A dislocation of the hip is usually painful and the affected individual is not able to move the leg. In the case of a posterior dislocation, the affected limb may appear shorter and bend inward, whereas an anterior dislocation will cause it to bend outward. When an injury to the associated nerve occurs, the side of the foot or ankle may be numb [10].

• Pain

  Symptoms of Hip Joint Dislocation Hip Pain - Severe intractable hip pain is felt immediately following hip dislocation. Pain is increased with activities. Inability to Move Leg - Patient is unable to move the injured limb. [epainassist.com]

  Medical charts and questionnaires were used to assess pain, functional outcome and satisfaction. [ncbi.nlm.nih.gov]

  Long-term disability after hip dislocations is very common: half of patients experience ongoing pain or reduced mobility. [patient.info]

  […] in the hip, especially when attempting to move the leg Pain that spreads to the legs, knees, and back Leg on the affected side appears shorter than the other leg Hip joint appears deformed Pain or numbness along the back of thighs if injury presses on [health.cvs.com]

• Falling

  Central dislocation of the hip The head of the femur is driven through the fractured acetabular floor following a fall or force directed along the length of the femur - eg, a car dashboard or a fall from height on to the feet. [patient.info]

  It is usually the result of a high-energy impact in circumstances such as a motor vehicle accident or a fall from a significant height. [ncbi.nlm.nih.gov]

  […] surgery Abnormal hip joint Severe falls, especially from heights Motor vehicle accidents Sports injuries, especially from football, rugby, skiing, and snowboarding Poor muscle control or weakness leading to falls High risk behaviors, such as excessive [health.cvs.com]

• Weakness

  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. [epainassist.com]

  Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by various degrees of muscle weakness. Closed reduction is the first choice of treatment for traumatic, non-recurring hip dislocation. [ncbi.nlm.nih.gov]

  Weak recommendations use "consider" or "suggested" phrasing. Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. [dynamed.com]

  Muscle weakness and alcohol abuse are two other risk factors the surgeon must screen for when planning treatment. Implant-related risk factors include small femoral head, and wear and tear on the polyethylene liner. [davisandderosa.com]

• Cerebral Palsy

  BACKGROUND: Spasticity is the major etiology for hip dislocation in nonambulatory cerebral palsy patients. Selective dorsal rhizotomy (SDR) was used to control lower extremity spasticity, but is now done infrequently in nonambulatory cerebral palsy. [ncbi.nlm.nih.gov]

  Below is some more articles on postural control, hip dislocation and children with cerebral palsy. Read additional research on Hip in Children with Severe Cerebral Palsy. [yourtherapysource.com]

  We found no systematic reviews and only two randomised controlled trials and one evidence report (by the American Academy of Cerebral Palsy and Developmental Medicine). 6 – 8 Clinical course of hip dislocation In children with cerebral palsy the hip is [bmj.com]

  Hip displacement in cerebral palsy. [bmcmusculoskeletdisord.biomedcentral.com]

• Surgical Procedure

  Rotational acetabular osteotomy could be an effective surgical procedure for reconstruction of the acetabulum by posterolateral rotation of the osteotomized acetabulum. [ncbi.nlm.nih.gov]

  A surgical procedure known as “closed reduction” puts the hip back in place manually, followed by a “spica cast” to hold the hip in place. The cast remains on the hip until the hip returns to normal placement. [intermountainhealthcare.org]

  He has special interest in less invasive surgical procedures, such as knee and shoulder arthroscopy. He has also been consecutively honored as one of America’s top orthopedists in 2009 and 2010. [utahorthopediccenters.com]

  This procedure can be performed under general anesthesia, spinal anesthesia, or through conscious sedation with muscle relaxants Open reduction and internal fixation (ORIF): Open reduction is a surgical procedure to realign the fractured bone, to its [dovemed.com]

• Hip Dislocation

  Also, Steward and Milford classified hip dislocation based on the stability of functional hip: Type 1: Hip dislocation with features of no or insignificant fracture. Most cases of the posterior hip dislocations are usually in type 1 group. [symptoma.com]

  Keywords Anterior hip dislocation; Open reduction; Hip joint Introduction Traumatic hip dislocation in children is rare, only 5% of all hip dislocations occur under 14 years of age [ 1 ]. [bone.imedpub.com]

  A violent force is usually required to dislocate an adult's hip but children may sustain a hip dislocation following relatively minor trauma. Most adult hip dislocations are caused by motor vehicle accidents or significant falls from height. [patient.info]

  […] in this case but significant soft tissue injury is likely Hip dislocation - Dislocated THR Hover on/off image to show/hide findings Tap on/off image to show/hide findings Click image to align with top of page Hip dislocation - Dislocated THR Patient [radiologymasterclass.co.uk]

