What is the initial step in troubleshooting a dislocation after hip arthroplasty in the operating room?

• A. Proceed directly to revision surgery
• B. Open reduction in the operating room
• C. Attempt closed reduction if permissible
• D. Reassess after imaging and delay management

Answer: (C)

The key step is to attempt a closed reduction under anesthesia with imaging guidance in the operating room. This noninvasive maneuver aims to restore the joint surface without opening the joint, using controlled traction and directional manipulation while fluoroscopy confirms realignment. If the reduction is successful and the components appear stable, you can reassess alignment and soft-tissue tension to ensure there’s no ongoing impingement or instability. Only if closed reduction fails or if imaging or intraoperative assessment suggests a mechanical obstacle—such as a malpositioned component, interposed tissue, periprosthetic fracture, or a loose/reinforced implant—should you move to open reduction or revision. This approach minimizes unnecessary surgery and quickly addresses the dislocation when feasible.