Hip Replacement Dislocation
Hip replacement dislocation symptoms of any type of joint occur when any of the bones slip out of the joint. For example, the shoulder involves the top of the arm bone which fits into the shoulder joint. When it pops or slips out of that place or the proper alignment, it is considered a dislocated shoulder. Dislocation of a joint can happen at any time and in almost any joint in the body, including the common areas like the hip, ankle, knee, and shoulder.
Dr. Karkare was in the news for his expertise on the treatment of recurrent hip dislocation
When a dislocation happens, it means the bones will no longer be where they should be and should be treated it as an emergency. Medical attention is recommended as soon as possible because if it is left untreated, the dislocation could lead to damage of the surrounding blood vessels, nerves or ligaments.
What Causes a Hip Replacement Dislocation?
Typically, dislocations of are the result of the joint experiencing an unbalanced or unexpected unbalanced impact. An example of how an impact might happen is if someone falls or experiences any type of hard hit to the affected joint or area. Joints are more likely to be dislocated again in the future after just one dislocation.
Who Is at Risk for a Hip Dislocation?
Even though a dislocated joint can happen to anyone at any age if they end up falling or face other types of trauma, older people are more likely to see dislocated joins. The elderly have a higher risk due to the higher amounts of good mobility and balance issues increasing the amounts of falls.
Children tend to be another group that is at high risk for a dislocated joint. Why are children a high risk? When children are left in unsupervised areas or play in areas that aren’t childproofed, they might take more chances and get involved with unsafe behavior during physical activities which leads to higher chance of an accident involving a dislocation happening.
What Are Hip Replacement Dislocation Symptoms?
With most dislocated joints, the dislocation is easy to notice. Signs of a dislocated joint can include swelling, bruises, or the joint being red or discolored. Dislocated joins can also look deformed or have strange shapes due to the dislocation.
Other symptoms include:
- painful movement
- loss of motion
- numbness or tingling around the dislocated joint
How to fix a dislocated hip
Several factors are involved when considering how to fix a dislocated hip. A reduction of the hip is generally the first step in the treatment process and will reposition the joint. This procedure is performed under anesthesia, either general anesthesia or light sedation. During the reduction procedure, the doctor will pull on the leg to reposition the hip within the socket.
It is common for the hip to “pop” back into the proper position. X-rays help find identifiable reasons for the joint dislocation to ensure the hip is properly repositioned. Doctors recommend surgery when multiple dislocations to the same joint occur and may be necessary to aid in the prevention of future dislocations. A surgeon uses special implants to keep future dislocations from happening. This route should be discussed with an orthopedic surgeon or another medical professional to determine the cause of recurring dislocations, and what to figure out what the best treatments options are available for the problem.
The choice of treatment determined by the doctors involved will depend on the joint that is dislocated and will also depend on the severity of the dislocation. Initial treatments for all dislocated joints should involve RICE: Rest, Ice, Compression, and Elevation. In some cases, the dislocated joint might go back into place naturally after this treatment.
If the joint fails to naturally return to normal, doctors may include one of the following treatments:
- manipulation or repositioning
In this method of stabilizing and realigning the joint, the doctor repositions the joint or manipulates the dislocated joint back into the proper place. Using anesthetic or sedative allow the patient to remain as calm and comfortable as possible. Sedation or anesthetics will also be a great aid in allowing the muscles surrounding the joint to be able to relax.
Doctors may advise patients to wear a cast, splint or sling, splint for several weeks after the joint is put back into and returns to its normal and proper place. All three routes will aid in a full recovery and healing of the joint by preventing too much movement allowing the joint to remain in its proper form.
Pain will vary depending on the severity of the injury and the pain will generally ease up on its own go with the proper alignment of the joint. However, in some cases, the doctor may prescribe muscle relaxers or pain relievers.
Surgeries needs in a few cases such as if your dislocation of the joint has caused damage to the surrounding blood vessels or nerves. If it doesn’t return to normal position, then surgery takes place.Surgery, if the same patient returns often with the same dislocated joints, may also be necessary. Surgery needs joint reconstruction and repairing any surrounding tissues or structures to prevent future dislocations. In some cases, a joint needs replacement such as a knee or hip replacement.
Rehabilitation will always begin after the doctor manipulates or properly repositions the joint into the correct position. The doctor will put together the best rehabilitation plan for each individual case. The main and very important goal of rehabilitation is to restore the range of motion and to slowly increase the joint’s strength
How Can You Prevent Dislocations Prevented?
The prevention all joint dislocations begins when one practice and develops safe behavior habits. General tips to aid the prevention of dislocations should include:
- When going up and down staircases, use handrails.
- Keep current, unexpired first aid kits on hand and in the area where there are high risks of dislocations.
- While working or walking through wet areas, such as bathrooms or professional kitchens, use non-skid mats.
- Make sure electrical cords are not in the path of those walking and keep them off the floor.
- Avoid using loose rugs or throw rugs.
To teach children to prevent and reduce the risk of possible dislocations, consider practicing and developing the following habits:
- Teach children safe behaviors.