• Hip Pain

  Symptoms of Hip Joint Dislocation Hip Pain - Severe intractable hip pain is felt immediately following hip dislocation. Pain is increased with activities. Inability to Move Leg - Patient is unable to move the injured limb. [epainassist.com]

  Author information 1 Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, NY. [ncbi.nlm.nih.gov]

  On this page: Pain at the front of the hip (anterior hip pain) Pain on the outside of the hip (lateral hip pain) Pain at the front of the hip Labral tear A labral tear of the hip joint is a tear to the cartilage lining of the hip joint, called the acetabulumm [sportsinjuryclinic.net]

• Arthritis

  Besides this patient, signs of arthritis (Grade I according to Tönnis classification) were found in one patient and heterotopic ossification was recorded in two patients, but neither was symptomatic. [ncbi.nlm.nih.gov]

  The risk of post-traumatic arthritis associated with this injury seems to be high in adults (67%) [ 4 ]. [omicsonline.org]

• Joint Dislocation

  Hip pain is extremely severe following hip joint dislocation or hip dislocation. Traumatic injury involving hip joint often causes dislocation of the hip joint. [epainassist.com]

  A case report of a bilateral asymmetrical hip joint dislocation with bilateral acetabular fracture in a 28-year-old man is presented. [ncbi.nlm.nih.gov]

  […] of hip joint, Coxofemoral luxation, Hip joint--Dislocation, Dislocation of Hip Joint, dislocation; hip, hip; dislocation, Dislocation of hip joint, Dislocation of hip joint (disorder), dislocation of the hip Dutch heupontwrichting, ontwrichte heup, heup [fpnotebook.com]

  Complications Complications of a joint dislocation can include: Tearing of the muscles, ligaments and tendons that reinforce the injured joint Nerve or blood vessel damage in or around your joint Susceptibility to reinjury if you have a severe dislocation [mayoclinic.org]

• Coxa Valga

  Previous cases have been associated with intra-articular neurofibromas, acetabular protrusio and femoral deformities such as coxa valga and in one case increased femoral offset.The authors review the literature on pelvic manifestations and report a case [ncbi.nlm.nih.gov]

  Our patients underwent femoral varus osteotomies to correct coxa valga with minimal femoral derotation osteotomies added. DOs of the acetabulum were added to increase the posterior coverage. [online.boneandjoint.org.uk]

  Common Problems With Hips Aseptic or Avascular necrosis Congenital Dislocation Perthes’ disease Aplasia of the acetabulum Coxa valga Coxa vara Osteoarthritis Dislocation (see image above of simple dislocation) Bursitis Legg-Perthes disease Bone tumor [healthpages.org]

  Intraosseous cystic lesions, periosteal bone proliferation coxa valga and protrusion acetabuli have also been reported [ 3 ]. Dislocation of the hip associated with NF-1 is a rare occurrence. [jmedicalcasereports.biomedcentral.com]

• Confusion

  Because there are 2 different kinds of herpes simplex viruses (HSV-1 and HSV-2) that can live on many body parts, lots of people are confused about what to call these infections. [plannedparenthood.org]

  This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain. Vision loss. [mayoclinic.org]

  If your child develops a headache, combined with confusion, seizure or fever during a cold sore outbreak: This could signal a dangerous brain infection caused by the virus, including meningitis or encephalitis. [healthychildren.org]

  It’s also possible to confuse the mild symptoms of herpes with other things, such as: pimples or skin conditions ingrown hairs the flu When symptoms appear around the lips, mouth, and throat, it’s called oral herpes. [healthline.com]

  Irregular presentation/appearance if: femoral head or neck are fractured femoral shaft fracture obtunded patient, confused, shocked …… 26. Physical Examination Pain to palpation of hip. Pain with attempted motion of hip. [slideshare.net]

• Stroke

  There was significant delay in the recognition of the dislocation due to the coexistent signs of the stroke. [ncbi.nlm.nih.gov]

  Complications Involving Anesthesia Like any major surgery involving general anesthesia, there is a low risk of strokes, heart attacks, pneumonia, and blood clots. [arthritis-health.com]

  Herpes Zoster Increases the Risk of Stroke and Myocardial Infarction. J Am Coll Cardiol. 2017 Jul 11. 70 (2):295-296. [Medline]. Wendling P. Analysis Strengthens Herpes Zoster Link With Stroke, MI. Medscape News & Perspective. [emedicine.medscape.com]

Hip dislocations can be diagnosed using different imaging techniques which include X-rays, computed tomography scan (CT), and magnetic resonance imaging (MRI).

