Anesthetic Strategies for Closed Reduction of Dislocated Total Hip Arthroplasty: A Scoping Review

BACKGROUND: Total hip arthroplasty (THA) is a frequently performed orthopedic procedure, with dislocation being a common complication, often requiring closed reduction. Anesthetic strategies for this vary, and evidence on the efficacy, safety, and cost-effectiveness of current strategies is limited. The aim of this review was to synthesize the existing literature on anesthetic strategies for closed reduction of dislocated THA to identify best practice, organizational challenges and potential knowledge gaps.

METHODS: A scoping review was designed and conducted in accordance with current scoping review guidelines. Following a systematic literature search, two independent authors screened studies for eligibility and extracted data on key outcomes including procedural success, anesthetic techniques, hospital setting, intraprocedural complications, and resource use.

RESULTS: Fifty-seven studies were included with no randomized controlled trials being identified. Case reports, case letters, literature reviews, group interviews, and survey studies were excluded due to risk of selection bias, resulting in 22 remaining studies. Median closed reduction success rate was 81% (IQR 77%-92%) for sedation and 95% (IQR 60%-96%) for general anesthesia. Sedation in the emergency department with propofol had higher reduction success rates than sedation with other drugs. However, inconsistent definitions, variation in the use of anesthetic drugs and dosing, and small sample sizes limited comparability between studies. Time from admission to procedure was 2.25 h (IQR 2.0-2.95) for sedation and 7.6 h (IQR 5.3-9) for general anesthesia. Length of stay was 1.09 days (IQR 0.84-1.31) for sedation and 3 days (IQR 1.3-3.4) for general anesthesia. Complications were infrequently and inconsistently reported.

CONCLUSION: A wide range of anesthetic strategies for reduction of dislocated THA were evaluated, with success rates varying considerably across studies. This review demonstrates a substantial gap in the literature regarding the anesthetic management of closed reduction of dislocated THA. High-quality evidence is needed to inform and balance patient-relevant outcomes.

EDITORIAL COMMENT: This scoping review presents an updated exploration of the considerations and alternatives for anesthetic management of cases for closed reduction of hip arthroplasty dislocation and closed reduction.