Hip > Hip Dislocation > Treatments

    Open Reduction

First Aid and Ambulance Care

FIRST AID

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:

   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.

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 room.

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.

Here is what you can expect and how you can cope while recovering at home from an operative 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.

   Perform 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.

   Expect 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.

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

   Stitches or staples usually are removed after two or three weeks.

   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 help 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 as soon as possible after surgery.

   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.

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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.