Hip joint dislocation is also known as a hip dislocation. Hip joint is form by head of femur and the concave cup shape acetabulum of the hip bone. Acetabulum is a part of ileum or hip bone. Pelvis is form by three bones known as ilium (ileus), pubic and ischium. Ileum is also known as hip bone. Acetabulum holds the round head of femur to form a hip joint. Femur is also known as thigh bone. Hip joint is also known as the acetabulo-femoral joint and weight bearing joint. The upper body weight passes through hip joint in sitting and standing position. Hip joint allows movement like flexion, extension, abduction, adduction and rotation of lower leg. Hip joint is exposed to wear and tear of cartilage covering acetabulum, capsule and ligament.
The dislocation may cause nerve damage and patient may feel numb below knee to ankle or foot area.
Types of Hip Dislocation
Hip dislocation is a term use for hip joint dislocation or separation. Hip dislocation is a condition which occurs when the head of the thigh bone or the femur moves out of its socket. Posterior hip joint dislocation is more common than anterior hip joint dislocation. Close to 90% of the dislocation or separation of femur is posterior dislocation and 10% is anterior dislocation. Hip dislocations are broadly classified into two types:
- Posterior Hip Dislocation.
- Anterior Hip Dislocation.
Posterior dislocation– Posterior dislocation causes head of femur to lie behind acetabulum. Following posterior dislocation leg is twisted inward resulting knee and feet turn inwards. The leg lies in partial flex position at hip joint and tilted to midline toward opposite leg (adduction).
Anterior dislocation- Following anterior dislocation head of the femur lies in front of acetabulum. The anterior dislocation causes knee as well as feet turns outward while leg is in semi-flex position at hip joint.
The anterior and posterior dislocation is often diagnosed just by looking at the position of leg. Following anterior or posterior dislocation, affected leg is unable to performed movements like flexion, extension, abduction, adduction and rotation at hip or knee joint.
Risk Factors of Hip Dislocation
The hip joint is formed by ball-shaped thigh bone (femur) and the acetabulum. The entire concave surface of socket of acetabulum is covered by cartilage. The part of cartilage overhangs beyond the edge of acetabular bone and known as labrum. Labrum cartilage is adhered to the neck of femur. The labrum, joint capsule and joint ligaments prevent separation of head of femur and acetabulum. In addition to tight hold by labrum and capsule of head of femur, the slippage of link between head of the femur and acetabulum is prevented by strong ligament attached to neck of femur and acetabulum. Concave shape socket (acetabulum), labrum (cartilage ring), ligaments and capsule makes the hip joint a stable joint. Therefore, the only high impact forces can cause dislocation of the hip joint. Joint dislocation is observed after fall as well as twist and turn of joint in individual suffering with diseases that causes weaknesses in ligaments, muscle, tendon and joint cartilage. Hip joint dislocation is also observed during contact sport involving direct impact of hip joint against hard object or surface.
Risk factors are as follows-
Osteoporosis– Individual suffering with osteoporosis are prone to fracture of major bones like femur and tibia. Occasionally, hip dislocation may be seen following wrong twist and turn.
Vitamin D deficiency- The labrum and acetabulum become shallow when individual is suffering with VI. D deficiency as bone become demineralized and weak.
Malnourishment- Malnourishment causes protein deficiency and generalized weakness. The protein and vitamin deficiency causes weak bone and muscles. The twist and turn associated with weak muscles and shallow acetabulum often causes dislocation.
Poor eye sights- Elderly with poor eye sight often slip and fall during normal regular movements in house or outside. The uncertain direction and perception of height may cause clumsy movement of lower extremities resulting in abnormal twist and turn of hip joint and dislocation.
Tripping- Individual of any age can tripped while walking, running or dancing. Unaware tripping causes uncoordinated movements and results in fall. Leg may twist in inward or outward hyper-rotation that often result in dislocation.
Congenital hip dislocation- Congenital hip dislocation is rare condition but may occur in few cases. Pediatrician and parents should always look out for abnormal lower leg position.
Causes of Hip Dislocation
Hip dislocations is often observed following head on collision or side impact during automobile accident. Children are more prone to hip dislocations compared to the adults. Additional injuries such as fracture of pelvis and femur are also associated with the dislocation of the hip. Hip joint dislocation is also associated with soft tissue injury. Soft tissue injuries observed are partial or complete tear of ligamental, capsule, tendon and muscle. Hip dislocation may be associated with separation of ligament and tendon from its attachment to femur or acetabulum. In addition, some dislocation may cause laceration of cartilages of acetabulum (labrum) of the hip joint.
