A dislocated hip is a severe medical emergency that occurs when the ball-shaped head of the thigh bone (femur) is forced out of its socket in the pelvis (acetabulum). Attempting to manually reposition a dislocated hip without specialized medical training is extremely dangerous and strictly prohibited. This action can cause catastrophic damage to surrounding nerves, blood vessels, and bone structure, potentially leading to permanent disability. The only safe response is to seek immediate medical attention at a hospital, which will initiate the professional process of reduction.
Understanding Hip Dislocation
The hip functions as a robust ball-and-socket joint, designed for wide-ranging motion and significant weight-bearing stability. The femoral head fits snugly into the acetabulum, supported by powerful ligaments and surrounding muscles. A hip dislocation requires immense force to tear the joint capsule and ligaments, typically resulting from high-energy trauma such as a car accident or a significant fall.
The vast majority of traumatic hip dislocations (approximately 90%) are classified as posterior, meaning the femoral head is driven backward out of the socket. This forces the leg into a recognizable position of internal rotation, adduction, and flexion. Anterior dislocations are much less common and present with the leg externally rotated and abducted.
The severity of this injury extends beyond the joint due to the proximity of neurovascular structures. The sciatic nerve, which runs directly behind the hip joint, is vulnerable to injury during dislocation, potentially resulting in foot drop or numbness. A concerning complication is avascular necrosis (AVN), where the blood supply to the femoral head is compromised. Delays in reduction significantly increase the risk of AVN, which causes bone death and eventual collapse of the femoral head.
Immediate Emergency Response
Immediately following a hip dislocation, the most important action is to call emergency medical services (EMS) or 911. The injured person must remain completely still, supporting the injured limb in the position it rests, even if it appears severely deformed. Any attempt by the patient or a bystander to reposition the limb can convert a simple dislocation into a more complex injury involving additional fractures or nerve damage.
While waiting for professional help, the patient should be kept calm and flat on their back. They must be monitored for signs of circulatory compromise in the foot, such as pallor or loss of sensation. Avoid giving the injured person anything to eat or drink, as they will likely require immediate sedation or general anesthesia upon arrival at the hospital. EMS personnel will safely immobilize the hip and transport the patient to a trauma center for urgent treatment.
Medical Reduction Procedures
The professional process of putting a hip back into place is called a closed reduction and represents an orthopedic emergency that must be performed as rapidly as possible. The goal is to reduce the hip within six hours of injury to minimize the risk of avascular necrosis. The procedure is always performed in a controlled emergency room or operating room setting under sedation or general anesthesia to relax the powerful hip muscles and manage the intense pain.
Before the reduction is attempted, X-rays confirm the direction of dislocation and check for associated fractures of the femoral head or acetabulum. The physician uses specific, controlled maneuvers involving longitudinal traction on the thigh bone while gently manipulating the leg’s rotation. Common closed reduction techniques include the Allis, Stimson, and Bigelow maneuvers, which rely on leveraging the femur to guide the head back into the socket.
The Allis maneuver involves flexing the hip and knee to 90 degrees and applying upward traction while an assistant stabilizes the pelvis. The Stimson technique, often called the gravity method, requires the patient to be prone with the leg hanging over the side of the bed, allowing gravity to assist with traction. If the closed reduction is successful, a distinct “clunk” is often felt, and a post-reduction X-ray is immediately taken to confirm concentric alignment and check for any bone fragments. If the hip cannot be reduced or remains unstable, or if bone fragments block the joint, an open reduction surgery is required.
Recovery and Long-Term Care
Following a successful closed reduction, the patient is monitored and enters a structured recovery phase focused on protecting the joint capsule and promoting healing. Initial care involves a period of protected weight-bearing, often requiring crutches or a walker for several weeks. Patients are advised to limit hip flexion to no more than 90 degrees and avoid crossing the legs to prevent re-dislocation while the soft tissues heal.
Physical therapy begins soon after the reduction, sometimes within a week, to restore the hip’s range of motion and strengthen the surrounding musculature. Early exercises focus on gentle, passive movement, gradually progressing to active strengthening of the hip flexors, extensors, and abductors. Full return to normal, vigorous activity can take approximately three to four months, depending on the severity of the initial injury and the presence of any associated nerve or bone damage.
Patients must remain aware of long-term risks, including post-traumatic arthritis and the delayed onset of avascular necrosis, which can take months to develop. Regular follow-up imaging, such as X-rays or MRI, is necessary to monitor the femoral head’s health. The risk of future dislocation is also elevated, making adherence to physical therapy and movement precautions important for long-term joint health.