Surgical Hip Dislocation
The hip joint is a ball and socket joint. The “ball” is the head of the femur, or thigh bone, and the “socket” is the cup shaped acetabulum. The joint is surrounded by muscles, ligaments, and tendons that support and hold the bones of the joint in place. Hip dislocation occurs when the head of the femur moves out of the socket. The femoral head can dislocate either backward (posterior dislocation) or forward (anterior dislocation).
Hip dislocation can be caused by injuries from motor vehicle accidents or severe falls. The common symptoms of hip dislocation include pain, inability to move your legs and numbness along the foot or ankle. A dislocation may also be associated with a fracture in the hip, back or knee bones. When you present to the clinic with these symptoms, your doctor performs a thorough physical examination and may order imaging studies such as X-rays to confirm the diagnosis.
Treatment involves reduction, in which your doctor repositions the bones to their normal position under anesthesia. Surgery may be performed to remove fragments of bone or torn tissues that block and prevent reduction. During your recovery, you are advised to limit movement and placing weight on the injured hip with the use of crutches. Physical therapy is vital in regaining the strength and mobility in your hip joint after treatment.
The hip plays an important role in supporting the upper body weight while standing, walking and running, and hip stability is crucial for these functions. The femur (thigh bone) and acetabulum (hip bone) join to form the hip joint, while the labrum (tissue rim that seals the hip joint) and the ligaments lining the hip capsule maintain the stability of the hip. Injury or damage to these structures can lead to a condition called hip instability. Hip instability happens when the hip joint becomes unstable causing various symptoms.
The most common symptoms of hip instability include
- Giving away of the hip
- Producing a clicking sound
Hip instability can be traumatic or atraumatic. Traumatic instability can be caused by injuries from sports or motor vehicle accidents. These injuries can damage the bony structures, labrum, and cartilage of the hip joint and can form loose bodies. It can range from severe dislocation to a simple subluxation (partial displacement) of the hip joint. Atraumatic instability can be caused by overuse or developmental/congenital abnormalities of the hip joint.
Conditions that can cause hip instability include:
- Labral and ligament tears
- Hip dysplasia (misaligned hip joint bones)
- Femoro acetabular impingement (abnormally shaped hip joint bones)
- Tears to the ligamentum teres
Your doctor will diagnosis hip instability based on your medical history and physical examination. Imaging studies such as plain X-rays, MRI, and MRI arthrography (use of a contrast agent) may also be ordered to confirm instability. Your doctor may also perform hip instability tests such as posterior impingement or dial test; both of which involve simple range of motion exercises.
Your doctor may start you off on a conservative/non-operative treatment approach such as protected weight bearing (crutch, cane, or wheelchair) and referral to a physical therapist for exercises. A physical therapist will instruct on special exercises, focused on improving your strength, balance, and flexibility.
When conservative options fail to resolve your symptoms or if you have large fractures, you may be recommended to undergo surgical management. Surgery can be arthroscopic (minimally invasive) or open depending on your condition. Most of the common causes for hip instability, such as damage to the hip capsule and ligaments surrounding the joint, and labral tears can be rectified arthroscopically. Your doctor will be the best person to address your concerns and help you overcome your instability.