Dislocation of hip
Encyclopedia
Dislocation of the hip is a common injury to the hip joint
. Dislocation occurs when the ball–shaped head of the femur
comes out of the cup–shaped acetabulum
set in the pelvis. This may happen to a varying degree. A dislocated hip, much more common in girls than in boys, is a condition that can either be congenital or acquired. Understanding the epidemiology, anatomy, difference between congenital and acquired, screening, treatments, and rehabilitation are all relevant to the topic.
and continues to have a high level for possibility of incidence throughout the first three months following the surgery. Following a primary total hip replacement surgery, 3.9% of patients experience hip dislocation during the twenty-six postoperative weeks. Following a revision total hip replacement surgery, approximately 14.4% of patients experience hip dislocation during the twenty-six postoperative weeks. The incidence of hip dislocation following hip replacement surgery greatly depends on patient, surgical and hip implant factors. Preoperative hip range is the most likely the most influential contribution as to weather a hip is able to remain stable or not. Because hip stability
greatly depends on hip range of motion it is crucial for a hip’s postoperative range of motion to fall within a certain range in order to ensure maximum stability.
Following partial or total hip replacement surgery, patients with 115 degrees or greater of combined preoperative adduction, internal rotation, and adduction as well as a posterior approach experienced hip dislocation at a considerably higher frequency than patients who had less than 115 degrees of combined hip range of motion. In addition to the degrees of range of motion a patient possesses post surgery; size of the femoral head is another large contributing factor to the stability of the hip. High preoperative motion in combination with a posterior approach and femoral head size that is less than 32 mm had the highest hip dislocation rate. In general, the larger the head of the femur post surgery, the less likely a patient is to experience dislocation. This is because during the replacement surgery, a patient’s “ball and socket” of the femur
head and hip socket are changed and no longer fit together in the perfect way they did prior to surgery. When a femur head is smaller than 32 mm post surgery, the loser the “ball” femur head fits inside the hip “socket”, therefore increasing the likelihood for the femur to slip and slide out of the socket, causing hip dislocation.
is divided into five age groups which are newborns less than one year old, the next age group is people from the ages of 1-17, the third age group is 18–44 years old, the fourth age group is 45-64, and the final age group is 65–88 years old. The age group of <1 has 2,233 cases which accounts for 60.07% of all known cases. The age group of 1-17 has 686 cases which accounts for 18.44% of all cases of congenital hip dislocation. The next age group which is 18-44 has 249 cases which accounts for 6.70% of all cases and the age group of 45-64 has 332 cases which is about 8.93% of all cases. Finally, the age group of 65-84 has 158 cases which accounts for 4.25% of all cases of congenital hip dislocation.The epidemiology also shows that females are more prevalent to get congenital hip dislocation compared to their male counterparts. Females had 2,571 cases which is 69.15% of all cases while for men there are 1,136 cases which makes up 30.56% of all cases of congenital hip dislocation. The costs vary from age groups. The mean costs for the age group <1 is $7,803 while the median cost is $ 7,045. The costs for the age group of 1-17 are $13,573 for a mean and the median cost is $12,513. The mean cost for the age group of 18-44 is $16,656 and the median cost is $14,082. Finally, the age group of 45-64 has a mean cost of $14,388 and a median cost of $12,321. The amount of days of the hospital stay varies as well. In the age group 1-17 the length of stay is about 2.7 days, for the people ages 18–44 the average stay is 4.4 days, and the people ages 45–64 stay for about 3.4 days in the hospital setting.
, hip extension
, hip abduction
, hip adduction
, hip external rotation
, hip internal rotation
, hip diagonal abduction, hip diagonal adduction, and anterior, posterior, lateral, and transverse pelvic rotation) that are associated with the hip, making the hip joint an important necessity.
and femur
are the two main bones that form the hip joint. There is an articulation of the head of the femur and the acetabulum of the pelvis. Together, they make the hip joint an enarthrodial joint. There are two pelvic bones (right and left), each consisting of the Ilium
, ischium, and the pubis
. They connect to form the symphysis pubis on the anterior side, while the posterior side connects with the sacrum
and coccyx
to form sacroiliac joints. These bones are joined with help of strong ligaments, making them slightly, movable joints. There are five strong and dense ligaments that help to reinforce the hip joint. They include the iliofemoral ligament, the teres ligament, the pubofemoral ligament, the ischiofemoral ligament, and the zona orbicularis ligament.
