Accidents and Injuries

Can knowing treatment options for a dislocated hip help individuals expedite rehabilitation and recovery?

Dislocated Hip

A dislocated hip is an uncommon injury but can happen due to trauma or following hip replacement surgery. It usually occurs after severe trauma, including motor vehicle collisions, falls, and sometimes sports injuries. (Caylyne Arnold et al., 2017) A dislocated hip can also occur after hip replacement surgery. Other injuries like ligament tears, cartilage damage, and bone fractures can occur alongside the dislocation. Most hip dislocations are treated with a joint reduction procedure that resets the ball into the socket. It is usually done with sedation or general anesthesia. Rehabilitation takes time and could be a few months before full recovery. Physical therapy can help restore motion and strength in the hip.

What Is It?

If the hip is only partially dislocated, it's called a hip subluxation. When this happens, the hip joint head only partially emerges from the socket. A dislocated hip is when the head or ball of the joint shifts or pops out of the socket. Because an artificial hip differs from a normal hip joint, the risk of dislocation increases after joint replacement. A study found that around 2% of individuals who undergo total hip replacement will experience hip dislocation within a year, with the cumulative risk increasing by approximately 1% over five years. (Jens Dargel et al., 2014) However, new technological prosthetics and surgical techniques are making this less common.

Hip Anatomy

• The hip ball-and-socket joint is called the femoroacetabular joint.
• The socket is called the acetabulum.
• The ball is called the femoral head.

The bony anatomy and strong ligaments, muscles, and tendons help to create a stable joint. Significant force must be applied to the joint for a hip dislocation to occur. Some individuals report feeling a snapping sensation of the hip. This usually is not a hip dislocation but indicates a different disorder known as snapping hip syndrome. (Paul Walker et al., 2021)

Posterior Hip Dislocation

• Around 90% of hip dislocations are posterior.
• In this type, the ball is pushed backward from the socket.
• Posterior dislocations can result in injuries or irritation to the sciatic nerve. (R Cornwall, T E Radomisli 2000)

Anterior Hip Dislocation

• Anterior dislocations are less common.
• In this type of injury, the ball is pushed out of the socket.

Hip Subluxation

• A hip subluxation occurs when the hip joint ball starts to come out of the socket partially.
• Also known as a partial dislocation, it can turn into a fully dislocated hip joint if not allowed to heal properly.

Symptoms

Symptoms can include:

• The leg is in an abnormal position.
• Difficulty moving.
• Severe hip pain.
• Inability to bear weight.
• Mechanical lower back pain can create confusion when making a proper diagnosis.
• With a posterior dislocation, the knee and foot will be rotated towards the body's midline.
• An anterior dislocation will rotate the knee and foot away from the midline. (American Academy of Orthopaedic Surgeons. 2021)

Causes

A dislocation can cause damage to the structures that hold the ball in the socket and can include:

• Cartilage damage to the joint - 
• Tears in the labrum and ligaments.
• Fractures of the bone at the joint.
• Injury to the vessels that supply blood can later lead to avascular necrosis or osteonecrosis of the hip. (Patrick Kellam, Robert F. Ostrum 2016)
• A hip dislocation increases the risk of developing joint arthritis following the injury and can raise the risk of needing a hip replacement later in life. (Hsuan-Hsiao Ma et al., 2020)

Developmental Dislocation of the Hip

• Some children are born with developmental dislocation of the hip or DDH.
• Children with DDH have hip joints that did not form correctly during development.
• This causes a loose fit in the socket.
• In some cases, the hip joint is completely dislocated.
• In others, it's prone to becoming dislocated.
• In milder cases, the joint is loose but not prone to becoming dislocated. (American Academy of Orthopaedic Surgeons. 2022)

Treatment

Joint reduction is the most common way to treat a dislocated hip. The procedure repositions the ball back into the socket and is usually done with sedation or under general anesthesia. Repositioning a hip requires significant force.  A hip dislocation is considered an emergency, and reduction should be performed immediately after the dislocation to prevent permanent complications and invasive treatment. (Caylyne Arnold et al., 2017)

• Once the ball is back in the socket, the healthcare provider will look for bone, cartilage, and ligament injuries.
• Depending on what the healthcare provider finds, further treatment may be necessary.
• Fractured or broken bones may need to be repaired to keep the ball within the socket.
• Damaged cartilage may have to be removed.

