Hip > Hip Dislocation > Treatments

   Non-Operative Closed Reduction

First Aid and Ambulance Care

FIRST AID

Hip dislocations require immediate treatment. Physicians generally suggest an ambulance be called to transport someone with a dislocated hip to the hospital's emergency room. 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:

   Immediately call for an ambulance.

   Do not attempt to move the injured hip or the injured person unless someone is present who knows how to properly immobilize the hip.

   Keep the injured person still and calm, lying flat on his back. Cover the injured person with a blanket if available.

   Some dislocations may cause open wounds. Cover the wound with a sterile dressing if available and wait for the paramedics to arrive.

   If 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.

AMBULANCE CARE

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.

A non-operative, or closed, reduction to correct a hip dislocation is performed without surgical instruments or incisions. Depending on the direction of your hip dislocation, you will lie on your back or stomach after you are given pain medications. Under anesthesia consisting of further pain medications, muscle relaxants, and sedatives, your physician and an assistant will stabilize your pelvis, flex or extend your hip and knee, apply traction to your lower extremity, and gently rotate your thigh internally or externally, to gently move the femoral head back into its original location within the acetabulum. While you are still under anesthesia, your surgeon and an assistant will also move your hip to assess its stability after reduction. The procedure usually takes less than a half-hour and is performed in either the emergency room or the operating room depending on the resources available to administer anesthesia. After the closed reduction attempt, a repeat x-ray is obtained to check to see if the hip is completely reduced, and to see if there are any fractures around the hip or loose bone fragments in the hip joint. In most cases, a CT scan will also be obtained to look for the presence of bone fragments within the joint, to make sure that the hip is completely reduced, and to look for and characterize possible fractures. If the closed reduction attempt is unsuccessful, another attempt under deeper anesthesia may be required. If this proves unsuccessful or there is an associated fracture, an open reduction, in which the surgeon makes an incision and directly exposes the hip to reduce the dislocation and fix any fractures, may be required. After successful reduction of a simple hip dislocation, you usually will experience marked pain relief. However, there usually is some mild residual pain that can be controlled with oral pain medications.

After a successful closed reduction of a hip dislocation, you will usually stay in the emergency room or recovery room for at least two hours while the anesthetic wears off. Associated injuries may dictate a hospital stay and operative intervention. You may have a foam pillow between your legs to keep your legs spread apart and your hips in a more stable position. You still should try to move your feet, ankles, and knees while you are in the recovery room and at home 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 hospital or, if necessary, be admitted to the hospital. You may require admission to the hospital for pain control. If your hip was unstable during range of motion, you may require temporary bracing, casting, or a surgical procedure to prevent your hip from redislocating. You may require the assistance of a walker or crutches to aid you with ambulation. Your surgeon will review your discharge and follow-up instructions with you before you go home.

Here is what you can expect and how you can cope while recovering at home from an non-operative closed reduction of your dislocated hip:

   Expect 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.

   Rest and modify your activities, but do not remain at bed rest, as inactivity results in deconditioning and may contribute to the development of blood clots.

   Your 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.

   If your hip is stable, then no bracing or casting is necessary. If it is unstable in certain positions, then you may be fitted with a brace or cast that prevents these positions. Usually, the brace or cast is worn for 6-8 weeks. The cast is usually made of fiberglass.

   A balanced diet, vitamin supplements, proper hydration, and exercise may help you recuperate and get you back on your feet again.

   You 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 assist you at home.

   Expect 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 within a week of non-operative reduction.

RELATED TOPICS

   Recovery-proof your home

   When 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 10 to 12 weeks, you should be up to unrestricted range of motion of the hip. 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 hip heals and gets stronger. This usually takes about three months. Your physician will monitor your recovery by physical examination and appropriate diagnostic testing including X-rays, CT scans and MRI (magnetic resonance imaging).

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 weight bearing should be avoided until it 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 like 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 and non–weight–bearing, like stationary bikes, swimming, and certain weightlifting programs. Your physician will usually schedule an MRI to make sure you have not developed avascular necrosis before clearing you to return to sports or activities.