An x-ray examination of the anteroposterior (AP), lateral side, including both internal and external oblique imaging of the femur assists in diagnosing the condition [11]. A complete X-ray evaluation of the affected hip is required in other to determine the extent and type of the dislocation. The anteroposterior view of the pelvis may reveal the size and appearance of the femoral head. In addition, the positioning of the femoral head in association with the acetabulum is assessed to determine whether surgery is required. Fractures of the acetabulum, femoral head or neck are better evaluated with lateral and oblique views. During hip dislocation management, post-reduction x-rays are important in order to evaluate the progress of the bone attachment (which is referred to as reduction process) and to identify loose bone fragments or fractures that may interfere with the completion of the reduction process or cause post-reduction complications.

Another technique for diagnosing a hip dislocation is the CT scan [12]. The choice of CT scan technique in the workup of hip dislocation is controversial, however, cases with closed reduction failure or an asymmetric joint space may necessitate the use of the technique. A CT scan assists in diagnosing loose bodies such as damaged soft tissues and fragments that can impair closed reduction; it is also useful to evaluate acetabular fractures.

Hip dislocation may also be diagnosed by magnetic resonance imaging. This technique is recommended in an acute hip dislocation with associated conditions, such as labral tears or cartilaginous loose bodies. Osteonecrosis which develops as a complication of the dislocation may also be diagnosed using an MRI after 4-6 weeks and is subsequently repeated after 3 months.

Generally, patients with hip dislocation are managed based on the diagnosis. In cases where there are no other damages or injuries to the hips, the femoral head is adjusted into the pelvis quickly (a process that is referred to as reduction) [8]. The delay in this process may result in avascular necrosis or osteonecrosis. Surgery may not be required. Patients may be given local or general anesthesia before the reduction process. Also, sedatives and muscle relaxants may be indicated, in other to allow for proper manipulation of the femur by the clinicians [13]. Hip joint reduction is usually done with the patient lying on a flat, rigid board facing up, and the hip is gently flexed, while the femur is pulled upwards. In cases of injury damage to the femoral head, nerves, acetabulum, as well as the presence of loose bone fragments at the hip joint, which may slow the reduction process, surgery may be indicated.

Patients with a posterior hip dislocation may be able to walk after 5-7 days following reduction. Some patients with severe cases may permanently require mobile aid to walk. After reduction, patients are not encouraged to engage in continuous bed rest, since it can increase chances of complications such as the formation of blood clots. Following surgery, physiotherapy activities such as passive exercise are employed to exercise the hip joint either manually or with the aid of a continuous passive motion machine.

The prognosis of hip dislocation depends on the nature and extent of the damage to the hip joint. The prognosis of anterior dislocations of the femoral head which do not include a fracture or injury is better than the prognosis of cases that affect the posterior end. Other factors such as osteonecrosis, arthritis, duration until resolution and injury severity play a major role in the determination of the outcome [9]. However, the reduction timing during treatment is considered to be the most important factor in the prognosis of the hip dislocation.

Following a hip dislocation, osteonecrosis may develop on the femoral head, which may result in a poor outcome. Previous studies reported an incidence rate of 4.8% and 52.9% in osteonecrosis development arising from the hip reduction before or after 6 hours of injury respectively. Symptoms of osteonecrosis arise most frequently within 2 years after the injury; sometimes, osteonecrosis may be observed as late as 5 years following the initial injury. Therefore, a proper management of patients with hip dislocation alongside imaging techniques in other to prevent osteonecrosis are important [9].

Arthritis may develop after hip dislocation, and it is the most common complication of the condition. This complication affects the prognostic outcome negatively. In addition, the sciatic nerve may also be affected due to the fracture or dislocation of the hip. In cases where nerve function is impaired after resolution, an examination is necessary [9].

Most dislocations involving the hip joint cause the head of the femur to be posteriorly shifted. The dislocations usually result from the flexing of both knee and the hip joint with pressure exerted to the knee. A hip dislocation may result from hitting the knee against a surface such as a car dashboard in a road traffic accident. Hip dislocations may also result from falls from a high altitude, such as during ladder climbing or through high-impact sports like wrestling, rugby, football and karate [3]. Most often, the traumatic force which causes dislocation of the hip joint may also affect other body parts. The accident may simultaneously damage or dislocate the knee, arm, or legs of the affected individual. Sometimes, the neck or head may also be fractured. Children may be affected by a congenital dislocated hip bone, referred to as hip dysplasia [4]. Undetected hip dysplasia may cause failure of the hip to develop normally.

In a dislocated hip, damage to the bones and to the related nerves, such as the sciatic nerve, may co-exist. Also, blood supply to the femoral head may be impaired, resulting into osteonecrosis.