Surgery

Surgery could be necessary to return the joint to its normal position. Hip arthroscopy can minimize the invasiveness of certain procedures. A surgeon inserts a microscopic camera into the hip joint to help the surgeon repair the injury using instruments inserted through other small incisions.

Hip replacement surgery replaces the ball and socket, a common and successful orthopedic surgical procedure. This surgery may be performed for various reasons, including trauma or arthritis, as it is common to develop early arthritis of the hip after this type of trauma. This is why many who have a dislocation ultimately need hip replacement surgery. As a major surgical procedure, it is not without risks. Possible complications include:

• Infection
• Aseptic loosening (the loosening of the joint without infection)
• Hip dislocation

Recovery

Recovering from a hip dislocation is a long process. Individuals will need to walk with crutches or other devices early in recovery. Physical therapy will improve the range of motion and strengthen the muscles around the hip. Recovery time will depend on whether other injuries, such as fractures or tears, are present. If the hip joint was reduced and there were no other injuries, it may take six to ten weeks to recover to the point where weight can be placed on the leg. It could be between two and three months for a full recovery. Keeping weight off the leg is important until the surgeon or physical therapist gives the all-clear. Injury Medical Chiropractic and Functional Medicine Clinic will work with an individual's primary healthcare provider and other surgeons or specialists to develop an optimal personalized treatment plan.

Chiropractic Solutions for Osteoarthritis

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Arnold, C., Fayos, Z., Bruner, D., Arnold, D., Gupta, N., & Nusbaum, J. (2017). Managing dislocations of the hip, knee, and ankle in the emergency department [digest]. Emergency medicine practice, 19(12 Suppl Points & Pearls), 1–2.

Dargel, J., Oppermann, J., Brüggemann, G. P., & Eysel, P. (2014). Dislocation following total hip replacement. Deutsches Arzteblatt international, 111(51-52), 884–890. https://doi.org/10.3238/arztebl.2014.0884

Walker, P., Ellis, E., Scofield, J., Kongchum, T., Sherman, W. F., & Kaye, A. D. (2021). Snapping Hip Syndrome: A Comprehensive Update. Orthopedic reviews, 13(2), 25088. https://doi.org/10.52965/001c.25088

Cornwall, R., & Radomisli, T. E. (2000). Nerve injury in traumatic dislocation of the hip. Clinical orthopaedics and related research, (377), 84–91. https://doi.org/10.1097/00003086-200008000-00012

American Academy of Orthopaedic Surgeons. (2021). Hip dislocation. https://orthoinfo.aaos.org/en/diseases--conditions/hip-dislocation

Kellam, P., & Ostrum, R. F. (2016). Systematic Review and Meta-Analysis of Avascular Necrosis and Posttraumatic Arthritis After Traumatic Hip Dislocation. Journal of orthopaedic trauma, 30(1), 10–16. https://doi.org/10.1097/BOT.0000000000000419

Ma, H. H., Huang, C. C., Pai, F. Y., Chang, M. C., Chen, W. M., & Huang, T. F. (2020). Long-term results in the patients with traumatic hip fracture-dislocation: Important prognostic factors. Journal of the Chinese Medical Association : JCMA, 83(7), 686–689. https://doi.org/10.1097/JCMA.0000000000000366

American Academy of Orthopaedic Surgeons. (2022). Developmental dislocation (dysplasia) of the hip (DDH). https://orthoinfo.aaos.org/en/diseases--conditions/developmental-dislocation-dysplasia-of-the-hip-ddh/

As one of the most load-bearing joints in the body, the hips nearly affect every movement. If the hip joint is involved in a vehicle crash, the space in the joint/hip capsule can fill with fluid, causing joint effusion or swelling, inflammation, dull-immobilizing pain, and stiffness. Hip pain is a common injury symptom reported after a vehicle crash. This pain can range from mild to severe and may be short-term or last for months. No matter the level of pain being experienced, action must be taken quickly to avoid long-term damage. Individuals need high-quality, patient-focused care from experienced specialists as soon as possible to get on the road to recovery.

Vehicle Crash Hip Injury

The hip joints must be healthy and work as effectively as possible to stay active. Arthritis, hip fractures, bursitis, tendonitis, injuries from falls, and automobile collisions are the most common causes of chronic hip pain. Depending upon the type of injury, individuals may experience pain symptoms in the thigh, groin, inside of the hip joint, or buttocks. 

