The Impact of Closed Reduction Attempts on Survival and Mortality Rates Following Dislocated Hip Hemiarthroplasty in Wales: A Multicentre National Study of 23,031 Patients

Dislocation following a hemiarthroplasty occurs in 2–7% of patients with high associated morbidity and mortality. Our study aims to assess the effect of closed reduction attempts on survival and mortality rates following hemiarthroplasty dislocation. A consecutive series of 23,031 patients treated with hemiarthroplasty for fractured neck of femur in Wales from January 2010 to December 2024. Data was collected retrospectively. 264 patients with a dislocated hemiarthroplasty were included (65 male and 199 female). Mean age at dislocation was 81 years (range 44–101 years). Average time to dislocation was 80 days: 65% (n=172) within 30 days following hemiarthroplasty, and 90% within 90 days (n=237). Only 18% (40/223) of initial closed reduction attempts were successful with no further dislocation. 25% (66/223) had multiple attempts at closed reduction. The overall median survival following dislocation was 603 days, and 12-month mortality was 40.5%. Based on closed reduction attempts preceding definitive management (0/1/>1 attempts): for revision THR median survival was 1973 days (n=15)/1036 days (n=42)/534 days (n=26), 12-month mortality was 46.7%/26.2%/38.5%; for revision hemiarthroplasty median survival was 978 days (n=6)/666 days (n=5)/174 days (n=2) and 12-month mortality was 16.7%/20%/100%; for closed reduction alone median survival for 1 attempt was 828 days (n=40) and 2 attempts was 602 days (n=15) and 12-month mortality was 35% and 26.7% respectively. Our study shows that median survival days decline with an increasing number of closed reduction attempts before definitive management for revision THR and revision hemiarthroplasty. Despite this, 25% of patients had >1 attempt at closed reduction. This highlights the benefits of early decision-making following hemiarthroplasty dislocation.