, pectineus, and sartorius
. The lateral side performs primarily hip abduction with help from the gluteus medius, gluteus minimus, external rotators, and the tensor fasciae latae
. The posterior side exhibits primarily hip extension with help from the gluteus maximus, hamstring muscles (biceps femoris, semitendinosus, semimembranosus), and the six deep external rotators (piriformis, obturator externus, obturator internus, gemellus superior, gemellus inferior, and quadrates femoris). The medial side performs primarily hip adduction with help from the adductor brevis, adductor longus, adductor magnus, and the gracilis
.
Hip flexion and hip extension take place in the sagittal plane while hip abduction and adduction move the femur in the frontal plane. Hip external and internal rotation laterally and medially moves the femur in the transverse plane, respectively. Anterior and posterior pelvic rotation involves anterior and posterior movement of the upper pelvis in the sagittal plane, respectively. Lateral pelvic rotation (left and right) occurs in the frontal plane, whereas transverse pelvic rotation (left and right) occurs in the horizontal plane.
In an anterior dislocation the limb will not be lengthened as noticeably and will be externally rotated.
. If it is not detected, the child's hip may develop incorrectly seen when the child begins to walk. If one hip is affected the child will have a limp and lurch and with bilateral dislocation there will be a waddling gait. On physical exam, with the baby in the supine
position, the examiner flexes the hips and knees both to 90 degrees, and, holding the knees, pushes gently downward, which may induce a posterior dislocation or subluxation
. Keeping the baby in this 90 degree flexed position, the examiner then externally rotates the thighs. A normal infant will demonstrate no evidence of dislocation. It can also be detected with the Galeazzi test
. Congenital hip dislocation is much more common in girls than boys.
Acquired hip dislocations are extremely painful and commonly occur during car accidents. They may be treated by surgical realignment and traction.
To actually dislocate a hip, a great amount of force
needs to be applied. Motor vehicle accidents are the most common ways that hip dislocations occur. Falls from high areas, such as a ladder, can also generate enough force to dislocate a hip. In older individuals, even a slight fall could cause this type of injury. This type of wear and tear that the body undergoes throughout the years leads to increased incidents of hip dislocation in the older population.
Hip injuries in sports are also quite common. In contact sports such as rugby and American football hip dislocation is a result of great amounts of force applied to the body during contact and collision. In other sports such as water skiing, skiing/snowboarding, gymnastics, and basketball these injuries are less common because there are fewer collisions in contact. However, when the amount of force to the hip joint is greater than the muscles of the hip can compensate for, hip injuries can still occur.
Several other injuries are also associated with hip dislocation. Fractures in the pelvis and legs, and minor back or head injuries can also occur along with a hip dislocation that is caused by a fall or athletic type of injury.
of the hip is a condition in which a child is born with a hip problem. Congenital hip dislocation is when the formation of the hip joint is abnormal. The ball at the top of the thighbone which is known as the femoral head is not stable within the socket which is also known as the acetabulum
. This abnormality may cause the ligaments of the hip to be loose or stretched. This condition is usually diagnosed once the baby is born; it mostly affects the left side of the hip in first-born children, girls, and babies born in a breech position. Girls are most prone to getting the hip dislocation compared to boys. The cause of this condition is still unknown; however, some factors of congenital hip dislocation are through heredity and racial background. It is also a known fact that it is more likely to occur in Native Americans than any of the other races. It also has a low prevalence risk in African Americans and southern Chinese
. Native Americans
are most likely to get congenital hip dislocation than any of the other races. The risk for Native Americans is about 25-50 cases for every 1000 people. The overall frequency of developmental dysplasia of the hip is approximately 1 case per 1000 individuals; however, Barlow believed that the incidence of hip instability
in newborns can be as high as 1 case for every 60 newborns.
