What is a dislocated hip?
A dislocated hip is the term to describe the displacement of the femoral head (top of the leg) from the hip joint; in essence it is when your hip has popped out of its socket. The top of the femoral bone (thigh bone) is the femoral head. It is formed into a smooth ball shape that fits perfectly into the hip socket on the pelvis called the acetabulum that’s why it is known as a ball-in-socket joint. The femoral head and acetabulum are surrounded by a tough capsule that encases the entire joint, strong ligaments and muscles keep the joint in place allowing the joint to be flexible yet incredibly strong and durable. In the case of a dislocated hip the muscles, ligaments and joint capsule have been dramatically overstretched causing them to tear and loosen, creating an unstable environment for the hip and allowing the femoral head to move out and away from the hip socket.
Why and when do dislocated hips happen?
Hip dislocations are normally the result of traumatic falls or violent impacts during road accidents. A dislocated hip can occur to anyone at any point during a lifetime. Hip dislocations tend to be more common within those who have had a hip replacement and the very young as it only takes a minor trauma to result in a dislocation.
Hip dislocation can be seen as the result of some contact sports however the direct violent downwards impact of the knee against a dash board in a car accident is the most common cause of a hip dislocation. A fall to the ground landing awkwardly on your leg can also cause dislocation although this type of injury mechanism normally occurs in the older generation with prosthetic hips. The severity of the injury to a hip during a dislocation leaves the joint weakened and prone to developing osteoarthritis at a later age. If a hip dislocation is not diagnosed quickly then there is a higher risk of developing avascular necrosis of the acetabulum which seriously damages the roof of the hip socket.
Hip dislocations are classified as anterior, posterior or central with posterior dislocations accounting for 90% of all hip dislocations. The number of hip dislocations seen have dramatically decreased since air bags and seatbelts where installed in cars as a legal requirement.
What does a dislocated hip feel like?
A dislocated hip will cause sudden and severe pain around the hip joint, across into the groin and down into the leg. There will most likely have been a pop or tearing noise at the time of dislocation. The leg will feel very weak and any leg movement or weight bearing will aggravate the already intense pain levels. Most patients will not be able to weight bear at all on the affected leg. Mild dislocations may not be as severe but will still cause a certain degree of discomfort and will result in a severe limp. The hip and leg will also look slightly different. Depending on the type of dislocation the leg will most likely be shortened and rotated inwards, mostly noticeable as your foot turns inwards. Due to the proximity of the major arteries and nerves that supply the leg will mean that some patients may experience numbness and pins and needles in the effected leg. Due to the fact that it takes a forceful trauma to cause a hip dislocation there are normally additional injuries and if not treated immediately severe complications may arise. This means a hip dislocation should always be considered a medical emergency.
What to do if a dislocated hip is suspected?
Your actions immediately after a dislocation can greatly improve your recovery and reduce your pain levels. As soon as the injury is sustained you should follow the P.R.I.C.E protocol this involves Protect andRest the hip by completely avoiding any walking or weight bearing. Ice by applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Compression, if possible try and keep the elastic bandage or pressure on the hip during the day to limit the swelling and make sure to take it off at night. Elevation, keep the hip raised on a pillow to help limit the swelling.
You should seek medical attention straight away in order to have the joint reset to its proper alignment; your doctor will most likely provide you with crutches in order to provide it with support whilst it heals. It is advisable to follow the H.A.R.M protocol over the first three days. Avoid any heat whether it is a hot bath or a heat pack for the first three days after this heat will be quite soothing for the stiffened joint. Avoid alcohol as it will increase any bleeding and swelling. Running or aggravating exercise movements should be avoided in case of further injury. Massage should be avoided over the first three days after injury as it will also increase any bleeding and swelling.
How is a dislocated hip diagnosed?
Patients may be taken to A&E and a full examination will be done to rule out any additional injuries or complications like femoral fractures and nerve or arterial damage which are common in hip dislocations due to the severity of the trauma. Your doctor will most likely order an x-ray of the hip and leg to confirm the diagnosis, identify the extent of the dislocation and rule out the presence of fractures. Occasionally an MRI or a CT scan will be ordered as this will give a more detailed view and rule out any additional damage or injury.
What treatments are available for a dislocated hip?
The treatment options and healing times for a dislocated hip vary depending on the severity of the dislocation and also on complications like the additional presence of a fracture or nerve damage. If a fracture is present or muscles are badly torn then there is an increased likelihood of surgical intervention. If the x-ray is clear then the femoral head will be safely manipulated back into the hip joint. This procedure is known as reduction and will be carried out under general anaesthetic and performed by a trained medical professional. If the reduction of the joint isn’t performed properly it can cause long term damage to the surrounding nerves, ligaments and cartilage. Severe cases not only require traction and reduction but will also need internal surgical fixation. The surgery will be followed by a period of protected weight-bearing.
Once the hip joint is back into position the doctor will instruct the patient to use crutches and rest completely whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. The crutches will be used for 3-4 weeks and all aggravating or painful activities avoided for 6-8 weeks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen the hip and arm to aid the healing process. Occasionally patients suffer from low back stiffness and discomfort due to the period of immobility and the use of crutches. In these cases manipulative therapies such as chiropractic or osteopathy can help. Many patients also find massage therapies and the Bowen technique good for relaxing the low back and hip muscles.