Follow-up
Return to Play
Athletes recovering from hip dislocations must follow a strict physical therapy regimen to ensure complete recovery of function. Stretching and range-of-motion exercises are important early in the recovery process, advancing to walking on crutches when the patient's pain fully resolves. Strengthening exercises of the muscles around the hip are important during the rehabilitation to take stress off the injured joint. The athlete should advance his or her rehabilitation regimen over time as tolerated, with light jogging by 6-8 weeks post injury, and regain full function in high-performance athletes by 3-4 months post injury.
Complications
A number of acute and chronic complications of hip dislocations exist, not all of which can be avoided with proper medical care and strict follow-up by the injured athlete. Acutely, avoiding the sequelae of sciatic nerve damage and the existence of bony fragments and soft tissues in the joint space is important. A thorough physical examination and review of the radiographic findings are required to avoid the consequences of these conditions.
Chronic complications (eg, avascular necrosis, osteoarthritis) may not be avoided with good follow-up care. Radiographs should be obtained at the previously described intervals, and an MRI should be performed within 6 weeks post injury to evaluate for avascular necrosis (see Maintenance Phase, Other Treatment). Unfortunately, even with compliant patients, early diagnosis, early and appropriate treatment, and good follow-up, some patients develop chondrolysis, avascular necrosis, and early degenerative joint disease (DJD).
Prevention
- No literature on the prevention of hip dislocations exists.
- As these injuries are generally high-velocity injuries, the success of any prevention program, other than high-risk activity avoidance, would be unlikely.
Prognosis
The amount of energy to the hip and the associated trauma during the initial injury are the most important factors related to prognosis. Fortunately, sports-related hip dislocations are usually caused by less energy than is generated during motor vehicle accidents. The prognosis is best when the hip is reduced as soon as possible, preferably less than 12 hours post injury. The prognosis is also dependent upon the amount of related fractures or damage associated with the joint. The less associated damage to the surrounding structures there is, the better the prognosis for full recovery.
Education
Although no studies on the prevention of hip dislocation exist, athletes that participate in high-performance activities need to understand the importance of performing proper warm-up techniques before competition and maintaining good overall flexibility and strength. These attributes are especially important during athletic events (eg, American football, rugby, alpine skiing) when high speeds can generate relatively large forces, which can cause serious injuries to competing athletes.
Miscellaneous
Medicolegal Pitfalls
- Delay in care of a hip dislocation can cause very serious medicolegal challenges. The most common complication of hip dislocations is avascular necrosis. The best way to prevent this occurrence is to reduce the injured hip as early as possible, preferably less than 6 hours after the injury. A common reason for delay of care is the inability to perform a closed reduction because of the presence of bony fragments or damaged soft tissue in the joint space. Care must be taken to obtain a CT scan in a timely fashion and to take the patient to the operating room for an open reduction.
- Another potential problem is an inaccurate or incomplete diagnosis. For example, missed associated injuries (neurologic or vascular injury, fractured femur or tibia, dislocated knee, knee ligament injury), or nonconcentric reductions could potentiate medicolegal consequences.
- A good neurologic examination should be performed on any patient with a hip dislocation before and after reduction. Damage to the sciatic nerve is a severe complication of hip dislocation that can be treated in the operating room by trained surgeons. Contusion or laceration of the sciatic nerve can be repaired surgically with subsequent return of function. The neurologic function must be documented post reduction because the sciatic nerve can be damaged during a closed-reduction maneuver. The status of the common peroneal branch also needs to be assessed and documented.
- Osteoarthritis is the most common long-term sequela of hip dislocation, and it can be exacerbated by the presence of bony fragments and soft tissue in the joint space. A thorough physical examination and close follow-up care with radiography should be performed to rule out the presence of debris in the injured hip joint space. Suspicious radiographs should be followed up with CT scanning for further evaluation.
The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Alexander Zlidenny, MD, and Federico E Vaca, MD, FACEP, to the development and writing of this article.
More on Hip Dislocation |
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| Differential Diagnoses & Workup: Hip Dislocation |
| Treatment & Medication: Hip Dislocation |
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Further Reading
Keywords
hip dislocation, hip joint, hip fracture, dislocated hip, traumatic hip dislocation, prosthetic hip dislocation, hip dysplasia, congenital hip dislocation, CDH, developmental dysplasia of the hip, DDH, prosthetic hip dislocation, hip fracture-dislocation