The early sign of congenital hip dislocation is when a person is able to hear "clicking" sounds when the legs are moved apart from one another. This condition can be treated if detected early. If this condition goes undetected it can cause one leg to "look" shorter than its counterpart and the buttocks folds are also not symmetrical which causes more creases to be present on the affected side, and skin folds at the thigh are uneven. Another sign is that when a child begins to walk he or she may have a limp and favor the affected side when walking. When a child is walking they may be also walking on their toes or they may even "waddle" like a duck. If the condition goes undetected this may cause negative long term effects such as osteoarthritis
as well affect the gait of the child when they first learn to walk. This condition may also cause the baby to start to learn how to walk much later than expected.
. In order to do the Ortolani maneuver it is recommended the examiner put the newborn baby in a position in which the contralateral hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. If a sound of a "clunk" of the femoral head moving over the acetabulum it is normal but the less likely the examiner hears the "clunk" sound that means the acetabulum was not fully developed. The next method that can be used is called the Barlow maneuver it is done by adducting the hip while pushing the thigh posteriorly. If the hip goes out of the socket it means it is dislocated and the newborn has a congenital hip dislocation. They examine the baby by laying the baby on its back and separating their two legs apart if a clicking sound can be heard then that means that the baby may have this condition. It is highly recommended that these maneuvers be done when a baby is not fussy because the baby may inhibit hip movement. There can also be another way to detect congenital hip dislocation and it is called the tonic labyrinthine reflex
(TLR). It is a reflex that is present in newborn babies. It is suggested that in order to do this reflex exercise the head is tilting back which causes the baby’s back to become stiffened, the legs are straightened and pushed together with the toes to point, and the arms bent at the elbows and wrists. Also the hands will be put into a fist or the fingers will be curled. If this reflex is present past the newborn stage the person may have an abnormal extension pattern.
. This particular procedure can be done on children from the ages of six months to two years old. If the closed reduction treatment does not work then open surgery is another option to use. After the closed or opened surgery is done the child must wear a cast or braces in order to keep the hip bone in the socket while it is healing. By using one of these treatment methods the child can have normal hip joint function.
and receive professional prescriptive exercises based on their individual abilities, progress, and overall range of motion. The following are some typical recommended exercises used as rehabilitation for hip dislocation. It is important to understand that each individual has different capabilities that can best be assessed by a physical therapist or medical professional, and that these are simply recommendations.
Joint
A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...
. Dislocation occurs when the ball–shaped head of the femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
comes out of the cup–shaped acetabulum
Acetabulum
The acetabulum is a concave surface of the pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint.-Structure:...
set in the pelvis. This may happen to a varying degree. A dislocated hip, much more common in girls than in boys, is a condition that can either be congenital or acquired. Understanding the epidemiology, anatomy, difference between congenital and acquired, screening, treatments, and rehabilitation are all relevant to the topic.
Epidemiology
Acquired hip dislocation has the highest incidence rate immediately after hip replacement surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
and continues to have a high level for possibility of incidence throughout the first three months following the surgery. Following a primary total hip replacement surgery, 3.9% of patients experience hip dislocation during the twenty-six postoperative weeks. Following a revision total hip replacement surgery, approximately 14.4% of patients experience hip dislocation during the twenty-six postoperative weeks. The incidence of hip dislocation following hip replacement surgery greatly depends on patient, surgical and hip implant factors. Preoperative hip range is the most likely the most influential contribution as to weather a hip is able to remain stable or not. Because hip stability
Joint stability
Joint stability refers to the resistance offered by various musculoskeletal tissues that surround a skeletal joint. Several subsystems ensure the stability of a joint. These are the passive, active and neural subsystems. The opposite of stability is instability...
greatly depends on hip range of motion it is crucial for a hip’s postoperative range of motion to fall within a certain range in order to ensure maximum stability.
Following partial or total hip replacement surgery, patients with 115 degrees or greater of combined preoperative adduction, internal rotation, and adduction as well as a posterior approach experienced hip dislocation at a considerably higher frequency than patients who had less than 115 degrees of combined hip range of motion. In addition to the degrees of range of motion a patient possesses post surgery; size of the femoral head is another large contributing factor to the stability of the hip. High preoperative motion in combination with a posterior approach and femoral head size that is less than 32 mm had the highest hip dislocation rate. In general, the larger the head of the femur post surgery, the less likely a patient is to experience dislocation. This is because during the replacement surgery, a patient’s “ball and socket” of the femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
head and hip socket are changed and no longer fit together in the perfect way they did prior to surgery. When a femur head is smaller than 32 mm post surgery, the loser the “ball” femur head fits inside the hip “socket”, therefore increasing the likelihood for the femur to slip and slide out of the socket, causing hip dislocation.
