PT  - JOURNAL ARTICLE
AU  - Leonoor Neline Tess Oerlemans
AU  - Wierd P Zijlstra
AU  - Heleen Lameijer
AU  - Constant W Coolsma
TI  - Is a hip flip the right trick?
AID  - 10.1136/emermed-2019-208932
DP  - 2019 Oct 18
TA  - Emergency Medicine Journal
PG  - emermed-2019-208932
4099  - http://emj.bmj.com/content/early/2019/10/18/emermed-2019-208932.short
4100  - http://emj.bmj.com/content/early/2019/10/18/emermed-2019-208932.full
AB  - Clinical introduction A 68-year-old man, with known spasticity and a total left hip arthroplasty (THA) performed 6 years ago, was brought to our ED after falling down the stairs. Laying on the stretcher, his left leg was internally rotated and in hyperflexion. An X-ray of the left hip was performed. The diagnosis of posterior hip dislocation was made (figure 1). The patient received sedation and analgesia with 75 mg propofol and 9 mg esketamine intravenously, and a closed reduction procedure was attempted using manual flexion, adduction, traction and internal rotation. Unfortunately, the reduction failed.Figure 1 The patient’s X-ray.Question Why is closed reduction not effective in this case?The femoral head is located more cranially expected, due to material failure. The whole THA should be replaced.This is an anterior dislocation. The closed reduction procedure should be performed by using extension, abduction, traction and internal rotation.The femoral head is not reduced centrally in the acetabulum and the closed reduction procedure should be repeated more forcefully.A dual-mobility cup is used and the liner is not in place anymore. Revision surgery is required.For answer see page 2