The hip joint is one of the most important joints in the human body. It allows us to walk, run, and jump. It bears our body’s weight and the force of the strong muscles of the hip and leg. Our hips are also one of our most flexible joints, which allows a greater range of motion than all other joints in the body, except for the shoulder. The hip is considered one of the more complex regions of our body due to its multi-axial arrangement, meaning it can move in many different directions. When they are healthy, it takes great force to hurt them. However, playing sports, running, overuse or falling can all sometimes lead to hip injuries. These include strains, bursitis, dislocations, and fractures. Certain diseases also lead to hip injuries or problems. Osteoarthritis can cause pain and limited motion. This condition of the hip causes weak bones that break easily, both of which are more common in older people.
Your hip is the joint where your thigh bone meets your pelvis bone. Hips are known as ball-and-socket joints because the ball-like top of your femur moves within a cup-like space in your pelvis. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur. A smooth tissue called articulate cartilage covers the surface of the ball and the socket. It creates a low friction surface that helps the bones glide easily across each other.
A hip dislocation occurs when the head of the thighbone is forced out of its socket in the hip bone. When there is a hip dislocation, the femoral head is pushed either backwards out of the socket, or forwards. It typically takes a major force to dislocate the hip. Car collisions and falls from significant heights are common causes and, as a result, other injuries like broken bones often occur with the dislocation. In rare cases, a hip dislocation can occur during impact sports like football. A hip dislocation is a very painful and serious medical emergency, where immediate treatment is necessary.
Causes & Symptoms
When there is a hip dislocation, the femoral head is pushed either backwards out of the socket, or forwards. In addition, posterior dislocation and anterior dislocation can occur as described below:
- Posterior dislocation – In approximately 90% of hip dislocation patients, the thighbone is pushed out of the socket in a backward direction. This is called a posterior dislocation. A posterior dislocation leaves the lower leg in a fixed position, with the knee and foot rotated in towards the middle of the body.
- Anterior dislocation – When the thighbone slips out of its socket in a forward direction, the hip will be bent only slightly, and the leg will rotate out and away from the middle of the body.
When the hip dislocates, the ligaments, labrum, muscles, and other soft tissues holding the bones in place are often damaged as well. The nerves around the hip may also be injured.
Hip dislocations are an uncommon injury in a normal hip. It takes a lot of energy to dislocate a hip, and most dislocations of the hip are due to motor vehicle injuries. Athletic injuries most often occur in football, rugby, downhill skiing, and snowboarding. In patients who have had hip replacements, a simple fall or abnormal movement may provide enough energy to dislocate the hip prosthesis.
Pain, deformity, muscle spasm, and inability to move the hip are common symptoms and signs of hip dislocation. The patient will not be able to bear weight or stand on the hip. Upon physical examination, the hip and leg will be in an abnormal position and there will be physical deformity. For instance, from a posterior hip dislocation, the hip will be short and internally rotated, meaning that the foot will be pointing inwards toward the midline of the body. For anterior hip dislocations, this will have a shortened leg with the foot externally rotated or pointing away from the midline of the body.
Who Gets Hip Dislocations?
Children can experience hip dislocations due to congenital conditions, which a doctor will most likely detect from a screening. This may include developmental hip dysplasia, where the hip joint does not form properly. Other risk factors include spastic hip disease, which is sometimes due to underlying medical conditions. Young, adult males are more likely to experience an accident-related hip dislocation. As motor vehicle accidents are a common cause of hip dislocations, people should be aware and wear a seatbelt to help prevent hip dislocation or other traumatic injuries.
Having a hip replacement can also increase the risk a patient will experience a hip dislocation. Other risk factors for a hip dislocation include:
- Susceptibility to falls – Falling increases the chances of a dislocated hip if you use your arms to brace for impact or if you land forcefully on a body part.
- Heredity – Some patients are born with ligaments that are looser and more prone to injury than those of other people.
- Sports participation – Many dislocations occur during high-impact sports, such as rugby and football.
How Does It Affect You? How Serious Is It?
Hip dislocation can have long-term consequences, particularly if there are associated fractures, such as the following:
As the thighbone is pushed out of the socket, particularly in posterior dislocations, it can crush and stretch nerves in the hip. The sciatic nerve, which extends from the lower back down the back of the legs, is the nerve most commonly affected. Injury to the sciatic nerve may cause weakness in the lower leg and affect the ability to move the knee, ankle, and foot normally. Sciatic nerve injury occurs in approximately 10% of hip dislocation patients. The majority of these patients will experience some nerve recovery.
As the thighbone is pushed out of the socket, it can also tear blood vessels and nerves. When the blood supply to the bone is lost, the bone can die, resulting in osteonecrosis. This is a painful condition that can ultimately lead to the destruction of the hip joint and arthritis.