Congenital
As of the year 2009 there are a total of 3,718 cases of congenital hip dislocation. The epidemiologyEpidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
is divided into five age groups which are newborns less than one year old, the next age group is people from the ages of 1-17, the third age group is 18–44 years old, the fourth age group is 45-64, and the final age group is 65–88 years old. The age group of <1 has 2,233 cases which accounts for 60.07% of all known cases. The age group of 1-17 has 686 cases which accounts for 18.44% of all cases of congenital hip dislocation. The next age group which is 18-44 has 249 cases which accounts for 6.70% of all cases and the age group of 45-64 has 332 cases which is about 8.93% of all cases. Finally, the age group of 65-84 has 158 cases which accounts for 4.25% of all cases of congenital hip dislocation.The epidemiology also shows that females are more prevalent to get congenital hip dislocation compared to their male counterparts. Females had 2,571 cases which is 69.15% of all cases while for men there are 1,136 cases which makes up 30.56% of all cases of congenital hip dislocation. The costs vary from age groups. The mean costs for the age group <1 is $7,803 while the median cost is $ 7,045. The costs for the age group of 1-17 are $13,573 for a mean and the median cost is $12,513. The mean cost for the age group of 18-44 is $16,656 and the median cost is $14,082. Finally, the age group of 45-64 has a mean cost of $14,388 and a median cost of $12,321. The amount of days of the hospital stay varies as well. In the age group 1-17 the length of stay is about 2.7 days, for the people ages 18–44 the average stay is 4.4 days, and the people ages 45–64 stay for about 3.4 days in the hospital setting.
Acquired
Hip dislocation cases in people in the age group from 1 through 17 years old is 434 which is 16.20%, the age group of 18-44 has 1,026 cases which accounts for 38.30% of hip dislocations, the age group of 45-64 has 563 cases which account for 21.00% of cases, and people from the ages of 65 through 84 years old have 210 cases which makes up 7.82% of cases of hip dislocation. Hip dislocation is more prevalent in males by 2% compared to females. Hip dislocation cases in males are 1,348 which accounts for 50.31% of cases and the number of hip dislocations in females are 1,312 which makes up of 48.96% of hip dislocations. Hip dislocation most likely occurs at the age group of people ages to 18-44.Human anatomy
The hip is considered one of the more complex regions of our body due to its multiaxial arrangement. There are many movements (hip flexionFlexion
In anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
, hip extension
Extension (kinesiology)
In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
, hip abduction
Abduction (kinesiology)
Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction.-Upper limb:* of arm at shoulder ** Supraspinatus** Deltoid* of hand at wrist...
, hip adduction
Adduction
Adduction is a movement which brings a part of the anatomy closer to the middle sagittal plane of the body. It is opposed to abduction.-Upper limb:* of arm at shoulder ** Subscapularis** Teres major** Pectoralis major** Infraspinatus...
, hip external rotation
External rotation
External rotation is rotation away from the center of the body.The muscles of external rotation include:* of arm/humerus at shoulder** Deltoid muscle** Infraspinatus** Teres minor* of thigh/femur at hip ** Gluteus maximus...
, hip internal rotation
Internal rotation
In anatomy, internal rotation is rotation towards the center of the body.The muscles of internal rotation include:* of arm/humerus at shoulder** Deltoid muscle** Subscapularis** Teres major** Latissimus dorsi...
, hip diagonal abduction, hip diagonal adduction, and anterior, posterior, lateral, and transverse pelvic rotation) that are associated with the hip, making the hip joint an important necessity.
Bones and joints
The pelvisPelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
and femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
are the two main bones that form the hip joint. There is an articulation of the head of the femur and the acetabulum of the pelvis. Together, they make the hip joint an enarthrodial joint. There are two pelvic bones (right and left), each consisting of the Ilium
Ilium (bone)
The ilium is the uppermost and largest bone of the pelvis, and appears in most vertebrates including mammals and birds, but not bony fish. All reptiles have an ilium except snakes, although some snake species have a tiny bone which is considered to be an ilium.The name comes from the Latin ,...
