Luxation of the hip: Causes, symptoms and treatment

A hip dislocation is a condition in which the femoral head of the femur (upper leg) ‘shoots’ out of the hip socket, usually as a result of a poorly fitting hip prosthesis, hip dysplasia or trauma. This condition is quite painful and prompt medical intervention (hip reduction) is desirable to prevent complications.

Causes

A Total Hip Prosthesis (THA)

Hip dislocation is the most common complication of THA, and can sometimes be linked to a poorly fitting prosthesis. Even as the patient with a hip prosthesis ages and the muscle mass around the prosthesis decreases, the hip can luxate more quickly.

Trauma

A traumatic hip dislocation can occur during a (car) accident. Such a traumatic luxation often causes considerable damage to ligaments, tissue and nerves around the hip. This additional damage must also be taken into account in the treatment to ensure a good recovery of the hip.

Hip dysplasia

In babies with this congenital deformity of the hips, dislocation can easily happen. Precisely because of the deformity, the femoral head can ‘shoot’ out of the hip socket much more quickly than in a healthy child.

Symptoms and diagnosis

The symptoms of a hip dislocation are:

  • The hip and leg cannot move (sufficiently).
  • A lot of pain in the hip, possibly radiating pain to the pelvis and leg.
  • Swelling of the tissue around the hip joint.
  • Possible bruising on the hip.

The diagnosis usually consists of a history, physical examination and taking an X-ray.
With certain luxations, an additional CT scan must be made to get a good picture of everything.

Complications

Possible complications of a hip dislocation:

  • A second dislocation
  • Damage to the nerve of the leg (to the sciatic nerve)
  • Coxarthosis: wear and tear of the femoral head
  • Necrosis (death) of the femoral head

The longer it takes to reposition the hip, the greater the chance of femoral head necrosis. That is why rapid medical intervention is certainly recommended in the event of a hip dislocation.

Therapy

The normal treatment of a hip dislocation during a hip prosthesis is a reduction. The hip is then moved/pulled back into position under local or general anesthesia. Further treatment is then chosen by the doctors according to the specific cause.
In case of early dislocation, bed rest or a brace may be indicated. If a problem is found with the prosthesis, surgery can sometimes be a solution. In the case of late dislocation, a brace or revision of the hip prosthesis is recommended, depending on the cause.
In the case of a traumatic luxation, the hip must also be repositioned as quickly as possible, in view of complications (femoral head necrosis).
In a baby with hip dysplasia , the treatment consists of keeping the legs spread with spreading pants or plaster casts. This ensures that the hips can develop correctly in the following months.
If that does not have sufficient effect, traction can be applied to the legs. This usually takes place in a hospital and ensures that the legs are spread a little further every day, with less risk of damage or new dislocation.
If hip dysplasia is not treated correctly in childhood, the patient may remain very susceptible to new hip dislocations even in adulthood.

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