Automobile accident– Head on collision during car accident causes severe injury to driver and front passenger. The hip dislocation may result because of direct impact of lower leg and knee against front of car as well as accelerated forward movement of driver and front passenger. Similarly, side impact can cause severe accelerated impact of hip joint from side and forced head of femur out of acetabular socket.
Work Accident– Hip dislocation is observed in individual tripping or slipping on slippery surface while carrying heavy object. Hip joint injury may result in hip dislocation when heavy moving object hits the hip joint from side.
Domestic Fall– Hip dislocation of elderly individual is observed following fall at home or parking lot. Domestic fall is observed when individual is tripping over carpet or falls while coming down the staircase at home. Similarly, slip and fall over slippery surface at home can cause hip dislocation in elderly suffering with osteoporosis.
Sport injury- Contact sport like football, rugby and wrestling causes incidental or forced fall over one of the hip joint. The injury involves impact against human body or slamming the lower body over hard surface. Such impact causes hip dislocation.
Symptoms and Signs of Hip Dislocation
Pain- Hip dislocation causes sudden intense pain at rest and with activities. Character of pain is burning and stabbing pain. Pain become worst with any attempt to move leg. Palpation or examination of the hip joint or any attempt to move hip joint result in intense pain.
Unable to move leg- Patient is unable to move lower leg following hip dislocation. In most cases hip joint dislocation causes loss of movement of entire leg. Any attempt to move leg provokes intense pain. Patients is able to move feet if sciatic nerve is not injured or dislocation is anterior in position.
Abnormal position of leg- The lower extremity indicates knee and feet is turn inward or outward depending on type of dislocation. Posterior dislocation the lower leg is twisted inward. Position of leg is fixed and unable to move. Similarly, anterior dislocation causes lower leg immobile and positon twisted outward.
Tingling and numbness- Posterior hip dislocation may cause injury of sciatic nerve resulting in tingling and numbness symptoms spread over lower leg below knee joint. Anterior dislocation causes similar symptoms spread over front of thigh and knee secondary to injury of femoral nerve.
Weakness in lower leg- The laceration or disruption of motor nerve fibers of sciatic or femoral nerve causes weakness in lower leg. Sciatic nerve injury causes predominantly weakness in leg below knee and femoral nerve injury causes weakness in thigh muscles.
Tests to Diagnose Hip Dislocation
X-Ray– X-Ray mostly shows fracture and dislocation. The diagnosis is confirmed by taking multiple images of hip joint in different position.
CT scan– CT scan of the hip joint is performed to get the 3 D view. The anterior or posterior dislocation is better evaluated with 3 D Computer Tomography.
MRI scan– MRI helps to diagnose hip dislocation as well as if any fracture of femur or pelvic bone is associated with dislocation. MRI scan is performed to evaluate position of blood vessels and nerves when bruises and symptoms of nerve damage is observed. Selective MRI performed to evaluate soft tissue injury. The rupture blood vessels and injured nerves are observed in MRI.
Treatment for Hip Dislocation
Hip dislocation may be associated with fracture of neck of femur, shaft of femur or pelvis. The first treatment of dislocation is to reduce the dislocation and place the head of femur within socket of acetabulum. Dislocation without fracture of pelvic bone or femur is treated with close reduction. If close reduction fails to correct the hip joint dislocation, then open surgery is performed to correct the dislocation. Open surgery is also needed if dislocation is associated with fracture of pelvis or femur bone.
Close reduction of hip dislocation- Hip dislocation must be treated immediately. Patient should avoid all movements of injured hip joint. Radiological study such as X-Ray, CT Scan and MRI should be performed to evaluate the type dislocation and rule out if there is any fracture of femur or pelvis or any other bones. Attempting movement of the hip and leg must be strictly avoided. Treatment for hip dislocation focuses on placing the dislocated head of femur into socket of acetabulum. The close reduction of dislocated hip joint to place head of femur in acetabulum is performed under general anesthesia. Anesthesia includes unconsciousness and in few difficult cases injection to paralyzed all skeletal muscles necessary prior to repeated attempt to reduce the dislocation and place the head of femur in socket. Once the muscles are paralyzed surgeon holds the leg with the help of assistant. The femur is pulled away from sockets of acetabulum using maneuvering and pull. Once the head of femur is in line with acetabulum the head is inserted into acetabular socket. The procedure is known as close reduction. The normal position of femur within acetabular socket is checked with X-Ray.