, ischium, and the pubis
Pubis (bone)
In vertebrates, the pubic bone is the ventral and anterior of the three principal bones composing either half of the pelvis.It is covered by a layer of fat, which is covered by the mons pubis....
. They connect to form the symphysis pubis on the anterior side, while the posterior side connects with the sacrum
Sacrum
In vertebrate anatomy the sacrum is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx...
and coccyx
Coccyx
The coccyx , commonly referred to as the tailbone, is the final segment of the vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between...
to form sacroiliac joints. These bones are joined with help of strong ligaments, making them slightly, movable joints. There are five strong and dense ligaments that help to reinforce the hip joint. They include the iliofemoral ligament, the teres ligament, the pubofemoral ligament, the ischiofemoral ligament, and the zona orbicularis ligament.
Muscles and movements
The location of many of the muscles associated with the hip joint and pelvic girdle depend on the action. The anterior side of the hip exhibits primarily hip flexion with help from the rectus femoris, iliopsoasIliopsoas
-External links:*...
, pectineus, and sartorius
Sartorius muscle
The Sartorius muscle – the longest muscle in the human body – is a long thin muscle that runs down the length of the thigh. Its upper portion forms the lateral border of the femoral triangle.-Origin and insertion:...
. The lateral side performs primarily hip abduction with help from the gluteus medius, gluteus minimus, external rotators, and the tensor fasciae latae
Tensor fasciae latae
The tensor fasciae latae or tensor fasciæ latæ is a muscle of the thigh. The English name for this muscle is the muscle that stretches the band on the side...
. The posterior side exhibits primarily hip extension with help from the gluteus maximus, hamstring muscles (biceps femoris, semitendinosus, semimembranosus), and the six deep external rotators (piriformis, obturator externus, obturator internus, gemellus superior, gemellus inferior, and quadrates femoris). The medial side performs primarily hip adduction with help from the adductor brevis, adductor longus, adductor magnus, and the gracilis
Gracilis muscle
The gracilis is the most superficial muscle on the medial side of the thigh. It is thin and flattened, broad above, narrow and tapering below.-Origin and insertion:...
.
Hip flexion and hip extension take place in the sagittal plane while hip abduction and adduction move the femur in the frontal plane. Hip external and internal rotation laterally and medially moves the femur in the transverse plane, respectively. Anterior and posterior pelvic rotation involves anterior and posterior movement of the upper pelvis in the sagittal plane, respectively. Lateral pelvic rotation (left and right) occurs in the frontal plane, whereas transverse pelvic rotation (left and right) occurs in the horizontal plane.
Anatomy relation to hip dislocation
The hip joint includes the articulation of the femoral head (of femur) and the acetabulum of the pelvis. In hip dislocation, the femoral head is dislodged from this socket. Posterior dislocation is the most prevalent, in which the femoral head lies posterior and superior to the acetabulum. This is most common when the femur is adducted and internally rotated. For the USMLE Step 1, think of it simply as most common dislocation of the hip occurs posterior & superior directions. The opposition is true for the shoulder, in the shoulder the most common dislocation occurs in the anterior and inferior directions. The posterior side of the hip exhibits primarily hip extension, dealing with the muscles: gluteus maximus, hamstring muscles (biceps femoris, semitendinosus, semimembranosus), and the six deep external rotators (piriformis, obturator externus, obturator internus, gemellus superior, gemellus inferior, and quadrates femoris).Posterior vs. anterior
Nine out of ten hip dislocations are posterior. The affected limb will be shortened and internally rotated in this case.In an anterior dislocation the limb will not be lengthened as noticeably and will be externally rotated.