- Watch and supervise children as needed.
- Ensure that your home is childproof and safe.
- Put gates on stairways to prevent falls.
A 55-year-old male who came to us complaining of recurrent right hip prosthesis dislocation. He states stated that this had been occurring since he had a right Total Hip Arthroplasty (THA) a few years ago done at an outside institution, and he was in severe pain and discomfort… Read more
What Is the Long-Term Outlook?
Every dislocation, like all injuries and individual, will have its own unique healing time. Most people, on average, within a few weeks will experience a full recovery. Some joints that have more of a weight-bearing role, such as the knees or hips, full recovery might require future surgeries as well as be taking months up to several years. Permanent damage to the bones and the blood vessels that supply oxygen and nutrients to the bones can cause permanent damage in some cases.
Treat your dislocation faster, so an injury will not worsen over time or become a permanent injury.However, keep in on the mind that is important to remember and be aware that the joint is going to be weaker and the chances of a dislocation in the future are more likely than before the dislocation. If you ignore dislocations or avoid medical attention, sooner than later can cause permanent damage such as cell death to parts of the bone surrounding the joint and permanent pain.
Frequently Asked Questions
What are the surgery-related factors that can lead to a hip dislocation?
If the implant is not positioned correctly, which means the inclination of the cup is not correct or the angle at which the stem is inserted into the thigh bone is not correct, the hip can dislocate. Another reason could be an incomplete soft tissue repair on the posterior (back) aspect. In the posterior approach to the hip, the posterior soft tissue structures are taken down and those need to be repaired adequately so that the capsule of the hip is closed properly and that helps in preventing artificial hip dislocation.
What are the patient-related factors that can lead to a hip dislocation?
Patient-related factors are factors in which the patient does not cooperate with recommended precautions that must be followed for about six weeks after the surgery. It is important that the patient should not be moving the hip in a certain position. Especially the leg should not turn in. You should be keeping your knee separated if you have had a hip replacement for about four to six weeks after the surgery. What I tell my patients is you should be looking at the inside if your knee, not on the outside of your knee after the surgery.
What are the implant-related factors that can lead to a hip dislocation ?
The implant-related factors are factors related directly to the design of the implant. As an example, if we use larger heads for replacing the joint, the jump distance is more and therefore the possibility of the hip dislocating is less. Also, there are certain implants which have a better range of motion, and because the range of motion allowed by the design of the prosthesis is more, the possibility of hip dislocating is more.
What does cup abduction and anteversion mean?
Cup abduction is the angle at which the cup is inclines “away” from the body. The place is the horizontal plane- the plane that goes from one hip to another and includes the entire spine.
Cup anteversion is the angle at which the cup is inclined in “front” of the body. This is in the plane perpendicular to the horizontal plane which excludes the spine.
What can the surgeon do during the operation to prevent the implant from dislocating?
Dislocation is an early postoperative complication after total hip replacement, and one of the ways to decrease that is by doing the surgery more accurately and placing the implants very accurately. It involves preoperative planning, it involves preoperative radiographic templating, and robotic assistance and computer-navigated assistance has recently been of significant help in planning the hip replacement surgery and also recently knee replacement surgery.
In addition, there are also rigorous intraoperative tests for hip stability. A good repair of the soft tissues during closure also helps decrease the risk of hip dislocation. The hip joint is made of a cup and stem and there is a ball in between the cup and the stem. The cup has to be accurately positioned inside the pelvis and it has to be in the correct abduction and anteversion.
Correct abduction means that the cup inclination should be at around 40 degrees in the horizontal plane and anteversion means that in the vertical plane the cup needs to be placed at about 20 degrees. Intraoperatively we look at the preoperative template, look at the coverage of the cup, and that helps in deciding the abduction.
We also see the height of the cup intraoperatively based on how much higher it is located with reference to the teardrop in the pelvis. The anteversion in addition can be determined by accurately positioning the cup over the inferior acetabular ligament, which is the ligament inside the cup overlying its lower end. Also, I use a cup-angled guide which I place over the cup and that has two parts over it and it helps me decide how much horizontal the cup is in and how much incline the cup is.
On the stem side, I decide the anteversion of the stem, which means the inclination of the stem with reference to shaft of the lower leg when I place it inside, because the knees bend in 90 degrees of flexion during the placement of the stem at the time it is broached. Also, before making the neck resection we look at something called as the resection length of the neck, which means the length at which the neck is resected.
We also look at something called the center distance, which means we measure the distance between two points in the bone inside the hip and postoperatively we make sure that that length is in accordance with the preoperative template. If the height offset and the anteversion of the stem is restored, the possibility of a surgical hip dislocation is lower than when done with good soft tissue closure.
What is effective treatment for recurrent hip dislocation?
Artificial hip dislocation means that the ball pops out of the joint and if this happens more than three times it needs surgery. Hip dislocation is an early postoperative complication. If it happens the first time it involves something called a hip reduction, which means that the patient is anesthetized and the head is placed back into the socket without surgery.
