Hip and prosthetic dislocation presenting to emergency department of Tan Tock Seng Hospital
Tan, Xuan Hao
Date of Issue2017-08-31
Lee Kong Chian School of Medicine (LKCMedicine)
Introduction: Native and prosthetic hip dislocations are emergencies. With an ageing society that is living longer, the increased incidence of hip fracture and resultant prosthetic implantation has led to a rise in prosthetic dislocations. This study will compare patients with hip and prosthetic dislocations presenting to Tan Tock Seng Hospital (TTSH) Emergency Department (ED). Methods: A retrospective review was conducted of hip and prosthetic dislocations between 1 Jan 2011 and 31 Dec 2015. Patients below 21 years old were excluded. Using descriptive and summary statistics, these factors were compared: demographics, previous dislocations, aetiology, injury pattern, severity, ED and inpatient management, and complications. Results: Fifty-nine patients (50.8% women) contributed to 81 ED encounters. The ratio of hip to prosthetic dislocation was approximately 1:1. Mean age of women (64.9 years) was significantly higher (p=0.01) than men (51.8 years). A higher proportion (p<0.01) of women (76.6%) had prosthetic dislocation compared to men (44.1%). Conversely, a higher proportion (p<0.01) of men (55.9%) had native dislocation than women (23.4%). Native and prosthetic dislocations were caused by high-energy and lowenergy transfer events respectively. Of the 59 patients, 29 had native dislocation, 17 had first prosthetic dislocation and 13 had recurrent prosthetic dislocation, accounting for 34 ED encounters that ranged from 2 to 6 dislocations/patient. Mean age of recurrent prosthetic dislocations was 75.3 years (SD 12.3) and women outnumbered men by 1.6:1. Median hospitalisation duration for native, prosthetic and recurrent prosthetic dislocations were 5 days (IQR 3.25-7.5), 1.5 days (IQR 1-5.25) and 1 day (IQR 1-2) respectively. Conclusion: Native hip dislocations secondary to high-energy transfer events were commoner in younger men who required longer hospitalisation. First and recurrent prosthetic dislocations secondary to low-energy transfer events were commoner in elderly women who needed short hospitalisation and hence potential for 24-hour admission should be explored for this group.
Final Year Project (FYP)