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The Faculty of Accident & Emergency Medicine Tenth Anniversary Meeting, 13–15 November 2003, Royal College of Surgeons of England, London, WC2A 3PE
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Roderick Little prize session

001 THE REDUCTION OF DISLOCATED HIP PROSTHESES IN THE EMERGENCY DEPARTMENT USING CONSCIOUS SEDATION: A PROSPECTIVE STUDY

S. J. Frymann, G. L. A. Cumberbatch, A. Stearman.A&E Department, Poole General Hospital, Longfleet Road, Poole, Dovset BH15 2JB

Objective: To determine the overall success rate of reduction of dislocated hip prostheses using conscious intravenous sedation in the Emergency Department. To determine the success rate for specific subgroups of these patients and the overall complication rate.

Design: A prospective observational study.

Population: All consecutive adult patients presenting to the Accident and Emergency Department of a District General Hospital from August 2000 to February 2003 with an isolated unilateral dislocation of a prosthetic hip.

Intervention: Attempted reduction of the dislocated hip prosthesis using conscious sedation.

Outcome measures: 1) Overall success rate of attempted reductions. 2) Overall complication rate of the sedation or procedure. 3) Success rate for 3 specific subgroups of patients.

Results: 101 patients were analysed. The overall success rate was 62% (95% CIs 53–71%). There were only 6 complications: 5 related to oversedation of the patient and 1 was a mild foot drop as a result of the procedure. Success rate for first dislocations was 50% (95% CIs 34–66%) compared with 69% (95% CIs 57–79%) for those with recurrent dislocations. The success rate was 82% (95% CIs 52–95%) for grade A dislocations, 54% for grade B (95% CIs 41–66%) and 69% for grade C (95% CIs 53–82%). For those patients presenting within <4 hours the success rate was 65% (95% CIs 54–74%), within 4–8 hours 57% (95% CIs 33–79%) and only 25% (95% CIs 5–70%) for those >8 hours. The mean time to attempted reduction of the joint using conscious sedation was 1.8 hours and for an equivalent group who were excluded and went on to have a general anaesthetic the mean time was 10.9 hours.

Conclusions: Attempted reduction of isolated unilateral prosthetic hip dislocation using conscious intravenous …

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