Congenital vs. acquired
Congenital hip dislocation must be detected early when it can be easily treated by a few weeks of tractionTraction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
. If it is not detected, the child's hip may develop incorrectly seen when the child begins to walk. If one hip is affected the child will have a limp and lurch and with bilateral dislocation there will be a waddling gait. On physical exam, with the baby in the supine
Supine
In grammar a supine is a form of verbal noun used in some languages.-In Latin:In Latin there are two supines, I and II . They are originally the accusative and dative or ablative forms of a verbal noun in the fourth declension, respectively. The first supine ends in -um. It has two uses. The first...
position, the examiner flexes the hips and knees both to 90 degrees, and, holding the knees, pushes gently downward, which may induce a posterior dislocation or subluxation
Subluxation
A subluxation may have different meanings, depending on the medical specialty involved. It implies the presence of an incomplete or partial dislocation of a joint or organ. The World Health Organization defines both the medical subluxation and the chiropractic subluxation...
. Keeping the baby in this 90 degree flexed position, the examiner then externally rotates the thighs. A normal infant will demonstrate no evidence of dislocation. It can also be detected with the Galeazzi test
Galeazzi test
The Galeazzi test, also known as the Allis sign, is used in the assessment of congenital dislocation/developmental dysplasia of the hip. It is performed by flexing an infant's knees in the supine position so that the ankles touch the buttocks. If the knees are not level then the test is positive,...
. Congenital hip dislocation is much more common in girls than boys.
Acquired hip dislocations are extremely painful and commonly occur during car accidents. They may be treated by surgical realignment and traction.
Acquired hip injuries
Usually hip dislocation occurs when the head of the femur dislodges from its socket form the pelvis. In most patients, the femur shifts out of its socket in a posterior dislocation direction. The hip is now in a position where it is twisted in toward the middle of the body. The femur could also shift in an anterior direction which the hip will twist outward and away from the middle of the body. This dislocation is very painful and patients are unable to move when it occurs. Due to the dislocation, there could be some nerve damage resulting in loss of feeling in the foot or ankle.To actually dislocate a hip, a great amount of force
Force
In physics, a force is any influence that causes an object to undergo a change in speed, a change in direction, or a change in shape. In other words, a force is that which can cause an object with mass to change its velocity , i.e., to accelerate, or which can cause a flexible object to deform...
needs to be applied. Motor vehicle accidents are the most common ways that hip dislocations occur. Falls from high areas, such as a ladder, can also generate enough force to dislocate a hip. In older individuals, even a slight fall could cause this type of injury. This type of wear and tear that the body undergoes throughout the years leads to increased incidents of hip dislocation in the older population.
Hip injuries in sports are also quite common. In contact sports such as rugby and American football hip dislocation is a result of great amounts of force applied to the body during contact and collision. In other sports such as water skiing, skiing/snowboarding, gymnastics, and basketball these injuries are less common because there are fewer collisions in contact. However, when the amount of force to the hip joint is greater than the muscles of the hip can compensate for, hip injuries can still occur.
Several other injuries are also associated with hip dislocation. Fractures in the pelvis and legs, and minor back or head injuries can also occur along with a hip dislocation that is caused by a fall or athletic type of injury.
Congenital hip dislocation
Congenital hip dislocation also known as dysplasiaDysplasia
Dysplasia , is a term used in pathology to refer to an abnormality of development. This generally consists of an expansion of immature cells, with a corresponding decrease in the number and location of mature cells. Dysplasia is often indicative of an early neoplastic process...
of the hip is a condition in which a child is born with a hip problem. Congenital hip dislocation is when the formation of the hip joint is abnormal. The ball at the top of the thighbone which is known as the femoral head is not stable within the socket which is also known as the acetabulum
Acetabulum
The acetabulum is a concave surface of the pelvis. The head of the femur meets with the pelvis at the acetabulum, forming the hip joint.-Structure:...
. This abnormality may cause the ligaments of the hip to be loose or stretched. This condition is usually diagnosed once the baby is born; it mostly affects the left side of the hip in first-born children, girls, and babies born in a breech position. Girls are most prone to getting the hip dislocation compared to boys. The cause of this condition is still unknown; however, some factors of congenital hip dislocation are through heredity and racial background. It is also a known fact that it is more likely to occur in Native Americans than any of the other races. It also has a low prevalence risk in African Americans and southern Chinese
Chinese people
The term Chinese people may refer to any of the following:*People with Han Chinese ethnicity ....