Hip dislocations commonly occur among adults and rarely among young individuals. About 5% of the cases are observed in patients below the age of 14 years and mostly affect males, due to injury resulting from low-energy sporting games or falls [5]. Only a few reports are available about the prevalence of hip dislocation among athletes and most cases (70%) result from road traffic accidents. Hip dislocations are commonly reported in sporting activities such as American football and rugby. In football, 3% of major injuries involve either a hip fracture or dislocation. Sports which include rugby, alpine skiing and snowboarding constitute the second most prevalent cause of hip dislocations [2].

Previous studies involving skiers and snowboarders reported a higher incidence of hip dislocation with or without a fracture among snowboarders when compared to skiers over a period of time [6]. Also, cases of hip dislocations and fractures among drivers and equestrians have been reported [7].

Anatomically, the hip joint is a ball and socket type of joint, which is usually stable and allows for proper movement. Therefore, a dislocation of the hip joint occurs rarely. The disorder arises due to the effect of high pressure on the hip bone, particularly the femoral head; a fracture of the posterior acetabular wall can accompany the dislocation. Sometimes, the neck of the femur and the articular cartilage of the femur may be involved. Injuries causing bone or cartilage fragmentation may cause a deposition of comminuted bodies or particles at the hip joint [8].

There is no medical literature about preventing the occurrence of hip dislocation, however, individuals are encouraged to be cautious and avoid any possible injuries or accidents which can result in the condition. High-risk individuals, particularly athletes of physically demanding games are trained, guided, and advised to wear protective materials to avoid hip dislocation.

Some anatomical joints of the body such as the wrist, shoulder or ankle joint are prone to dislocation following accidental events. However, hip joint dislocation is relatively rare and is usually caused by accidents resulting from sports, road traffic accidnts and other physical activities [1]. Severe traumatic conditions which are referred to as large-force traumas from accidents are usually the main factor causing hip dislocation [1]. The traumatic conditions arise from a high-energy impact and may cause injury or dislocation of the hip. Sporting activities with increased risk for hip dislocation include American football, rugby, gymnastics (such as vaults, acrobatics, floor exercise, etc.), running, basketball, car race, equestrian sports (horse riding, polo, horse racing, etc.) and water and alpine skiing (snowboarding) [2].

The dislocation of the femoral bone may either be anterior or posterior. The posterior type of hip dislocation is the most common form in traumatic dislocations. The posterior hip dislocation is classified into different groups depending on the damaging effect of the injury on the bone.

Based on the radiographic features, Thompson-Epstein classified hip dislocation into:

• Type 1: Hip dislocation with or without features of minor fracture.
• Type 2: Hip dislocation with features of large, single fracture of posterior rim of the acetabulum.
• Type 3: Hip dislocation in which the rim of acetabulum is fragmented, with or without major fragments.
• Type 4: Hip dislocation involving acetabular floor fracture.
• Type 5: Involves femoral head fracture.

Also, Steward and Milford classified hip dislocation based on the stability of functional hip:

• Type 1: Hip dislocation with features of no or insignificant fracture. Most cases of the posterior hip dislocations are usually in type 1 group.
• Type 2: Hip dislocation associated with a single or fragmented posterior rim, but the hip still remains stable in a functional range of motion or movement.
• Type 3: The dislocated hib results in gross instability of the hip joint, which is secondary to loss of physical support.
• Type 4: Occurs with femoral head fracture.

Due to the morbidity and severe effect on the physical posture, which are commonly associated with hip dislocations, a proper management of the condition is very important. Prompt and proper treatment is necessary in other to prevent chronic sequelae such as avascular necrosis.

Hip dislocation results from the separation of the thighbone (femur) head from the pelvic bone (pelvis) socket. It is an uncommon condition and it is caused by severe injury. High-impact injuries resulting from accidents, which affect the hip joint, may result in the dislocation of the hip. The accident can be due to high-altitude falls, road traffic accidents or sporting activities including high-energy sports such as American football, rugby, football, skiing, and snowboarding.

Major symptoms of hip dislocation include severe pain of the affected leg, as patients are unable to move the leg. Injury that affects the associated sciatic nerve, may result in numbness or pain at the joint. Hip dislocations are diagnosed by the clinician after the previous history of the patient has been taken, including the nature of the injury that caused the condition. Various clinical investigations may be requested to evaluate the state of the dislocation. These investigations include x-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scan. Clinical treatment in which the dislocated hip is re-joined or manipulated into the normal position is called reduction. The clinician may administer anesthesia or sedatives during treatment and may non-surgically manipulate the hip bones to the normal state. However, surgery may be required if there are complications due to bone fragments or loose bodies that can impair reduction process.

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