Dislocated Hip: Why You Should Never Move It, What to Do, and Recovery

Can you move a dislocated hip?

A dislocated hip is a severe medical emergency that requires immediate professional medical attention; attempting to move or reduce it yourself can cause significant, irreversible damage.

Understanding Hip Dislocation

A hip dislocation occurs when the head of the femur (thigh bone) is forced out of the acetabulum (the socket in the pelvis). This is a profoundly painful and debilitating injury, typically resulting from high-impact trauma.

• Anatomy Involved: The hip joint is a large, deep ball-and-socket joint, inherently stable due to its bony configuration, strong joint capsule, and numerous powerful surrounding ligaments and muscles.
• Types:
  • Posterior Dislocation: The most common type (90% of cases), where the femoral head is driven backward out of the socket. Often seen in dashboard injuries during car accidents. The leg typically appears shortened, internally rotated, and adducted.
  • Anterior Dislocation: Less common, where the femoral head is forced forward. The leg usually appears externally rotated and abducted.
  • Central Dislocation: Involves a fracture of the acetabulum, with the femoral head pushed into the pelvis.
• Causes: While rare in healthy individuals due to the joint's robust structure, dislocations are most often caused by:
  • High-energy trauma (e.g., motor vehicle collisions, falls from significant heights).
  • Severe sports injuries.
  • In individuals with prosthetic hips, dislocations can occur with less force due to specific movements or positioning.

Why You Should NEVER Attempt to Move a Dislocated Hip

Attempting to manipulate or "pop back in" a dislocated hip without medical expertise is extremely dangerous and can lead to catastrophic complications.

• Risk of Further Injury: The primary reason against self-intervention is the high risk of compounding the initial injury.
  • Nerve Damage: The sciatic nerve, which runs directly behind the hip joint, is highly vulnerable during dislocation. Improper manipulation can stretch, crush, or tear this vital nerve, leading to permanent foot drop or other neurological deficits.
  • Blood Vessel Damage: The blood supply to the femoral head can be compromised during dislocation. Attempting to move it can further damage these delicate vessels, increasing the risk of avascular necrosis (death of bone tissue due to lack of blood supply), which can lead to collapse of the femoral head and severe arthritis.
  • Ligament and Capsule Tearing: The powerful ligaments and joint capsule that stabilize the hip are already damaged during a dislocation. Untrained manipulation can worsen these tears, leading to chronic instability or persistent pain.
  • Associated Fractures: It's common for hip dislocations to occur alongside fractures of the femoral head, acetabulum, or pelvis. Moving the limb without an X-ray can displace these fractures, turning a potentially manageable injury into a surgical emergency with long-term consequences.
  • Increased Pain and Shock: The extreme pain of a dislocation can induce shock. Improper movement will intensify this pain and worsen the patient's condition.
• Anatomical Complexity: Reducing a dislocated hip requires precise anatomical knowledge, specific maneuvers, and often significant force, which must be applied correctly to avoid further damage. The muscles surrounding the hip will spasm intensely, making manual reduction extremely difficult and painful without sedation.
• Lack of Diagnostic Tools: Without X-rays or other imaging, it's impossible to know if there are associated fractures or other complications that would contraindicate certain reduction techniques.

Immediate Actions When a Hip Dislocation is Suspected

If you suspect a hip dislocation, immediate and appropriate action is crucial for preserving the joint and preventing further harm.

• Call Emergency Services (911 or your local equivalent) Immediately: Hip dislocation is a medical emergency requiring professional transportation and care.
• Do Not Move the Person: Unless they are in immediate danger (e.g., fire, collapsing structure), do not attempt to move the injured individual. Movement can worsen the injury.
• Immobilize the Leg: Gently support the injured leg in the position you find it. Do not attempt to straighten, rotate, or force it into a different position. You can use pillows or rolled blankets to provide support.
• Manage Shock: Keep the person warm and comfortable. Reassure them and try to keep them calm until medical help arrives.
• Do Not Give Food or Drink: The person may require sedation or surgery, and an empty stomach is necessary for these procedures.

