A hip dislocation occurs when the head of the femur (the ball at the top of the thigh bone) is forcibly displaced from the acetabulum (the cup-shaped socket in the pelvis). This severe orthopedic trauma disrupts the body’s largest ball-and-socket joint. The immense force required often results from high-energy events like motor vehicle accidents or falls from significant heights. A dislocated hip is a medical emergency requiring immediate professional intervention to prevent long-term damage.
Immediate Safety Warning and First Steps
Attempting to manipulate a dislocated hip without medical training is extremely dangerous and must be avoided. The hip joint is surrounded by major nerves and blood vessels, which can be severely damaged during uncontrolled movement. Forcing the joint can tear the sciatic nerve or compromise the blood supply to the femoral head, leading to avascular necrosis (tissue death).
The immediate priority is to call emergency medical services immediately. The patient should be kept as still and comfortable as possible, preferably lying flat, to prevent further movement of the injured limb. Do not attempt to move the patient unless absolutely necessary for safety, and do not try to straighten or reposition the leg.
Immobilizing the affected limb in the position it rests minimizes the risk of additional soft tissue injury. If possible, cover the patient with a blanket to maintain body temperature, as trauma can induce shock. Do not allow the patient to eat or drink anything, as they will likely require sedation or general anesthesia upon arrival at the hospital.
Medical Assessment and Professional Reduction Techniques
Upon arrival at a medical facility, the process begins with a rapid assessment, including X-rays to confirm the dislocation and check for associated fractures. Approximately 90% of traumatic hip dislocations are posterior (femoral head pushed backward). The less common anterior dislocation occurs when the femoral head is displaced forward.
Identifying the type of dislocation and any bone fragments is necessary before attempting closed reduction. The urgency of this procedure is driven by the risk of avascular necrosis, which increases significantly if the hip remains dislocated for more than six hours. Prolonged displacement damages the delicate blood vessels supplying the femoral head, making prompt reduction crucial for joint survival.
Closed reduction requires the patient to be completely relaxed because the hip muscles are some of the strongest in the body. The procedure is performed under procedural sedation and analgesia, often requiring strong muscle relaxants to overcome protective muscle spasms. A team of medical professionals executes the reduction to ensure controlled force and counter-traction.
One common technique for posterior dislocations is the Allis maneuver. The patient lies on their back while an assistant stabilizes the pelvis. The physician flexes the patient’s hip and knee to a 90-degree angle and applies steady, upward traction along the femur. Gentle internal and external rotation guides the femoral head back into the socket.
Another approach is the Stimson technique, which utilizes gravity. The patient is positioned face-down with the injured leg hanging over the side of the gurney, allowing the hip and knee to naturally flex to 90 degrees. The physician applies a gentle, downward force to the lower leg while slowly rotating the foot inward and outward. A successful reduction is often accompanied by a distinct “clunk” sensation.
Post-Reduction Care and Rehabilitation
Immediately following closed reduction, follow-up imaging is performed, typically including X-rays and often a computed tomography (CT) scan. This imaging confirms the femoral head is perfectly seated within the acetabulum. It also helps identify any small bone fragments or debris created during the injury or reduction. Fragments within the joint space can lead to instability or long-term damage, potentially necessitating surgical removal.
The patient is closely monitored for signs of neurovascular compromise, especially the function of the sciatic nerve and leg circulation. Even after successful reduction, a stretched or compressed nerve may cause temporary weakness or numbness in the foot and ankle, requiring ongoing observation. A typical hospital stay lasts a few days to manage pain and ensure stability before discharge.
The initial recovery phase involves strict weight-bearing restrictions, often requiring crutches for several weeks to allow the joint capsule and ligaments to heal. The duration of non-weight-bearing depends on whether associated fractures were present; simple dislocations generally allow earlier weight-bearing. This period is followed by a gradual transition to partial and then full weight-bearing.
Physical therapy is a fundamental component of rehabilitation, focusing on restoring full range of motion and building strength in the surrounding muscles. Specific exercises target the gluteal muscles and deep hip rotators, which provide dynamic stability to the joint. Strengthening these muscles helps prevent re-dislocation, a common concern after the initial injury. A full return to pre-injury activity may take several months.