Dislocated Hip

A hip dislocation causes severe pain and joint deformity and swelling.

• Hip dislocations are an abnormal repositioning of the ball and socket hip joint. There are many types of hip dislocations.
• Large-force trauma to the hip is the major cause of hip dislocations.
• Rick factors include any exposure to trauma, usually blunt trauma, as may occur in auto accidents, and certain sports.
• Symptoms and signs of a dislocated hip is acute severe pain in the hip and/or associated structures, an inability to walk or move one's leg, and possible numbness, tingling, bruising, and swelling.
• Doctors may use X-rays, CT, and MRI to diagnose the extent of a hip dislocation. An orthopedist should be consulted.
• Avascular necrosis, arthritis, myositis ossificans, and muscle and/or gait problems may occur as complications.
• The recovery time may be about 3-4 months in athletes, but each individual will have different recovery times. Prognosis vary from person to person.
• The risk of hip dislocation may be reduced by avoiding falls, wearing protective sports gear, and living a healthy lifestyle.

Hip dislocations are either anterior or posterior repositioning of the femoral head in relation to the acetabulum of the pelvis (repositioning of the ball-and-socket hip joint) with the majority being traumatic posterior dislocations. Some dislocations may be termed partial, and a few may be bilateral. There are several types (Thompson-Epstein, Steward and Miford, for example) based on radiographic findings or functional hip stability. Congenital hip displacement occurs when abnormal formation of the hip joint occurs. Because hip dislocations usually require a significant force, related injuries need to be considered as well.

The most common cause of hip dislocations is due to large-force trauma to the hip joint such as seen in car accidents or pedestrians struck by a car. Athletic events that can result in large-force impacts like football, rugby, skiing, and many others may result in hip dislocations.

Risk factors, in general, are related to exposure to large-force energy (blunt trauma usually). Risk factors include automobile accidents and participation in athletic events that may include football, race car driving, equestrian sports, rugby, gymnastics, water and/or snow skiing, and many others.

The usual symptom and signs are acute severe pain in the hip (joint pain) and/or upper leg after a large-force trauma to the hip. Pain may also occur in the knee, lower leg, and/or back. In addition, the individual usually cannot walk or move their leg. Numbness and/or tingling in the leg may occur with neurological damage. Bruising and swelling may begin.

The imaging studies used to diagnose hip dislocations may be determined by the orthopedist and/or emergency medicine physicians. Consultation with an orthopedic surgeon is encouraged. Recommended radiographs are AP, lateral, internal, and external oblique views of the hip joint. In addition, additional studies such as CT and /or MRI are usually requested to help decide if a closed reduction or surgical intervention is needed (for example, a Ganz surgical procedure). Imaging studies will also determine if there are related fractures. Internal bleeding needs to be considered and ruled out.

Treatment options for hip displacement are dependent on each patient's condition and may range from closed reduction to hip replacement. The quicker reduction of the joint (within 6 hours of injury), the better chance for recovery without major complications. Some patients may require surgery to reduce or replace the hip joint. Pain reduction and rehabilitation are also important treatments.

Complications of hip dislocation can be severe and long term: avascular necrosis, arthritis, myositis ossificans (abnormal bone growth in muscle), labral (cartilage) tears, permanent shortening of muscle, muscle weakness, physical deformity of hip/leg, and gait problems (abnormalities walking). Hip dislocation after hip replacement is rare, but the risk is highest in the first few months after replacement surgery.

The prognosis for a dislocated hip depends on each individual's condition and is related to how fast the hip is reduced and how well a person does their rehabilitation program. Some athletes may begin running in 6-8 weeks and return to sports within 3-4 months. However, each person is different and may require longer time for recovery. However, about 50% of patients with a dislocated hip will develop arthritis in it over time.

Risk of hip dislocation can be reduced by avoiding falls, wearing protective gear in sports, staying physically active, and sustaining a healthy weight.