The Medical Process of Hip Reduction

Once the patient arrives at a medical facility, a structured approach is taken to safely reduce the dislocation.

• Diagnosis:
  • A thorough physical examination will assess the limb's position, pain levels, and neurovascular status.
  • X-rays are essential to confirm the dislocation, determine its type (anterior/posterior), and rule out any associated fractures of the femoral head, acetabulum, or pelvis. This step is critical before any reduction attempt.
• Anesthesia/Sedation: Hip reduction is an extremely painful procedure. Patients are typically given strong pain medication and conscious sedation or general anesthesia to relax the powerful hip muscles and allow for effective manipulation.
• Closed Reduction: This is the primary method, performed by an orthopedic surgeon or emergency physician. Specific maneuvers are used to gently, but firmly, guide the femoral head back into the acetabulum. The technique varies depending on whether it's a posterior or anterior dislocation.
• Open Reduction: If closed reduction fails, or if there are significant associated fractures, trapped soft tissues, or bone fragments within the joint, surgical intervention (open reduction) may be necessary. This involves an incision to directly visualize and realign the joint.
• Post-Reduction Confirmation: After reduction, follow-up X-rays are immediately taken to confirm that the femoral head is correctly seated within the acetabulum and to check for any new fractures or complications.

Recovery and Rehabilitation

Recovery from a hip dislocation is a multi-stage process that requires patience and adherence to medical advice.

• Initial Rest and Protection:
  • Patients typically use crutches or a walker and have restricted weight-bearing for several weeks to allow the joint capsule and ligaments to heal.
  • Specific hip precautions (e.g., avoiding extreme flexion, adduction, or internal rotation) may be prescribed, particularly for patients with prosthetic hips.
• Pain Management: Medications will be prescribed to manage post-reduction pain and discomfort.
• Physical Therapy: This is a crucial component of recovery. A physical therapist will guide the patient through:
  • Early Range of Motion Exercises: To prevent stiffness.
  • Strengthening Exercises: Focusing on the gluteal muscles, core, and quadriceps to improve hip stability.
  • Gait Training: Re-learning how to walk properly and safely.
• Monitoring for Complications: Patients are closely monitored for potential long-term complications, which include:
  • Avascular Necrosis (AVN): Occurs if the blood supply to the femoral head is permanently damaged, leading to bone death. This can manifest months or even years after the injury.
  • Re-dislocation: The risk is higher after the initial injury, especially if rehabilitation protocols are not followed.
  • Post-Traumatic Arthritis: Damage to the articular cartilage can lead to early onset of arthritis.
  • Sciatic Nerve Palsy: Persistent nerve damage from the initial injury or reduction.
• Return to Activity: Gradual return to normal activities and sports is guided by the physical therapist and orthopedic surgeon, based on the individual's progress and the severity of the initial injury.

Preventing Hip Dislocation

While not all dislocations are preventable, especially those resulting from high-impact trauma, certain measures can reduce risk.

• For the General Population:
  • Safe Driving Practices: Wearing seatbelts correctly significantly reduces the risk of dashboard injuries.
  • Fall Prevention: Addressing home hazards, improving balance through exercise, and using assistive devices if needed.
  • Sports Safety: Using proper technique, wearing appropriate protective gear, and conditioning muscles around the hip.
• For Individuals with Total Hip Replacements:
  • Adhering strictly to post-operative precautions provided by the surgeon and physical therapist, which typically involve avoiding specific movements that can cause dislocation (e.g., deep squats, crossing legs, extreme internal rotation).
  • Strengthening the muscles around the prosthetic joint.

Conclusion

A dislocated hip is a profound injury that demands immediate, expert medical attention. While the instinct might be to "fix" it, attempting to move or reduce a dislocated hip without professional medical training and diagnostic tools is incredibly dangerous. It carries a severe risk of causing permanent nerve damage, blood vessel compromise leading to bone death, or exacerbating associated fractures. Prioritize safety: stabilize the injured individual, call emergency services immediately, and allow trained medical professionals to manage this complex and serious condition.