The protective cartilage covering the bone may also be damaged, which increases the risk of developing arthritis in the joint. Arthritis can eventually lead to the need for other procedures, such as a total hip replacement.
Recommended Treatment & Rehabilitation
Physical examination often clinically diagnoses hip dislocation. A doctor might be able to observe a deformity at the hip, as well as abnormal positioning of the hip.
X-rays confirm the diagnosis of hip dislocation. The doctor will also look for any complications associated with the hip dislocation, including injury to the femoral artery that runs in front of the joint and the sciatic nerve located in the back of the hip. Depending upon the situation, the doctor may assess the patient for other injuries that might be present.
The most important treatment of a dislocated hip is to properly position the ball back into the socket, which is called a joint reduction. In order to reposition the hip joint, the patient will often require general anesthesia.
Unlike a shoulder dislocation, where many patients can reposition the dislocation on their own; a hip dislocation normally requires significant force to reposition. In some cases, surgery is required to enable the joint to return to its normal position.
Once the ball is back in the socket, your doctor will then evaluate for other injuries, including injury to the bone, cartilage, and ligaments. Depending on your injuries, further treatment may be necessary. Broken bones may need to be repaired in order to keep the ball within the socket, and damaged cartilage may have to be removed from the joint.
Hip arthroscopy is becoming more commonly used as a tool to help minimize the invasiveness of certain types of procedures performed when treating this type of injury. In addition, the development of early arthritis of the hip can be common following this type of trauma to the hip joint. Therefore, many patients who have a hip dislocation ultimately require hip replacement surgery.
Hip replacement surgery is performed to replace the ball and socket of the damaged hip joint. This surgery can be performed for many reasons, including trauma or arthritis. It is among the most common and most successful orthopedic surgeries, but it is a major surgical procedure that is not without risk. In most cases, most patients who undergo hip replacement surgery are able to resume a normal, active lifestyle without significant discomfort from their hip joint.
It is recommended to perform exercises in order to reduce any further symptoms linked to pain in general. You can try these exercises at home or elsewhere:
Your hamstring attaches to the pelvis behind your hip and works to bend your knees and extend your hips. Tightness here may cause pain in the back of your hips and limit your ability to move normally. To perform this exercise, you first off lie on your back with both knees out straight. Then, bend one knee, and place both hands behind your knee. While holding behind your knee, straighten your knee all the way out. Finally, hold the straight knee position for 60 seconds, then repeat three times for each side.
Hip flexor stretch
Your hip flexors are located in the front of your hip and thigh and are often tight when you have osteoarthritis, or if you sit for a long period of time. To stretch these hip flexors, you first place one knee on the floor and have the other foot flat in front of you. Keep your shoulders and chest up high, then tighten your abdominals. Slide your body forwards until you feel a pull in the front of your hip and thigh on the knee that is on the floor. Hold the position for 60 seconds, and repeat three times for each side.
Iliotibial band stretch
Lie on your side (the side that you wish to stretch should be on top). Keep your bottom knee bent for stability, then reach back and grab the ankle of your upper leg and bend your knee. You should feel a pull in the front of your thigh. While keeping your knee bent, gently rest the foot of your bottom leg on top of your upper knee. Use your foot on top of your knee to slowly pull your upper knee down towards the floor. You should feel a pulling sensation on the side of your kneecap where the iliotibial band crosses the knee joint. Finally, hold this position for 60 seconds, then relax before repeating this stretch three more times.
Straight leg raise
Lie on your back with one knee bent and one knee straight. Tighten your quadriceps muscle on the front of your straight leg and engage your abdominals. Lift your straight leg up about 12 inches. Hold this position for three seconds, then lower your leg down slowly before repeating 15 more times.
Alternative & Homeopathic Treatment
In some cases, hip pain is nothing more than a short-term annoyance, whilst in other cases it can be a sign of a serious health problem. If you have mild to moderate hip pain, these at-home treatments can help ease symptoms linked to this condition, such as:
- Rest – Avoid doing things that require you to bend at the hip or put a lot of pressure on the hip. Avoid sleeping on the side of your hip that is painful and sitting for long periods of time.
- Pain relievers – Some pain-relieving medications like acetaminophen, ibuprofen, and naproxen can help reduce inflammation that might be causing or aggravating your hip pain.
- Cold and heat application – Treating pain with heat and coldness may help; wrap an ice pack or a bag of frozen vegetables in a towel to ice your hip. A warm bath or shower may also help reduce your pain and prepare your muscles for stretching.
- Stretch – Gently stretching your body may reduce hip pain, especially if the cause is a strain or pinched nerve.