Hip Dislocation: Symptoms, Types, Causes and Treatment

Hip dislocation is a serious and often traumatic injury where the femoral head is forced out of the acetabular socket of the pelvis. Whether resulting from high-energy trauma, congenital conditions, or surgical complications, hip dislocation is considered an orthopedic emergency requiring urgent assessment and intervention. Understanding the symptoms, types, causes, and treatments of hip dislocation is essential for both patients and healthcare providers to ensure optimal outcomes and prevent long-term disability.

Symptoms of Hip Dislocation

Recognizing the symptoms of hip dislocation is crucial for rapid diagnosis and treatment. The experience can range from intense pain and immobility to visible deformities, depending on the type and severity of the dislocation. Prompt identification of these symptoms can dramatically influence the long-term prognosis and the occurrence of complications.

Symptom	Description	Associated Findings	Sources
Pain	Severe hip/groin pain	Often radiates to lower back or leg	1 3 6 9 10
Deformity	Visible limb shortening/rotation	"Duck-like" posture with abnormal alignment	1 3 6 10
Immobility	Inability to move or bear weight	Immediate loss of function	3 9 10
Nerve Injury	Numbness, weakness in leg/foot	Especially sciatic nerve involvement	10 13
Other	Swelling, bruising, possible shock	May have concurrent injuries	8 10

Table 1: Key Symptoms

Severe Pain and Deformity

The hallmark of hip dislocation is intense pain localized to the hip or groin. This pain can be excruciating, often making any movement impossible. In some cases, pain may radiate to the lower back or leg, particularly if nerve involvement is present 1 3 6 9 10.

Deformity is often obvious—patients may present with their leg rotated inward (posterior dislocation) or outward (anterior dislocation), with the limb appearing shortened. Some congenital cases, such as bilateral dislocation, may result in abnormal posture described as "duck-like," due to changes in spine and pelvic alignment 1.

Immobility and Loss of Function

A dislocated hip renders the affected limb functionally useless. Patients are unable to walk, stand, or move the leg due to both pain and mechanical blockage 3 9 10. Attempting to move the hip typically worsens the pain.

Nerve and Vascular Complications

Nerve injury, particularly to the sciatic nerve, is a well-recognized complication, leading to numbness, tingling, or weakness in the leg or foot. Vascular compromise, though less common, can threaten limb viability 10 13.

Associated Symptoms

Depending on the cause, other symptoms may include swelling, bruising, or signs of shock. In cases of trauma, additional injuries—such as fractures of the pelvis, femur, or other body regions—are common and must be considered 8 10.

Types of Hip Dislocation

Hip dislocations are not all the same; they are classified based on the direction of dislocation, associated injuries, and underlying cause. Understanding the type helps guide treatment and predict outcomes.

Type	Description	Key Features	Sources
Posterior	Femoral head displaced backward	Most common; limb inward	3 5 6 10
Anterior	Femoral head displaced forward	Limb outward, less common	5 6
Central	Femoral head pushed into pelvis	Often with acetabular fracture	3 13
Congenital	Dislocation present at birth	Morphologic variations	1 2 12
Fracture-Dislocation	Dislocation with associated fracture	Complex, needs surgery	3 4 13
Prosthetic	After hip replacement or surgery	Multifactorial causes	6 7 11

Table 2: Types of Hip Dislocation

Posterior Dislocation

Posterior dislocation is by far the most common type, accounting for over 90% of traumatic cases. It typically results from force applied to a flexed knee with the hip also flexed (such as hitting the dashboard in a car crash). The limb is usually shortened, internally rotated, and adducted (drawn toward the midline) 3 5 6 10.

Anterior Dislocation

Anterior dislocations are less common. They occur when a force is applied to an extended, externally rotated leg. The limb appears abducted and externally rotated. Prognosis is generally better than for posterior dislocations 5 6.

Central Dislocation

Central dislocation refers to the femoral head being driven into the acetabulum, commonly with an associated fracture of the socket. This is considered a complex injury, often resulting from high-energy trauma 3 13.

Congenital Hip Dislocation

Some individuals are born with a dislocated hip (developmental dysplasia of the hip). Congenital dislocations may be bilateral or unilateral and can lead to abnormal spinal alignment, gait disturbances, and chronic pain if untreated. Morphologic distinctions—such as low and high dislocation—are important in adult cases 1 2 12.

Fracture-Dislocation

In these complex injuries, the dislocation is accompanied by a fracture of the femoral head, neck, or acetabulum. These are severe injuries requiring surgical intervention and have a higher risk of complications 3 4 13.

Prosthetic (Post-Surgical) Dislocation

Dislocation after total hip replacement is a significant complication, often caused by malpositioned implants, soft tissue laxity, or patient factors. Both early and late dislocations can occur, each with specific risk profiles 6 7 11.

Causes of Hip Dislocation

The causes of hip dislocation vary by age, mechanism, and underlying anatomy. Understanding these causes helps inform prevention, risk assessment, and tailored treatment strategies.

