Once you have determined that a prosthetic hip has dislocated, you’ll have to decide if it’s safe to reduce the dislocation. The only contraindication to reduction is if there is a fracture. In that case, you’ll need to consult a specialist.
Similarly, if the patient is not a good candidate for procedural sedation, you should defer to anesthesiology and orthopedic surgery.
Sedation for a prosthetic hip reduction
Reduction of a prosthetic hip is a painful procedure, and you’ll need to use propofol for sedation. Alternatively, you can perform an ultrasound-guided fascia iliaca block (learn how to do this in Medmastery's Ultrasound-Guided Nerve Block Masterclass).
Procedure for reducing a prosthetic hip dislocation
Strangely enough, the doctor’s positioning when performing this reduction resembles the classic pose of the pirate on Captain Morgan’s rum label.
Just in case you're not familiar with Captain Morgan, here's a step-by-step description of how you would position your patient for a prosthetic hip reduction:
- While your patient is sedated and lying on their back, have an assistant hold their pelvis down toward the bed (or strap the patient down firmly with buckles or a bed sheet). This will prevent the hip from lifting during the procedure.
- Lift the patient’s dislocated leg and place your knee under the patient’s knee (Captain Morgan stance).
- Push your knee up and internally and externally rotate the patient’s hip.
- At the same time, apply downward pressure on the patient’s distal tibia with your hand.
You’ll feel a clunk when the hip is reduced. You should confirm the reduction with a post-procedure x-ray.
Finally, place a knee immobilizer on the patient's knee to limit hip motion and prevent another dislocation. Patients will need to follow up with an orthopedist and arrange for physiotherapy after the reduction.
That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a free trial account, which will give you access to free videos and downloads. We’ll help you make the right decisions for yourself and your patients.
- Hendey, GW and Avila, A. 2011. The Captain Morgan technique for the reduction of the dislocated hip. Ann Emerg Med. 58: 536–540. PMID: 21839540
- Roberts, J. 2019. “Management of common dislocations”. In: Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th edition. Philadelphia: Elsevier.