Learn About Dislocated Hip Treatment Options

Understanding Hip Dislocation: What Happens and Why Treatment Matters

A dislocated hip occurs when the head of the thighbone (femur) slips out of its socket in the pelvis (acetabulum). This is a serious injury that requires medical attention. The hip joint is a ball-and-socket joint designed to support your body weight and allow movement in multiple directions. When this joint dislocates, the bones no longer align properly, causing severe pain, loss of function, and potential nerve or blood vessel damage.

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Hip dislocations account for approximately 5 percent of all joint dislocations, making them less common than shoulder or knee dislocations. However, they are often associated with significant trauma. Most hip dislocations result from high-impact events such as motor vehicle accidents, falls from heights, or sports injuries. In older adults with weakened bones, even a simple fall can cause a hip dislocation, particularly if osteoporosis is present.

The direction of dislocation matters for treatment planning. An anterior dislocation (forward displacement) occurs in about 10 to 20 percent of cases and typically results from a direct blow to the back of the hip. A posterior dislocation (backward displacement) accounts for 80 to 90 percent of cases and usually happens when the hip is flexed and a strong force is applied, such as in car accidents where the knee strikes the dashboard.

Understanding the anatomy helps explain why prompt treatment is necessary. When the femoral head dislocates, surrounding muscles, tendons, and ligaments stretch or tear. Blood vessels may be compressed, reducing blood flow to the bone. Nerves can be stretched or pinched, causing numbness or weakness. The longer a hip remains dislocated, the greater the risk of permanent damage, including avascular necrosis—death of bone tissue due to loss of blood supply.

Practical Takeaway: Recognize that a dislocated hip is a medical emergency requiring hospital care. Symptoms include severe hip pain, inability to move the leg, visible deformity, swelling, and bruising. Do not attempt to straighten or move the hip yourself. Seek immediate emergency medical care if you suspect a hip dislocation.

Initial Emergency Treatment and Reduction Procedures

The first step in treating a dislocated hip is reduction—returning the femoral head to its socket. This procedure must be performed by a healthcare provider, typically in an emergency department. Before reduction, imaging studies such as X-rays or CT scans are usually taken to confirm the dislocation, determine its direction, and check for associated fractures of the hip or pelvis.

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Reduction is often performed under sedation or general anesthesia to relax muscles and minimize pain. The physician uses specific maneuvers based on the direction of dislocation. For posterior dislocations, the most common type, the surgeon typically flexes the hip and knee, then applies gentle traction and internal rotation to guide the femoral head back into the socket. For anterior dislocations, external rotation and abduction movements are used. Studies show that successful reduction can be achieved in 80 to 90 percent of cases using closed reduction techniques, meaning no surgical incision is required.

Timing is critical for successful reduction. When reduction occurs within 12 hours of injury, outcomes are significantly better. After 12 hours, complications such as avascular necrosis become more likely, even after successful reduction. In cases where closed reduction fails or where associated fractures are present, open reduction may be necessary. This surgical approach involves making an incision to directly visualize and reduce the dislocation.

After reduction, post-reduction imaging confirms that the femoral head has returned to the socket properly. The healthcare team assesses for any associated injuries, including fractures of the femoral head, acetabulum, or pelvis. These associated injuries occur in 5 to 20 percent of hip dislocations and significantly affect treatment planning and recovery. Some patients may require additional surgery to address fractures or repair torn soft tissues.

Practical Takeaway: Learn that reduction must occur in a hospital setting with medical professionals present. The procedure is typically successful when performed promptly. Ask your healthcare provider about any associated injuries discovered during imaging, as these may affect your rehabilitation timeline.

Non-Surgical Treatment and Immobilization Approaches

After successful reduction, non-surgical treatment focuses on protecting the hip and allowing soft tissues to heal. For dislocations without significant associated fractures, conservative treatment may be the primary approach. This typically involves a period of immobilization using a hip spica cast or brace that limits hip movement, particularly flexion, adduction, and internal rotation—movements that increase dislocation risk.

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The immobilization period typically lasts 6 to 12 weeks, depending on the severity of soft tissue damage and the presence of fractures. During this time, patients are advised to use crutches or a walker to avoid putting weight on the affected leg, as weight-bearing can disrupt the healing process and increase dislocation risk. Bed rest in the initial phase is common, with gradual progression to sitting and standing as tolerated.

Pain management is an important component of early treatment. Over-the-counter pain relievers such as acetaminophen or ibuprofen may be recommended for mild discomfort. For moderate to severe pain, healthcare providers may prescribe stronger medications such as opioids for short-term use. Ice applied to the hip during the first 48 to 72 hours can help reduce swelling. After the acute phase, heat may provide comfort and support muscle relaxation.

Physical therapy begins early in the non-surgical treatment pathway, though the intensity is carefully controlled during immobilization. Therapists teach patients how to move safely, how to use assistive devices, and how to perform gentle range-of-motion exercises within the restrictions imposed by the brace or cast. As healing progresses, therapists introduce strengthening exercises for the hip muscles, particularly the gluteus maximus and hip abductors, which help stabilize the joint and prevent re-dislocation.

Practical Takeaway: Understand that non-surgical treatment requires patience and adherence to movement restrictions. Follow your healthcare provider's guidelines on weight-bearing and immobilization to allow the soft tissues surrounding the hip joint to heal properly. Participate actively in prescribed physical therapy to rebuild strength and restore function.

Surgical Treatment Options for Complex Cases

Surgical intervention becomes necessary when closed reduction fails, when significant fractures accompany the dislocation, or when soft tissue damage is extensive. The goal of surgery is to stabilize the hip joint and repair associated injuries. Several surgical approaches exist, and the choice depends on the specific injury pattern and patient factors.

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Open reduction and internal fixation (ORIF) is performed when the femoral head or acetabulum has fractured. Surgeons make an incision to directly visualize the joint, reduce any fractures, and use screws, plates, or other hardware to hold the bones in proper alignment. Femoral head fractures occur in 7 to 17 percent of hip dislocations and can lead to long-term arthritis if not properly treated. Acetabular fractures are present in 10 to 25 percent of dislocations and require precise reduction to restore the socket's shape.

Soft tissue repair is often needed alongside fracture treatment. Torn labra—the cartilage that lines the hip socket—may be repaired using sutures anchored to bone. The ligamentum teres, a ligament inside the hip joint, may also require repair. Some surgeons use arthroscopy—a minimally invasive technique using a small camera—to assess and treat soft tissue injuries during or after reduction.

Posterior hip capsular repair may be performed for posterior dislocations with significant soft tissue damage. The hip capsule is the tissue envelope surrounding the joint. When severely torn, it may not hold the femoral head securely. Repair involves suturing the capsular tissues together to restore their stabilizing function. This procedure is particularly relevant for younger, more active patients who have a higher risk of recurrent dislocation.

The choice between surgical approaches varies based on individual circumstances. Open reduction through a posterior approach is common for posterior dislocations with fractures. An anterior approach may be used for anterior dislocations or when anterior column fractures are present. Lateral approaches may be selected depending on the fracture pattern. Recovery from surgical treatment is longer than non-surgical treatment, typically requiring 3 to 6 months for substantial healing.