Cause	Description	Typical Scenario	Sources
Trauma	High-energy impact (e.g., car crash)	Young adults, athletes	3 8 9 10
Congenital	Developmental dysplasia or malformation	Infants, children	1 2 12
Iatrogenic	Surgical complication (e.g., hip replacement)	Older adults, post-op	6 7 11
Pathologic	Underlying bone/joint disease	Rare, e.g., tumors	6
Recurrent	Previous dislocation, instability	Ligament laxity, poor healing	7 11

Table 3: Causes of Hip Dislocation

Traumatic Causes

Trauma is the leading cause of hip dislocation, especially in young adults. Motor vehicle collisions (MVCs) are the most frequent culprits, followed by falls from height and sports injuries. The immense force required often results in associated injuries, such as pelvic fractures or nerve damage 3 8 9 10.

• MVCs: Most common in unrestrained passengers; dashboard injuries drive the femur backward, causing posterior dislocation 8 10.
• Sports Injuries: High-velocity impacts in contact sports can also dislocate the hip.

Congenital and Developmental Causes

Congenital hip dislocation arises from improper development of the hip joint, often detected in infancy. Risk factors include breech birth, family history, and female gender. If untreated, these dislocations can persist into adulthood, causing chronic pain and functional impairment 1 2 12.

Iatrogenic (Surgical) Causes

Hip dislocation is a known complication after total hip arthroplasty (replacement). Factors contributing to surgical dislocations include:

• Malpositioned implants
• Soft tissue imbalance or laxity
• Patient non-compliance with post-op precautions
• Revision surgeries
• Component or implant design issues 6 7 11

Pathologic and Recurrent Dislocations

Rarely, diseases such as tumors or infections weaken the joint, making dislocation more likely even with minor trauma. Patients with previous dislocations or chronic instability are at higher risk for recurrence, especially if the underlying cause is not corrected 6 7 11.

Treatment of Hip Dislocation

Managing hip dislocation is a time-sensitive process that balances the need for rapid reduction with the careful assessment of associated injuries and complications. Treatment strategies vary based on the type, cause, and complexity of the dislocation.

Treatment	Approach	Indications/Notes	Sources
Closed Reduction	Manual repositioning under sedation	First-line for most acute cases	3 6 9 10
Open Reduction	Surgical intervention	Failed closed reduction, fracture-dislocation	4 6 13
Bracing	Orthopedic brace or abduction pillow	Infants, post-reduction support	11 12
Surgery	Internal fixation, implant revision	Fracture-dislocation, prosthetic cases	4 6 7 11 13
Rehabilitation	Physical therapy, gradual weight-bearing	Prevents stiffness, restores function	6 7 14
Prevention	Patient education, surgical technique	Reduces recurrence	7 11

Table 4: Treatment Modalities

Emergency Reduction

Timely reduction—repositioning the femoral head into the acetabulum—is critical. Delays beyond 6-8 hours increase the risk of avascular necrosis (bone death) of the femoral head 4 9 10 13. Closed reduction, performed under sedation or anesthesia, is the primary method for most cases 3 6 9 10.

• Posterior Dislocation: Longitudinal traction with internal rotation.
• Anterior Dislocation: Inline traction and external rotation, sometimes with manual assistance on the femoral head 6.

Open Reduction and Surgical Management

If closed reduction fails or if there are associated fractures (fracture-dislocation), open surgical intervention is necessary. Surgery may also be required for irreducible hips, prosthetic dislocations, or when there is neurovascular compromise 4 6 13. Fracture-dislocations often involve internal fixation of the femur or acetabulum.

Bracing and Immobilization

In infants with congenital hip dislocation, bracing (such as the Pavlik harness) can be effective, achieving a high rate of successful reductions if started early. Failure rates increase if treatment begins late or if the hip is initially irreducible 12. In adults, abduction pillows or braces may help maintain reduction post-operatively or after closed reduction, though evidence is limited 11.

Rehabilitation

Physical therapy is essential for restoring strength, range of motion, and function after hip dislocation. Early mobilization prevents stiffness, and a tailored rehab plan supports optimal recovery 6 7 14.

Prevention and Recurrence

For prosthetic dislocations, prevention focuses on correct implant positioning, restoring soft-tissue tension, and patient education regarding movements that increase the risk of dislocation. In some cases, revision surgery or constrained implants may be necessary for recurrent instability 7 11.

Complications and Long-Term Outcomes

Despite optimal treatment, complications like avascular necrosis, posttraumatic osteoarthritis, and heterotopic ossification can occur, particularly after severe injuries or delayed reduction. Early recognition and prompt intervention are key to minimizing these risks 4 13.

Conclusion

Hip dislocation is a complex clinical problem with significant implications for mobility, pain, and long-term joint health. Rapid diagnosis and tailored management are essential to optimize outcomes and reduce complications.

Key Takeaways:

• Symptoms include severe hip pain, visible deformity, immobility, and possible nerve injury.
• Types are classified by direction (posterior, anterior, central), cause (traumatic, congenital, prosthetic), and complexity (simple, fracture-dislocation).
• Causes predominantly involve trauma (especially high-energy accidents), congenital disorders, or surgical complications.
• Treatment centers on urgent reduction, with surgery indicated for complex cases, and rehabilitation to restore function and prevent recurrence.

Understanding the nuances of hip dislocation—from early recognition to advanced surgical techniques—empowers both patients and clinicians to achieve the best possible outcomes.