. Native Americans
Indigenous peoples of the Americas
The indigenous peoples of the Americas are the pre-Columbian inhabitants of North and South America, their descendants and other ethnic groups who are identified with those peoples. Indigenous peoples are known in Canada as Aboriginal peoples, and in the United States as Native Americans...
are most likely to get congenital hip dislocation than any of the other races. The risk for Native Americans is about 25-50 cases for every 1000 people. The overall frequency of developmental dysplasia of the hip is approximately 1 case per 1000 individuals; however, Barlow believed that the incidence of hip instability
Instability
In numerous fields of study, the component of instability within a system is generally characterized by some of the outputs or internal states growing without bounds...
in newborns can be as high as 1 case for every 60 newborns.
The early sign of congenital hip dislocation is when a person is able to hear "clicking" sounds when the legs are moved apart from one another. This condition can be treated if detected early. If this condition goes undetected it can cause one leg to "look" shorter than its counterpart and the buttocks folds are also not symmetrical which causes more creases to be present on the affected side, and skin folds at the thigh are uneven. Another sign is that when a child begins to walk he or she may have a limp and favor the affected side when walking. When a child is walking they may be also walking on their toes or they may even "waddle" like a duck. If the condition goes undetected this may cause negative long term effects such as osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...
as well affect the gait of the child when they first learn to walk. This condition may also cause the baby to start to learn how to walk much later than expected.
Screening
Screening for congenital hip dislocation is done once the newborn baby is born. The hospital staff does a number of reflex exercises to check that all of the baby’s reactions are normal. There are two ways that congenital hip dislocation can be detected through the Ortolani maneuver and the Barlow maneuverBarlow maneuver
The Barlow maneuver is a physical examination performed on infants to screen for developmental dysplasia of the hip. It is named for T.G. Barlow, 1962 at Hope Hospital Salford, Manchester....
. In order to do the Ortolani maneuver it is recommended the examiner put the newborn baby in a position in which the contralateral hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. If a sound of a "clunk" of the femoral head moving over the acetabulum it is normal but the less likely the examiner hears the "clunk" sound that means the acetabulum was not fully developed. The next method that can be used is called the Barlow maneuver it is done by adducting the hip while pushing the thigh posteriorly. If the hip goes out of the socket it means it is dislocated and the newborn has a congenital hip dislocation. They examine the baby by laying the baby on its back and separating their two legs apart if a clicking sound can be heard then that means that the baby may have this condition. It is highly recommended that these maneuvers be done when a baby is not fussy because the baby may inhibit hip movement. There can also be another way to detect congenital hip dislocation and it is called the tonic labyrinthine reflex
Tonic labyrinthine reflex
The tonic labyrinthine reflex is a primitive reflex found in newborn humans. With this reflex, tilting the head back while lying on the back causes the back to stiffen and even arch backwards, the legs to straighten, stiffen, and push together, the toes to point, the arms to bend at the elbows...
(TLR). It is a reflex that is present in newborn babies. It is suggested that in order to do this reflex exercise the head is tilting back which causes the baby’s back to become stiffened, the legs are straightened and pushed together with the toes to point, and the arms bent at the elbows and wrists. Also the hands will be put into a fist or the fingers will be curled. If this reflex is present past the newborn stage the person may have an abnormal extension pattern.
Treatment
There are numerous ways in order to address this condition. One treatment that can be used on newborns or infants is called a Pavlik harness. The Pavlik harness is a device that has straps that holds the femoral bone in the acetabulum in place to prevent movement in order to prevent the condition from getting much worse as well as try to put the femoral head in the acetabulum in the correct position. Another treatment method that can be used to fix the condition is closed reduction in which the hip is positioned into place with the use of anesthesiaAnesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
. This particular procedure can be done on children from the ages of six months to two years old. If the closed reduction treatment does not work then open surgery is another option to use. After the closed or opened surgery is done the child must wear a cast or braces in order to keep the hip bone in the socket while it is healing. By using one of these treatment methods the child can have normal hip joint function.