Associated Injuries

The most common injuries that cause pain in the hip after a collision include:

• Hip ligament sprain
• Bursitis
• Tendonitis
• Hip labral tear
• Hip dislocation
• Hip fracture
• Acetabular fracture

Hip Ligament Sprains or Strains

• A hip ligament sprain or strain is caused by overstretched or torn ligaments.
• These tissues attach bones to other bones and provide stability to the joints.
• These injuries may only require rest and ice to heal, depending on the severity.
• Chiropractic, decompression, and physical massage therapies may be necessary for realignment and to keep muscles flexible and relaxed.

Bursitis

• Bursitis is an inflammation of the bursa, or the fluid-filled sac providing cushioning/material between bones and muscles.
• It is one of the main causes of hip pain after an automobile collision and requires immediate medical attention.

Tendonitis

• Tendonitis is a type of injury that affects soft tissues like tendons and ligaments, as opposed to bone and muscle.
• Tendonitis can result in chronic pain and various discomfort symptoms in and around the hip area if left untreated.

Hip Labral Tear

• A hip labral tear is a type of joint damage in which the soft tissue/labrum that covers the hip's socket gets torn.
• The tissue ensures that the thighbone head moves smoothly within the joint.
• Damage to the labrum can lead to severe pain symptoms and affect mobility.

Hip Dislocation

• A hip dislocation means the femur ball has popped out of the socket, causing the upper leg bone to slide out of place.
• Hip dislocations can cause avascular necrosis, which is the death of bone tissue from a blockage in the blood supply.

Hip Fractures

• The hip bones can be broken down into three parts:
• Ilium
• Pubis
• Ischium
• A hip fracture, or broken hip, occurs whenever a break, crack, or crush happens to any one of these parts of the hip.

Acetabular Fracture

• An acetabular fracture is a break or a crack outside the hip socket that holds the hip and thigh bones together.
• A fracture to this body part is not as common because of the location.
• Significant force and impact are often necessary to cause this type of fracture.

Symptoms

If any of the following symptoms after a vehicle crash are experienced, it could be a hip injury and should be examined by a medical professional. These include:

• Soreness or tenderness at the site of injury.
• Bruising.
• Swelling.
• Difficulty moving the hip/s.
• Intense pain when walking.
• Limping.
• Loss of muscle strength.
• Abdominal pain.
• Knee pain.
• Groin pain.

Treatment and  Rehabilitation

A doctor or specialist should always evaluate hip problems and pain symptoms. With the help of a physical examination and diagnostics like X-rays, CT Scans, or an MRI, a physician can diagnose and recommend treatment options. Treatment after a vehicle crash depends on the severity of the damage. For example, hip fractures often require immediate surgery, while other injuries may only necessitate medication, rest, and rehabilitation. Possible treatment plans include:

• Rest
• Pain, muscle relaxants, and anti-inflammatory medication.
• Physical therapy
• Massage therapy
• Chiropractic realignment
• Spinal decompression
• Exercise therapy
• Steroid injections
• Surgery - after surgery, a physical therapist can help stretch and work on muscles around the hip to gain mobility and flexibility for a complete recovery.
• Total hip replacement

Our team collaborates with the necessary specialists to provide the complete care needed to experience full recovery and healing for long-term relief. The team will work together to form a comprehensive treatment plan to strengthen the hip muscles for better support and increased range of motion.

Movement as Medicine

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Cooper, Joseph, et al. "Hip dislocations and concurrent injuries in motor vehicle collisions." Injury vol. 49,7 (2018): 1297-1301. doi:10.1016/j.injury.2018.04.023

Fadl, Shaimaa A, and Claire K Sandstrom. "Pattern Recognition: A Mechanism-based Approach to Injury Detection after Motor Vehicle Collisions." Radiographics: a review publication of the Radiological Society of North America, Inc vol. 39,3 (2019): 857-876. doi:10.1148/rg.2019180063

Frank, C J et al. "Acetabular fractures." The Nebraska medical journal vol. 80,5 (1995): 118-23.

Masiewicz, Spencer, et al. "Posterior Hip Dislocation." StatPearls, StatPearls Publishing, 22 April 2023.

Monma, H, and T Sugita. "Is the mechanism of traumatic posterior dislocation of the hip a brake pedal injury rather than a dashboard injury?." Injury vol. 32,3 (2001): 221-2. doi:10.1016/s0020-1383(00)00183-2

Patel, Vijal, et al. "The association between knee airbag deployment and knee-thigh-hip fracture injury risk in motor vehicle collisions: A matched cohort study." Accident; Analysis and Prevention vol. 50 (2013): 964-7. doi:10.1016/j.aap.2012.07.023