The Journal of Hip Surgery 2022; 06(03): 143-148
DOI: 10.1055/s-0042-1756273
Case Report

Increased Postoperative Pseudosubluxation after Total Hip Arthroplasty: A Complication Accelerated by the COVID-19 Pandemic

1   Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
James V. Bono
2   Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
› Author Affiliations


The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) has accelerated the utilization of spinal anesthesia for total hip arthroplasty. Subsequently, an increase in postoperative prosthetic subluxation has been noted at our institution. We report on our experience with this complication in six patients. We also reviewed the literature for similar cases and potential risk factors. This complication may be treated by either closed reduction or watchful waiting. However, no modifications to postoperative protocols are necessary.

Publication History

Received: 08 October 2021

Accepted: 07 June 2022

Article published online:
07 September 2022

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  • References

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
  • 2 Sanchez-Sotelo J, Haidukewych GJ, Boberg CJ. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 2006; 88 (02) 290-294
  • 3 Crawford D, Berend K, Morris M. Hip instability. In: Surgery of the Hip. 2nd ed.. North Andover, MA: Elsevier; 2019: 1226-1238
  • 4 Miric A, Kahn B, Waldman B, Sculco TP. Characteristics and natural history of transient postoperative pseudosubluxation after total hip arthroplasty. J Arthroplasty 2000; 15 (06) 736-743
  • 5 Cha YH, Jo WL, Lee YK, Ha YC, Parvizi J, Koo KH. Incidence, risk factors and prognosis of transient pseudosubluxation after total hip arthroplasty. Hip Int 2019; 29 (02) 134-140
  • 6 Weissman DN, de Perio MA, Radonovich Jr LJ. COVID-19 and risks posed to personnel during endotracheal intubation. JAMA 2020; 323 (20) 2027-2028
  • 7 Ibrahim MS, Twaij H, Giebaly DE, Nizam I, Haddad FS. Enhanced recovery in total hip replacement: a clinical review. Bone Joint J 2013; 95-B (12) 1587-1594
  • 8 Basques BA, Toy JO, Bohl DD, Golinvaux NS, Grauer JN. General compared with spinal anesthesia for total hip arthroplasty. J Bone Joint Surg Am 2015; 97 (06) 455-461
  • 9 Turcotte JJ, Stone AH, Gilmor RJ, Formica JW, King PJ. The effect of neuraxial anesthesia on postoperative outcomes in total joint arthroplasty with rapid recovery protocols. J Arthroplasty 2020; 35 (04) 950-954
  • 10 Brull R, MacFarlane A, Chan V. Spinal, epidural, and caudal anesthesia. In: Miller's Anesthesia. 9th ed.. North Andover, MA:: Elsevier; 2019: 1413-1449
  • 11 Wyles CC, Pagnano MW, Trousdale RT. et al. More predictable return of motor function with mepivacaine versus bupivacaine spinal anesthetic in total hip and total knee arthroplasty: a double-blinded, randomized clinical trial. J Bone Joint Surg Am 2020; 102 (18) 1609-1615
  • 12 Lee JH, Lee SI, Lee SC, Choi SR, Rhee WJ. At therapeutic concentration bupivacaine causes neuromuscular blockade and enhances rocuronium-induced blockade. Korean J Anesthesiol 2012; 62 (05) 468-473
  • 13 Tuttle AA, Katz JA, Bridenbaugh PO, Quinlan R, Knarr D. A double-blind comparison of the abdominal wall relaxation produced by epidural 0.75% ropivacaine and 0.75% bupivacaine in gynecologic surgery. Reg Anesth 1995; 20 (06) 515-520
  • 14 Dastane M, Dorr LD, Tarwala R, Wan Z. Hip offset in total hip arthroplasty: quantitative measurement with navigation. Clin Orthop Relat Res 2011; 469 (02) 429-436
  • 15 Domb BG, Chen JW, Kyin C. et al. Primary robotic-arm assisted total hip arthroplasty: an analysis of 501 hips with 44-month follow-up. Orthopedics 2021; 44 (02) 70-76
  • 16 Emara AK, Samuel LT, Acuña AJ, Kuo A, Khlopas A, Kamath AF. Robotic-arm assisted versus manual total hip arthroplasty: Systematic review and meta-analysis of radiographic accuracy. Int J Med Robot 2021; 17 (06) e2332
  • 17 Ng J, Marson BA, Broodryk A. Foot drop following closed reduction of a total hip replacement. BMJ Case Rep 2016; 2016 (Mar): 1-3
  • 18 Mulhall KJ, Masterson E, Burke TE. Routine recovery room radiographs after total hip arthroplasty: ineffective for screening and unsuitable as baseline for longitudinal follow-up evaluation. J Arthroplasty 2004; 19 (03) 313-317