Rehabilitation
Hip dislocation rehabilitation can take anywhere from two to three months, depending on that patient. Complications to nearby nerves and blood vessels can cause loss of blood supply to the bone, also known as osteonecrosis. The protective cartilage on the bone can also be disturbed from this type of injury. For this reason, it is important for patients to contact a physician and get treatment immediately following injury.- The first step to recovering from a hip dislocation is reduction. This refers to putting the bones back into their intended positions. Normally, this is done by a physician while the patient is under a sedativeSedativeA sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
. Other times, a surgical procedure is required to reduce the hip bones back into their natural state. - Next, rest, ice, and take anti-inflammatory medication to reduce swellingSwelling (medical)In medical parlance, swelling is the transient enlargement or protuberance in the body and may include tumors. According to cause, it may be congenital, traumatic, inflammatory, neoplastic or miscellaneous....
at the hip. - Weight bearing is allowed for the type one posterior dislocation, but should only be done as pain allows and patient is comfortable.
- Within 5–7 days of the injury occurrence, patients may perform passive range of motion exercises to increase flexibility.
- A walking aid should be used until the patient is comfortable with both weight bearing and range of motion.
Exercises used for rehabilitation
Individuals suffering from hip dislocation should participate in physical therapyPhysical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
and receive professional prescriptive exercises based on their individual abilities, progress, and overall range of motion. The following are some typical recommended exercises used as rehabilitation for hip dislocation. It is important to understand that each individual has different capabilities that can best be assessed by a physical therapist or medical professional, and that these are simply recommendations.
- Bridge- Lay flat on back. Place arms with palms down beside body. Keep feet hip distance apart and bend knees. Slowly lift hips upward. Hold position for three to five seconds. This helps strengthen the gluts and increase stability of the hip joint.
- SupineSupineIn grammar a supine is a form of verbal noun used in some languages.-In Latin:In Latin there are two supines, I and II . They are originally the accusative and dative or ablative forms of a verbal noun in the fourth declension, respectively. The first supine ends in -um. It has two uses. The first...
leg abductionAbduction (kinesiology)Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction.-Upper limb:* of arm at shoulder ** Supraspinatus** Deltoid* of hand at wrist...
- Lay flat on back. Slowly slide leg away from body and then back in, keeping the knees straight. This exercises the gluteus medius and helps to maintain stability in the hip while walking. - Side Lying Leg abductionAbduction (kinesiology)Abduction, in functional anatomy, is a movement which draws a limb away from the median plane of the body. It is thus opposed to adduction.-Upper limb:* of arm at shoulder ** Supraspinatus** Deltoid* of hand at wrist...
- Lay on one side with one leg on top of the other. Slowly lift the top leg towards the ceiling and then lower it back down slowly. - Standing Hip abduction- Standing up and holding on to a nearby surface, slowly lift one leg away from the midline of the body and then lower it back to starting position. This is simply a more advanced way to do any of the lying hip abduction exercises, and should be done as the patient progresses in rehab.
- Knee raises- While standing and holding onto a chair, slowly lift one leg off the ground and bring it closer to the body while bending the knee. Then lower the leg back down slowly. This helps to strengthen the hip flexor muscles and retain stability in the hip.
- Hip flexionFlexionIn anatomy, flexion is a position that is made possible by the joint angle decreasing. The skeletal and muscular systems work together to move the joint into a "flexed" position. For example the elbow is flexed when the hand is brought closer to the shoulder...
and extensionExtension (kinesiology)In kinesiology, extension is a movement of a joint that results in increased angle between two bones or body surfaces at a joint. Extension usually results in straightening of the bones or body surfaces involved. For example, extension is produced by extending the flexed elbow. Straightening of...
s- Standing, hold on to a nearby chair or surface. Swing one leg forwards away from you, and hold the position for three to five seconds. Then swing the leg slowly backwards and behind your body. Hold for three to five seconds. This exercise helps to increase range of motion, as well as strengthening the hip flexor and hip extensor muscles that control much of the hip joint. - Adding ankle weights to any exercises can be done as progress is made in rehabilitation.
External links
- Illustration at MedlineMEDLINEMEDLINE is a bibliographic database of life sciences and biomedical information. It includes bibliographic information for articles from academic journals covering medicine, nursing, pharmacy, dentistry, veterinary medicine, and health care...
- Resource for parents of babies undergoing treatment in a hip spica cast for developmental dysplasia of the hip