Hip Dislocation

A hip dislocation occurs when the head of the thighbone (femur) slips out of its socket in the hip
bone (pelvis or acetabulum). In approximately 90% of patients, the thighbone is pushed out of its
socket in a backwards direction (posterior dislocation). This leaves the hip in a fixed position,
bent and twisted in toward the middle of the body. The thighbone can also slip out of its socket
in a forward direction (anterior dislocation). If this occurs, the hip will be bent only slightly, and
the leg will twist out and away from the middle of the body.

A hip dislocation is very painful. Patients are unable to move the leg and, if there is nerve
damage, may not have any feeling in the foot or ankle area.

Anatomy

The hip joint capsule consists of thick longitudinal fibers in addition to much stronger
ligamentous condensations (iliofemoral, ischiofemoral, and pubofemoral). Forty percent of the
femoral head is covered by the bony acetabulum, and the labrum increases the coverage and the
stability of the joint. The sciatic nerve passes directly posterior to the hip joint and is therefore
susceptible to injury in posterior dislocations

Causes

The hip is a ball-and-socket joint: the ball-shaped head of the femur fits inside a cup-shaped
socket in the pelvis. The structure of a ball-and-socket joint gives it a great deal of stability and
allows it to move freely. A great amount of force is required to pop the thighbone out of its
socket, but that's just what happens in a hip dislocation.

Motor vehicle accidents are the most common cause of hip dislocations. (Wearing a seatbelt can
greatly reduce your risk.)

Falls from a height (such as a fall from a ladder) or industrial accidents can also generate enough
force to dislocate a hip.

With hip dislocations, there are often other injuries, including fractures in the pelvis and legs,
back injuries, or head injuries.

Classification

Hip dislocations are classified based on the head / acetabulum relationship and by the presence
of associated fractures.

Posterior hip dislocations are described by the Thompson and Epstein Classification:

• Type I - Simple dislocation with or without an insignificant posterior wall fragment

 • Type II - Dislocation with a single large posterior wall fragment
• Type III - Dislocation with a comminuted posterior wall fragment
• Type IV - Dislocation with fracture of the acetabular floor
• Type V - Dislocation with fracture of the femoral head

Anterior hip dislocations are described by the Epstein Classification:

• Type I - Superior dislocations (pubic and subspinous locations)

A - No associated fractures

B - Associated fracture or impaction of the femoral head

C - Associated fracture of the acetabulum

• Type II - Inferior dislocations (obturator and perineal locations)

A - No associated fractures

B - Associated fracture or impaction of the femoral head

C - Associated fracture of the acetabulum

Symptoms

Symptoms include:

• Severe pain in the hip, especially when attempting to move the leg
• Leg on the affected side appears shorter than the other leg
• Hip joint appears deformed
• Pain or numbness along the sciatic nerve area (back of thighs) if injury presses on this
nerve

Presentation

The classic deformity in a posterior hip dislocation is hip flexion, internal rotation, and
adduction. The patient is typically is severe pain and cannot move the involved lower extremity.

Diagnosis

A hip dislocation is an orthopaedic emergency. Call for help immediately. Do not try to move the
injured person, but keep him or her warm with blankets.

The doctor will ask about your symptoms, how the injury occurred, and will examine your hip
and leg.
Tests may include:

• X-ray —a test that uses radiation to take a picture of structures inside the body, especially
bones
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the
body, used to view fractures of the pelvis

Treatment

Treatments include:

Closed Reduction

The doctor will manipulate the thigh and leg. This is to try to put the ball of the femur back into
the hip socket. You may be given medications to relax, such as:

• Pain medication
• Sedation
• Muscle relaxants
• General or spinal anesthesia

Closed reduction, if possible, should be achieved on an emergent basis due to the risk of
osteonecrosis. Regardless of the direction of the dislocation, the reduction can be attempted with
the patient in supine position and by applying in-line traction. General anesthesia is preferred;
however, more often closed reduction under sedation is performed in the emergency room.
There are several methods described. In the Allis method, the surgeon stands on the stretcher.
By pulling just below the knee, he/she applies traction in line with the femur. The assistant
applies counter traction by pushing downward on both ASIS's. With steady increasing traction,
the hip is flexed to ~70 degrees. Adduction and gentle internal and external rotation of the hip
help the hip pass across the lip of the acetabulum. A lateral directed force may also help. This
can be applied with an assistant's hands on the upper thigh, or with a sheet wrapped around the
ipsilateral groin and pulled in a lateral and superior direction. Stability should be checked

Open Reduction

If closed reduction is doesn't work, you may need surgery. Open reduction is often needed if the
thigh or pelvic bones are also broken.

Following treatment, the surgeon will request another set of X-rays and possibly a computed
tomography (CT) scan to make sure that the bones are in the proper position.

After the open and closed reduction is accomplished, the physician immobilizes the joint to
allow for healing through sling, taping, splints, cast or traction devices.

Rehabilitation
It takes time—sometimes 2 to 3 months—for the hip to heal after a dislocation. The
rehabilitation time may be longer if there are additional fractures. An orthopaedic surgeon may
recommend traction for a short period of time, followed by controlled exercises using a
continuous passive motion machine.

Patients can probably begin walking with crutches when free of pain. A walking aid, such as a
cane, should be used until the limp disappears.

A hip dislocation can have long-term consequences, particularly if there are associated fractures.
As the thighbone is pushed out of its socket, it can disrupt blood vessels and nerves. When blood
supply to the bone is lost, the bone can die, resulting in avascular necrosis or osteonecrosis. The
protective cartilage covering the bone may also be damaged, which increases the risk of
developing arthritis in the joint.

Prevention

There are no guidelines for preventing hip dislocation. Most come from car accidents or sports
injuries. To reduce your risk, take the following steps:

• Wear your seatbelt in the car.

• Obey speed limits and other traffic laws.
• Do not drink and drive.
• Wear proper safety equipment for sports.