Dislocation > Treatments
First Aid and Ambulance Care
Hip dislocations require immediate treatment. Delays
in treatment greater than six to eight hours can result
in further complications to the injury. Physicians generally
suggest an ambulance be called to transport someone
with a dislocated hip to the hospital's emergency room.
Often there are associated injuries that require transport
by emergency services to the hospital for an evaluation
by a trauma team. If you or someone you know dislocates
a hip, the following first aid tips can help you better
understand what to do:
call for an ambulance.
not attempt to move the injured hip or the injured person
unless someone is present who knows how to properly
immobilize the hip.
the injured person still and calm, lying flat on his
back. Cover the injured person with a blanket if available.
dislocations may cause open wounds. Cover the wound
with a sterile dressing if available and wait for the
paramedics to arrive.
possible, do not let injured people eat or drink. They
may be going under anesthesia soon. The paramedics can
give someone an IV if they need fluids, so avoid giving
the injured person anything by mouth.
Paramedics will most likely immobilize your hip and
place you securely onto a gurney in the back of the
ambulance. If possible, it is a good idea to have someone
accompany you to the hospital to assist you. Most dislocated
hips feel as though they desperately need to be popped
back into place. However, paramedics generally do not
treat you before arrival at the emergency room because
there could be complications that should be treated
in the hospital. Remember that a dislocated hip can
cause a variety of damage to tissues, which requires
a proper diagnosis in the emergency room before most
dislocations can be reset.
Hip reduction is done as soon as possible
after a hip dislocation due to the increased risk of
osteonecrosis (also called avascular necrosis), a deficiency
of the blood supply to the femoral head that causes
the bone to die and collapse. If a closed reduction
attempt is unsuccessful at completely relocating the
femoral head within the acetabulum, there is an associated
fracture that renders the hip unstable, or there are
bone fragments in the joint, an open reduction, in which
the surgeon makes an incision and directly exposes the
hip to reduce the dislocation and fix any fractures,
is indicated. The operation generally lasts anywhere
from two to four hours. After you are brought into the
operating room, you will be administered anesthesia.
After discussion with the anesthesia team and your surgeon,
the best type of anesthesia for you will be selected.
You may receive either general anesthesia or spinal
or epidural anesthesia. In each of these cases, you
will not feel any pain during the operation. With general
anesthesia, you will be completely asleep with a machine
to assist your breathing. With spinal or epidural anesthesia,
numbing medications are injected into your spinal canal
and other medications are given intravenously to help
you relax. The major difference between spinal and epidural
anesthesia is the duration of anesthesia that can be
achieved. With epidural anesthesia, an indwelling catheter
is left in the spinal canal to continuously administer
numbing medications so that a longer period of anesthesia
is possible. Spinal anesthesia lasts as long as the
injected medication takes to wear off - about four to
six hours. After anesthesia is induced, you will be
securely positioned with your bony prominences well–padded.
Your position will depend on the direction of your dislocation,
the presence of any fractures, and your surgeon's preference.
Your surgeon will then make an incision over your hip,
divide the underlying soft-tissue structures, and expose
your dislocated hip. The length of your incision will
be at least eight inches long, depending on your body
size, the nature of your injury, and the presence of
any fractures or loose bodies within the joint. Your
surgeon will then assess your injury under direct visualization,
relocate your dislocated hip, and address any other
problems such as fractures or loose bodies in the joint.
Your surgeon will then close your wound with dissolvable
and non-dissolvable sutures and staples. Often, a drain
is left in the wound to help prevent a hematoma, a collection
of bloody fluid, from accumulating. The drain will be
removed a few days after surgery when the drainage collected
decreases. Finally, a dressing will be placed over your
wound. You will then be transported to the recovery
After operative reduction to correct
a hip dislocation, you usually will stay in the recovery
room for at least two hours while the anesthetic wears
off. You may have a foam pillow between your legs to
keep your legs spread apart and your hips in a more
stable position. Despite this, you should try to move
your feet, ankles, and knees while you are in the recovery
room to improve circulation. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the anesthesiologist, will
determine when you are ready to leave the recovery room
and go to the floor for post–operative care.
You will require admission to the
hospital for at least two days for routine post–operative
care, pain control, physical therapy, and, if your hip
was unstable during ranging, you may require temporary
bracing or casting to prevent your hip from redislocating
in certain positions while your soft–tissues heal.
Your surgeon may also instruct you to limit the amount
of weight you place on your affected extremity. You
will require the assistance of a walker or crutches
to aid you with ambulation while you recuperate. In
some cases, your surgeon will send you for radiation
therapy to your hip to help prevent bone formation within
the soft–tissues surrounding your hip that can
limit motion and cause pain. Your surgeon may also prescribe
blood–thinning medications and compression stockings
to help prevent blood clots from forming within your
legs. After surgery, you may experience significant
pain, and you will be given adequate pain medications.
