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Door to relocation time for dislocated hip prosthesis: multicentre comparison of emergency department procedural sedation versus theatre-based general anaesthesia
  1. J Gagg1,
  2. L Jones1,
  3. G Shingler2,
  4. N Bothma3,
  5. H Simpkins4,
  6. S Gill5,
  7. J Benger6,
  8. G Lloyd1
  1. 1
    Emergency Department, Royal Devon and Exeter Hospital, Exeter, UK
  2. 2
    Emergency Department, Frenchay Hospital, Bristol, UK
  3. 3
    Emergency Department, Derriford Hospital, Plymouth, UK
  4. 4
    Emergency Department, Musgrove Park Hospital, Taunton, UK
  5. 5
    Emergency Department, Bristol Royal Infirmary, Bristol, UK
  6. 6
    Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Dr G Lloyd, Emergency Department, Royal Devon & Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK; gavin.lloyd{at}


Background: Dislocation of a hip prosthesis is a painful event which has an incidence of 4% for primary total hip arthroplasty. Relocation is traditionally performed under general anaesthesia in the operating theatre, but relocation using sedation in the emergency department (ED) has been reported, with a limited success rate of 62%. A study was undertaken to compare door to relocation times for ED sedation and theatre general anaesthesia.

Methods: The notes of all patients attending five centres in the south west of England with prosthetic hip dislocation over a 12-month period between 2005 and 2006 were retrospectively reviewed using standardised data collection forms.

Results: Successful ED reduction was significantly quicker than failed ED reduction and theatre-based general anaesthesia (2 h 21 min vs 8 h 32 min; p<0.001). No statistical difference was found between failed ED reduction and theatre general anaesthesia.

Conclusions: Reduction of dislocated hip prostheses in the ED saves nearly 6 h compared with theatre-based general anaesthesia and is therefore advocated.

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  • Competing interests: None declared.

  • Ethics approval: The local research ethics committee did not require formal review of this study.

  • Contributions: JG collated and analysed the raw data and co-wrote the paper. GS, NB, HS and SM collected the data from their respective emergency departments. LJ and JB advised and helped supervise the study; JB edited the paper. GL had the original idea, supervised the study, co-wrote the paper and acts as guarantor.

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