Hip Reduction Techniques

1. HIP
REDUCTION
TECHNIQUE
DR. S. A. MEDWAY
1ST JUNE 2017

2. THE PROBLEM
Congenital/Paed Dislocated Hips
Dislocated THRs
- Charlies Patients
- Perhaps 5% of Primary THR
- Up to 30% of Revision THR
- Beware Constrained Liner THR!
- Metal ring around acetabular component
- Need reduction in OT
Dislocated Native Hips
- High Energy Trauma
Dislocated Hip Resurfacing
- Call for Help

4. CONSIDERATIONS
- Primary survey
- Other injuries
- Make the diagnosis
- Diagnose any complications
- Procedural sedation
- Timing

5. MAKE THE DIAGNOSIS
Posterior Dislocation 90%
- Mechanism: FLEXION, ADDUCTION, INTERNAL ROTATION
- Xray: Small Femoral Head, Lesser Trochanter less prominent
- Usually from posterior approach operation (look for scar)
Anterior Dislocation
- Mechanism: EXTENSION, ABDUCTION, EXTERNAL
ROTATION
- Xray: Large Femoral Head, Lesser Trochanter more
prominent
- Usually from anterior approach operation (becoming more
common)

6. GENERAL PRINCIPLES
Like ALL Dislocations
- Stop opposing forces
- Traction & Countertraction
- Restore the anatomy by re-opposing the joint surfaces

7. GET THE FORCES RIGHT
(POSTERIOR DISLOCATION)

8. TECHNIQUE 1
(THE BEST)
ALLIS TECHNIQUE

9. TECHNIQUE 1
(THE BEST)
ALLIS TECHNIQUE
(WADDELL VARIANT)

10. TECHNIQUE 1
(THE BEST)
ALLIS TECHNIQUE
Allis Video
https://www.youtube.com/watch?v=W89jgZbeBEc&t=141s

11. TECHNIQUE 2
CAPTAIN MORGAN

12. TECHNIQUE 2
CAPTAIN MORGAN
Captain Morgan Video
https://www.youtube.com/watch?v=HlMVx-ZWOQg

13. TECHNIQUE 3
WHISTLER

14. TECHNIQUE 3
WHISTLER
Whistler Video
https://www.youtube.com/watch?v=UxUhW4Zac74

15. TECHNIQUE 4
EAST BALTIMORE LIFT

16. TECHNIQUE 4
EAST BALTIMORE LIFT
East Baltimore Lift Video
https://www.youtube.com/watch?v=ZNP1luk1q-Q

17. TECHNIQUE 5
STIMPSON METHOD

18. TECHNIQUE 5
STIMPSON METHOD
Stimpson Example

19. TECHNIQUES FOR
ANTERIOR DISLOCATION

20. TECHNIQUES FOR
ANTERIOR DISLOCATION

21. POST REDUCTION
Examine
- Neurovascular status
- Joint movements
- Compare medial malleolar heights when leg straight
Image again
- Xray vs. CT Scan
Disposition
- CCT & Home vs. Ortho Ward Admit vs. Ortho Theatre

22. COMPLICATIONS
EARLY
- Sciatic Nerve Injury
- Femoral Nerve Injury
- Femoral Artery Injury
- Fractures
- Knee Injury

23. COMPLICATIONS
LATE
- Avascular Necrosis
- Osteoarthritis
- Instability / Recurrent Dislocation
- Complications of Immobilisation