Open reduction of hip dislocation- Rarely close reduction is unsuccessful and surgeon is unable to place head of femur within acetabulum. In such cases open reduction is recommended. Open reduction involves surgical procedure. Surgery is performed either under general or spinal anesthesia. Skin incision is extended to hip joint and under direct vision dislocated head of femur is placed socket of acetabulum. If dislocation is associated with fracture of femur or pelvis, then fracture is also treated same time as correction of dislocation.
Post-surgery treatment- Following surgery depends on joint stability all or some of the following treatments are advised.
Patient following close reduction advised complete rest for 3 to 5 day. Then patient can resume restricted activities. If patient has undergone open surgery, then rest period may extend to 2 to 4 weeks. During rest patient is advised to perform movement of lower leg muscles to prevent deep vein thrombosis. Exercises are advised by
Physical Therapist. After one week following close reduction and 4 weeks after open reduction patient is advised to ambulate with crutches, walker, and cane.
- NSAIDs- Non-steroidal anti-inflammatory drugs like ibuprofen, naproxen, ketoprofen and celecoxib help in reducing pain and inflammation. Pain is often mild to moderate after close reduction and most pain is treated with NSAIDs.
- Opioids- Narcotic pain medication is also used for moderate to severe pain, but this is taken only for very short period. Pain following open surgery is treated with opioids for 5 to 7 days.
V shape pillow and Bracing or casting –
- Close reduction- Immediately following close reduction patient is advised to use V shape pillow. The pillow is placed between both leg. Pillow restrict the involuntary movement of hip joint and helps to maintain head of femur placed within socket of acetabulum.
- Open reduction- Patient is put in fiberglass cast after open reduction. The cast helps to restrict the movement of hip joint and promote rapid healing. Patient is left in cast for 4 to 6weeks or longer depend
Physical therapy for hip dislocation is important in speeding up the healing process. Physical therapy also decreases the likelihood of recurrence of hip dislocation in the future. Immediately following open or close surgery bed side physical therapy is performed to improve blood circulation in lower leg. The physical therapy includes massage treatment, ultrasound and infrared therapy as well as supervised exercises of lower leg and upper body. After 2 weeks following close reduction and removal of cast after open reduction patient is advised exercises to help to build muscles and improve joint coordination.
House rehab program-
House rehab is advised following close reduction as well as open reduction. Following close reduction after initial period of rest of 3 to 5 days, patient is taught to walk around the house to performed the daily household and personal activities. Similarly, following open reduction patient is trained to use crutched or wheel chair for movement inside or outside house.
Exercises for Hip Dislocation
Most hip dislocation are treated with close reduction and some with open reduction. After repositioning the head within socket of acetabulum, patient is either advised to rest the hip joint for 4 to 6 weeks.
Resistive Hip Abduction Exercise for Hip Dislocation:
This exercise is performed by using tubing or an exercise band to strengthen the muscles of the hip. The exercise band helps in strengthening by supplying increased resistance. Using sturdy chair or a table helps in performing this exercise. Tie an exercise band around the table or chair’s leg and place the injured leg (left leg) into the loop and stretch the loop away from chair. Keep the opposite hand (right hand) over the table or chair to support upper body.
Gradually lift the injured leg (left leg) away from the body in side ward direction. Hold the position for about 3 seconds and gradually bring the leg to the initial position. Repeat 10 times.
Upright Knee Raise Exercise for Hip Dislocation:
This exercise is performed by doing standing knee raises in order to strengthen the muscles. Stand over the side of the chair and grab the back of the sturdy chair with the help of the hands.
Now gradually raise injured leg (left leg) from the floor and smoothly bend the knee. Then, raise the leg toward the upper body. Avoid lifting the knee more than waist level. Hold the position for about 3 seconds. Gradually bring the leg to the initial position. Repeat 10 times. Perform same exercise four times daily.
Hip Flexion and Extension Exercise for Hip Dislocation:
This exercise is performed in standing position. Stand next to a chair so injured side is away from chair and normal side is close to chair. Hold the back of chair while doing exercise. Slowly and carefully swing the leg forward and backward making sure knee is straight. Forward swing causes flexion and backward swing causes extension of lower leg at the hip joint. This exercise can be performed either in the water or on the floor. If the exercise is being performed in water, the water level must reach chest or waist.
Hold the position of lower leg in extension as well as flexion position for 5 seconds. Repeat 10 times. Note that only the hip is in motion and avoid moving the upper body and neck while performing this exercise.
Hip dislocation is a serious condition. Individual must be seen by a emergency medical doctor or orthopedic surgeon if suffering with hip pain and unable to move lower leg. In such cases one must call 911 or ambulance. Exercises described above must be discuss with physical therapist, orthopedic surgeon or primary care physician to decide when to begin exercises and if these exercises are appropriate for the injury or pain.
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