etomidate, and 28.9% in the opiate/benzodiazepine groups. The propofol group was significantly different from the other 2agents (p ≤ 0.01). Sedation complications were found 7.3% of the time in the propofol , 11.7% in the etomidate , and 21.3% in the opiate/benzodiazepine group, (p=0.02 propofol vs. others) . Average recovery times were 25.2 minutes for propofol, 30.8 minutes for etomidate, and 44.4 minutes for opiate/benzodiazepine (p = 0.05 for propofol vs. other agents).For reduction of dislocated total hip arthroplasty under procedural sedation, propofol appears to have fewer complications and a trend toward more rapid recovery than both etomidate and opiate/benzodiazepine. These data support the use of propofol as first line agent for procedural sedation of dislocated total hip arthroplasty, with fewer complications and a shorter recovery period.

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Invagination of elevated lip liner preventing reduction of dislocated total hip.

Publications

Invagination of elevated lip liner preventing reduction of dislocated total hip.

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