After reduction, an x-ray is obtained to ensure that the reduction of the hip is accurate and the hip dislocation has been resolved. If the hip dislocates more than three times, typically it needs a revision surgery to prevent it from happening again.
What sort of surgery is performed for recurrent hip dislocation?
The most important thing that I do is see what is causing the hip dislocation. There are surgeon factors, patient factors, and implant factors. If there are surgeon factors, as an example if the cup is placed incorrectly or the stem is placed incorrectly, a CT scan is performed which shows very accurately where the implant has been placed and usually reposition of these implants can fix the issue of recurrent hip dislocation.
If the length of the hip is smaller compared to the preoperative length, the hip is also unstable and the solution to that is increasing the length of the stem. If the femoral anteversion, which means the placement of the implant to the thigh bone, if it is rotated abnormally that rotation has to be corrected to fix the issue of recurrent hip dislocation.
If there are patient-related factors they need to be resolved. It means the patient has to follow hip dislocation precautions postoperatively.
Implant-related factors can be resolved using newer implants where the geometry of the implant allows a better range of motion and decreases the risk of dislocation. Using the larger head decreases the possibility of hip dislocation because the jump distance is increased.
One of the devices that can be used in prevention of hip dislocation, especially when a cause is not very clear, is called a constrained liner. The head is locked into the cup and the possibility of a hip dislocation is dramatically decreased. The patient does not have to follow hip dislocation precautions after this type of surgery and the problem is usually resolved for life.
What are the symptoms of a hip dislocation?
After artificial hip replacement, dislocation may happen within the first few weeks of surgery and usually it happens with the hip is rotated in a certain way that it shouldn’t be rotated, implying that the hip dislocation precautions that the patient should be following have not been followed. There is sudden pain.
There is shortening of the extremity. The extremity is rotated inwards and the patient is unable to walk. The patient has to be immediately taken to the hospital where the patient is sedated and the hip is reduced, which means that the head is popped back into the socket.
How common is dislocation after a hip replacement?
Dislocation is a fairly rare complication of a hip replacement. If the hip is approached through the posterior approach, the hip commonly dislocates backwards. Hip dislocation is certainly possible but less common even after anterior hip replacement in which the head pops in front of the hip joint.
How soon does hip dislocation have to be treated?
The hip dislocation is treated emergently. There have been times that the hip has dislocated but it took time for the patient to get to the hospital or anesthetic could not be administered to the patient because of medical reasons. It is okay to keep the hip dislocated for a few days so long as there is no imminent neurovascular deficit, which means that there is no deterioration in neurological function or blood supply.
Once the hip is relocated, the outcomes are not going to be significantly different than a hip that is reduced immediately after dislocating and the outcomes will depend on the cause of the hip dislocation.
Is there a hip prosthesis that cannot dislocate?
There is no hip prosthesis that cannot dislocate. Even a constrained prosthesis which is used to treat recurrent dislocation does dislocate if not placed properly or if not taken care of properly.
Can a partial hip replacement dislocate?
It is certainly possible for a partial hip replacement to dislocate if the hip dislocation precautions are not followed. Most partial hip replacements are done using a posterior approach and posterior hip dislocation precautions do need to be followed after partial hip replacement, also known as hemiarthroplasty.
Can a native hip be dislocated?
Yes, a native hip also can be dislocated, although it is extremely hard to dislocate a native hip joint, which means a joint that has not been replaced. It is caused most commonly by motor vehicle accidents.
What are the things that a patient should and should not be doing after a hip replacement surgery to avoid the hip getting dislocated?
Most surgeons and physical therapists follow something called the 90-degrees rule, which means that the hip should not be bent beyond 90 degrees. You shouldn’t be squatting after hip replacement surgery. Remember that the hip dislocation precautions are not something which have to be observed for life, but only for four to six weeks after the surgery.
I feel it is more important to keep the knees separated after hip replacement surgery to decrease the hip getting dislocated. It is okay to cross your ankles, but the knees should be separated after the surgery for a few weeks while the soft tissues heal. Physical therapists after hip replacement surgery will reinforce this, although the surgeon also will talk to the patient before and after the surgery and reinforce these precautions. Sleeping with a pillow in between the legs ensures that the knees are separated.
The hip can be accidentally bent when picking up things, so patients are given a grasper and told to wear socks after the surgery. The patients are advised not to turn their legs inwards. They are told not to cross their legs. They are told not to turn their body with their legs fixed. However, these are difficult to follow. One thing I tell patients is keep the knees separated and don’t bend beyond 90 degrees. I keep it easy and simple and if the patients remember only this they will be following proper hip dislocation precautions.
Why choose Dr. Kakare?
As a top joint replacement specialist in New York City, Dr. Karkare has a stellar reputation, extensive experience, ensuring patients have the broadest array of safe and effective treatment options to relieve pain and other symptoms.
Doctor Karkare performs an in-depth evaluation of each patient to determine if an anterior approach would be a good choice or if another approach might be preferred before any procedure is performed.
This enables every patient to make an informed, educated decision so they can feel confident in their care every step of the way.
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