Variation in care provision for dislocation of hip replacement: a national UK survey

Abstract Background Dislocation is a severe complication after total hip replacement (THR), with multifactorial causes, and characterised by severe pain, reduced quality of life, poorer function and long-term psychological impact. Patients have reported variability in care experience for dislocation, and care provision is unclear. We aimed to understand current care provision for dislocation after THR in the UK, and identify areas for improvement and associated barriers. Methods Between February and May 2024, an online survey of current care practice (local NHS Trust approval reference CAE-158) at UK orthopaedic hospitals was conducted. The survey was sent to healthcare professionals involved in the treatment and management of dislocation across emergency care, orthopaedics and physiotherapy. Data was analysed using Microsoft Excel. Results Responses were received from 46 hospitals (England n = 41; Northern Ireland n = 3; Scotland n = 1; Wales n = 1). Initial treatment for dislocation after hip replacement in most hospitals was closed reduction performed at the emergency department (ED) or in theatre. Most hospitals provided routine orthopaedic follow-up and physiotherapy care after initial treatment. However, care protocols were not standardised, and there was a lack of psychological support provision for patients. Recommendations for improvement included enhancing ED capacity to deliver care, having a standardised care pathway, provision of psychological support for patients, and better communication/access to the orthopaedics care team when dislocations occur. Perceived barriers to optimal care provision included a lack of funding and expertise, limited staff time, a need for staff training and variability in care protocols. Conclusion This survey highlighted a lack of standardisation in care protocols and areas of service improvement, including barriers/facilitators, at the 46 hospitals that participated. Further research is needed to inform the development of a standard care pathway for dislocation after hip replacement. Clinical trial number Not Applicable