Hip Dislocation

What is a hip dislocation?

A hip dislocation is when the ball of the femur is forced out of the acetabulum socket. There are two main types of hip dislocations. Ninety percent of cases are posterior dislocations, in which the head of the femur is forced backward. Ten percent of cases are anterior dislocations, in which the head of the femur is forced forward.

Symptoms include severe, sudden-onset pain in the affected leg, pain that is worse when this leg is moved, an inability to bear weight on the leg and an appearance that the leg is shorter. Numbness, tingling, and weakness throughout the affected leg are also likely.

Treatment options will include measures to make sure you are stable, such as IV fluids, blood transfusion, or antibiotics, either closed or open reduction to put the hip back into its proper position, as well as rest and physical therapy.

You should seek immediate medical care at an urgent care clinic or ER. A doctor will confirm the diagnosis with X-Ray or CT imaging, and if confirmed, you will be admitted to the hospital to have complete bed rest. Surgery is usually advised to stabilize the slipped bone and prevent it from moving further.

Hip dislocation symptoms

Main symptoms

Most people with a hip dislocation will develop pain described by the following details.

• Severe, sudden-onset pain
• The pain will be worse when the leg is moved
• No weight-bearing: You are usually not able to bear any weight on the affected leg because of the pain.

Types of dislocations

Some people with a hip dislocation may notice an abnormal position of the leg on the side of the hip dislocation. The affected leg will often appear shorter than the other leg.

• Posterior dislocations: In posterior dislocations, in which the head of the femur is forced backward out of the socket, the leg may be bent forward at the hip, directed toward the midline of the body, and rotated inward so that the knee and foot turn toward the other leg.
• Anterior dislocations: In anterior dislocations, in which the head of the femur is forced forward out of the socket, the leg may be bent forward at the hip, directed outward away from the midline of the body, and rotated outward so that the knee and foot turn away from the other leg.

Other symptoms

In some cases, people with a hip dislocation may experience numbness, tingling, or weakness in the leg or foot on the side of the hip dislocation. This may occur because the nerves that supply the leg and foot were damaged by the hip dislocation. The most common nerve to be injured is a large nerve, the sciatic nerve, which is injured in about 10% of cases. Injury to this nerve may cause an inability to move the foot and ankle and numbness over the lower leg and foot.

Hip dislocation causes

Most hip dislocations are caused by trauma to the hip, although in some cases, abnormal development of the hip joint can lead to hip dislocations.

Trauma to the hip

The most common cause of hip dislocations is trauma to the hip. An injury usually must be of sufficient energy to cause a hip dislocation. A common cause is motor vehicle collisions, particularly when the knee hits the dashboard during a sudden stop, also known as a “dashboard dislocation.” The force is transmitted up the leg and forces the hip out of the socket. A fall from a significant height can also generate enough force to cause a hip dislocation.

Developmental dysplasia of the hip

Developmental dysplasia of the hip refers to a set of conditions in which the hip joint does not develop properly in infants and young children. This results in an unstable hip joint that is prone to developing a hip dislocation.

Treatment options and prevention for hip dislocation

When a hip dislocation is suspected, the doctor will usually first order imaging studies to confirm the diagnosis of hip dislocation and look for other injuries that may have also been caused by the trauma, such as fractures in the femur or pelvic bone. Once imaging has been done, the doctor may recommend various treatments to fix the dislocation and assist in long-term recovery. Pain management is typically addressed with NSAIDs like ibuprofen or acetaminophen to reduce pain and inflammation.

IV fluids, blood transfusion, and antibiotic medications

If you develop a hip dislocation after a trauma, the treatment team will usually first make sure you’re stable. Depending on the severity of the trauma and the nature of the injury, treatment may include IV fluids, blood transfusion if there is significant bleeding, and antibiotic medications to prevent the development of an infection.

Closed reduction without surgery

In cases of hip dislocation with no other injuries, including no fractures and no injuries to nerves or blood vessels, the doctor may recommend a closed reduction without surgery. In a closed reduction, the doctor administers anesthesia and then manipulates the joint to put the bones back into their normal place. After a closed reduction, the doctor may order another imaging test to ensure the bones are in the proper position.

Open reduction with surgery

In cases of hip dislocation with other associated injuries, such as fractures of the femur or pelvis bone or injuries to the nerves or blood vessels, the doctor may recommend an open reduction. In an open reduction, you are taken to the operating room and placed under anesthesia, and the bones are placed in their normal position using surgery. During surgery, the surgeon can also fix other fractured bones and remove fragments of bone that may be broken off.

Rest and physical therapy

After the hip dislocation has been reduced (the bones placed back in their normal position), it may take two to three months for the hip to heal, or longer if there are other associated injuries such as fractures. After that, your doctor will likely recommend:

• Rest: For the first few weeks after the hip dislocation, the doctor may recommend limiting movement of the hip to prevent the hip from dislocating again.
• Physical therapy: This is usually recommended to develop a plan to regain function in the hip during and after recovery.

When to seek further consultation for hip dislocation

If you experience severe hip pain or inability to move the leg

If you experience any symptoms of hip dislocation after trauma, such as severe hip pain, an inability to move the leg, or numbness or tingling in the leg or foot, you should go to the emergency room or call an ambulance. A hip dislocation from trauma is a medical emergency that should be treated immediately, ideally within six hours.

If you are involved in a high-energy trauma with damage to the legs

If you are involved in a high-energy traumatic incident such as a motor vehicle collision or a fall from a significant height that involves injury to your hip or legs, you should consider going to the emergency room or calling an ambulance, even if you do not think you have the symptoms of hip dislocation. You may have experienced a hip dislocation with minimal symptoms or other associated injuries that require treatment. Your healthcare team can order imaging tests to determine the extent of your injuries and recommend the appropriate treatments.