Immediately after surgery, you will require a combination
of IV (intravenous), IM (intramuscular), and oral pain
medications. When you go home, you will be given a prescription
for oral pain medications. Once you are awake and alert,
steady on your feet, able to perform your activities
of daily living, obtaining adequate pain control with
oral pain medications, able to urinate, without nausea
or vomiting, and, if necessary, fitted with the appropriate
brace or cast, you may be able to go. If your need further
physical therapy or time to recuperate, you may be transferred
to a rehabilitation hospital or subacute facility. Your
surgeon will review your discharge and follow–up
instructions with you before you go home. If the hip
is stable, then no bracing or casting is necessary.
If the hip is unstable in certain positions, then the
patient is fitted with a brace or cast that prevents
these positions. Usually the brace or cast is worn for
six to eight weeks. The cast is usually made of fiberglass.
what you can expect and how you can cope while recovering
at home from an operative reduction of your dislocated
some pain for the first week or so. If needed, take
oral pain medications as instructed by your physician.
The pain tends to decrease each day. Call your physician
if you experience unexpected pain.
wound care as instructed by your physician. Monitor
your wound for drainage, increased redness, and increased
swelling. A certain amount of redness and swelling is
expected following surgery, but a sudden increase in
drainage, swelling, or pain should be brought to the
attention of your physician. If you experience fever
or chills, contact your physician as soon as possible.
to experience some pain or discomfort for a week or
so. If needed, take pain medication as instructed. The
pain tends to decrease each day after surgery. Contact
your physician if unexpected pain arises.
and modify your activities, but do not remain at bedrest,
as inactivity results in deconditioning and may contribute
to the development of blood clots.
or staples usually are removed after two or three weeks.
balanced diet, vitamin supplements, proper hydration,
and exercise may help you recuperate and get you back
on your feet again.
may find it difficult to move around your house and
perform even simple household tasks like cooking, bathing,
and laundry. You should arrange for someone to be available
to visit you once or twice a day for several weeks.
If you live alone, the hospital can refer a social worker
or nurse to help you at home.
to begin range of motion and walking exercises as soon
as possible as instructed by your physician. Your physician
will likely refer you to a physical therapist to begin
supervised strengthening and stretching exercises as
soon as possible after surgery.
physician may prescribe a V–shaped pillow to be
worn between your legs that keeps your legs spread apart
and your hip in a more stable position.
to call the doctor after surgery
Though everyone's rehabilitation
program is slightly different, physical therapy follows
a general pattern. Regaining range of motion is crucial.
Movement may be painful at first, but it is important
to avoid stiffening in of your hip. However, you do
not want to go beyond the prescribed ranges of motion
for your hip and risk a repeat dislocation. For the
first few weeks, your physical therapist may help you
move your hip in different directions to preserve joint
motion and strength. As time progresses and more healing
occurs, your physician will gradually increase the allowed
range of motion of the hip. By ten to 12 weeks, you
should be up to unrestricted range of motion of the
hip. In general, the rehabilitation time following an
open, operative reduction is longer than that of a closed
reduction. If you have had a simple hip dislocation
without a fracture, then you are usually allowed to
bear weight as tolerated on the affected lower extremity
with a walker or crutches as needed. If you have sustained
a hip fracture, then the amount of weight that you will
be allowed to bear will be limited by your physician.
Physical therapy also seeks to keep the muscles around
your hip strong. It can take a minimum of six weeks
for any soft–tissue damage around the hip joint
to heal. Patients should eventually be able to resume
previous functional activities like stair climbing,
single leg support, swimming, and driving. You may be
able to begin more vigorous activities as your hipbone
heals and gets stronger. This usually takes about three
months. Two to six months after your injury reduction,
your physician may order an MRI (magnetic resonance
imaging) of the hip to detect any signs of osteonecrosis
(also called avascular necrosis), which is a deficiency
of the blood supply to the femoral head that causes
the bone to die and collapse.
Once your dislocated hip has healed,
rebuilding and maintaining muscle strength around your
hip can help you return to your previous level of function
and avoid further injuries. If necessary, you may also
consider training with a physical therapist to improve
your balance and coordination, which can help decrease
the chances of falls. Since most hip dislocations are
the result of accidental trauma, early evaluation and
treatment should be stressed to prevent complications.
If you experience a recurrence of hip pain, your physician
should be contacted and activities should be limited
until you are evaluated. Contact sports and activities
increase your chances of re–injuring your hip.
Your physician may advise you to avoid contact sports
and high–impact activities such as downhill skiing.
Another way to help prevent further hip injuries is
to learn to avoid activities that put your hip in potentially
unstable positions. After a hip dislocation, take it
easy until you have regained hip stability and strength.
If your physician believes that post–traumatic
arthritis might be a major issue, avoid high–impact
activities and activities that cause you pain. Remember,
there is no substitute for conditioning. It is essential
to adhere to the hip muscle strengthening program you
learned during rehabilitation throughout the remainder
of your life. The best strengthening programs focus
on low–impact activities like stationary bikes,
swimming, and certain weightlifting programs.