Hip Dislocation

 

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Original Editors

Top Contributors - Annelies Noppe, Leana Louw, Lucinda hampton, Kim Jackson, Lokiru Paul, Anas Mohamed, Kirenga Bamurange Liliane, WikiSysop and Vidya Acharya  

Search Strategy

Keywords: Luxation of the hip, hip luxation, dislocation of the hip, physical therapy hip luxation, congenital dislocation hip, Hip dysplasia, comparison, differential diagnosis, symptoms

Databases: PubMed

Definition/Description

Luxation of the hip is a dislocation of the hip. Which means that the head of the femur comes out of the acetabulum. Most of the times this causes damage at the tissues around the hip.

Clinically Relevant Anatomy

The hip anatomy exist of the acetabulum and the caput femoris. The acetabulum has the shape of a cup and the caput femoris has the shape of a ball. These caput femoris placed in the acetabulum creates the hip joint which is an ball-and-socket or articulatio spheroidea. So The femoral head has to ‘roll’ in the acetabulum. ⁶

The hip is a bearing ball joint with as main function support. The stability of the hip joint is provided mainly by the capsule and by the muscles and ligaments who are located there. They stabilize the femoral head in the acetabulum and ensure that the hip joint can make all the necessary movements.

Epidemiology /Etiology

Characteristics of patients with an increased risk of developing a luxation: female gender, alcohol abuse, various preoperative disorders and older age because decreased muscle mass reduces the stress on the hip prosthesis and decreases the natural protection against hip dislocation.
Older people often have balance disorders, making them often have fall and this increases the risk of dislocation. Moreover, they often have neuromuscular dysfunction. In particular, neuropathy causes an increased luxation risk. Even with a (pre) cerebrovascular accident (CVA) is the risk high. Cognitive impairment is also associated with more dislocations.
The biggest risk factors for hip luxation are great dexterity, poor follow instructions and increased tendency to fall ¹⁰.

There are two main causes for a luxation of the hip :

- Congenital hip dislocation

- Acquired hip dislocation
          Hip dislocation after an accident (posterior / anterior) or hip dislocation after hip replacement surgery.

Congenital hip dislocation (CHD)
This condition has recently been renamed developmental dysplasia of the hip or DDH. All newborn babies have their hips checked for DDH within a few days of birth and at six weeks by doctors, so that treatment can be started early if necessary, long before damage occurs¹⁴. CHD occurs with an incidence that vary between 1.5 and 20 per 1.000 births and 8 times more commonly in girls than in boys ¹,² . This is explained by the greater mobility of the hip by women ³.

Acquired hip dislocation
The traumatic luxation of the hip, mostly caused by car accidents, is always the result of an external force with high intensity. This means that this is rarely the only injury being suffered. In the direction of the force, we distinguish 2 main types of hip dislocations: luxatio posterior, where the caput femoris is pushed out of the acetabulum (by far the most common, 85% - 90% ⁴) and the luxatio anterior, whereby the femoral head is moved forward. By posterior dislocation the hip is in a fixed position, bent and twisted in toward the middle of the body. By the anterior dislocation, the femur has slip out of its socket in a forward direction where the hip will be bent only slightly and the leg will twist out and away from the middle of the body.
Dislocation after hip replacement surgery has the highest incidence rate immediately after the surgery or in the first three months. The incidence of hip dislocation following hip replacement surgery greatly depends on patient, surgical and hip implant factors. In general, the larger the head of the femur post surgery, the less likely a patient is to experience dislocation.

Characteristics/Clinical Presentation

Pain
Severe pain is the most common symptom. Because the femur is separated, muscles and tendons can be damaged as well. The knee can also hurt.

Swelling
There can be a swelling at the site of the injury. The surrounding skin is puffy.

Hip or leg deformity
In most of the cases is the affected leg shortened. The hip joint appears deformed

Hip immobility
Patients can experience difficulty moving the affected hip and so the inability to walk because of the pain and swelling.

Differential Diagnosis

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Diagnostic Procedures

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Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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