Hip pain is extremely severe after dislocation of the hip joint or hip dislocation . A traumatic injury involving the hip joint often causes dislocation of the hip joint. Hip dislocation is common after total hip joint replacement surgery and car accident . Hip dislocation is the complete separation of the femoral head from the acetabulum. Impact of trauma on hip joint or incompatibility of ball prosthesis and recess after total hip replacement surgery causes the femoral head to be dislodged from its acetabulum (pelvic bone socket).Partial hip dislocation is also known as subluxation. Subluxation is rare and is mainly associated with partial fracture of the acetabulum. The multi-axial movement of the normal hip joint involves flexion, extension, abduction, adduction, diagonal rotation and pelvic rotation.
Dislocation of the hip joint associated with severe hip pain is a medical emergency and treatment should be performed within 6 to 8 hours to prevent avascular necrosis. Lack of blood supply to the dislocated hip and to the acetabular bone can cause avascular necrosis, resulting in intractable pain in the hip.
Generally, hip dislocation occurs when the femoral head is dislodged from its acetabular cavity. In most patients, the femur moves out of its socket and is posterior to the acetabulum and pelvis (posterior dislocation). The pain in the hip becomes excruciating with any passive or active movement of the injured leg. Hip dislocation may be associated with nerve damage and significant loss of blood, causing massive compression of the blood nerve, resulting in severe pain in the hip.
Causes of traumatic dislocation of the hip joint
- Car Accident
- Work accident
- Violent injury, such as falls or blows to the hip.
Causes of post-surgical dislocation of the hip joint
- Total hip replacement surgery – after surgery 15% of patients develop severe hip pain associated with dislocation of the hip joint within 24 weeks or 6 months.
- The surgery involves removing the head and neck of the femur and inserting the artificial head and neck over the femoral bone. In the same way acetabular is trimmed and resurfaced. The appropriate size of the femoral head should coincide with the semicircular cavity of the acetabulum. The larger or smaller size of the acetabulum compared to the femoral head can cause dislocation and severe pain in the hip.
Types of dislocation of the hip joint
- Congenital Dislocation of the Hip – Congenital dislocation of the hip is caused by dysplasia of the femoral head and / or acetabular cavity.
- Seen in newborns or young children.
- Common in girls
- Early detection is important for close reduction and conservative treatment with a few weeks of traction.
- Swinging leg – If bilateral hip dislocation is not treated, walking is observed when the child begins to walk. Unilateral unilateral dislocation of the hip joint may be associated with lameness during gait.
- Acquired Hip Dislocations
- Anterior Dislocation – 8% of hip dislocations are anterior dislocations. Anterior dislocation may cause injury to the femoral nerve and femoral artery. Laceration or rupture of the femoral artery can cause profuse bleeding and bruising in front of the hip joint. Massive hematoma and pressure on the femoral nerve cause severe pain in the hip.
- Posterior Dislocation – Ninety percent of the dislocations are posterior dislocation. Posterior dislocation usually causes damage to the sciatic nerve and severe pain in the hip.
- Central luxation – central luxation is rare. Central dislocation is often associated with acetabular fracture and may require surgical repair.
- Recurrent Dislocation – Causes ligament injuries.
Symptoms of dislocation of the hip joint
- Hip Pain – Severe and intractable hip pain is felt immediately after hip dislocation. Pain is increased with activities.
- Inability to move the leg – The patient can not move the injured limb.
- Numbness and tingling – Symptoms such as tingling and numbness are observed after injury to the sciatic or femoral nerve.
- Muscle weakness – Nerve damage causes damage to the motor nerve and paralysis of the affected leg muscles.
- Clicking on the sound of the hip joint – seen in the juvenile congenital dislocation of the hip with flexion, extension and lateral rotation.
Signs of dislocation of the hip joint
- Short-wound Leg- On inspection, injured leg appears to be smaller than normal leg
- Position of the leg with hip dislocation – The leg is short and is abducted or adducted, either internally or externally rotated.
- Fractured Femur – The posterior hip dislocation is seen in 90% of cases. Posterior hip dislocation may be associated with fracture of the femoral neck and acetabulum.
- Sensory nerve injury – anterior dislocation of the hip joint is seen in 20% of cases. Anterior hip dislocation is associated with femoral nerve injury, resulting in tingling and numbness in the thigh and knee joint.
- Motor Nerve Injury – Injury to the femoral nerve causes paralysis of the muscles. Muscles that receive motor nerves from the femoral nerves are paralyzed after injury to the femoral nerve.
- Inability to walk or walk .
Diagnosis and Investigation for Hip Joint Dislocation
- Magnetic Resonance Imaging
- Computed tomography
Treatment for dislocation of the hip joint
Initial treatment for dislocation of the hip joint causing pain in the hip
- Analgesics for the treatment of hip pain
- Pain is treated with NSAIDs such as Motrin, Naproxen and Celebrex.
- Opioids- Severe hip pain after hip dislocation may not respond to NSAIDs and may need to be treated with antibiotics.
- Close Hip Dislocation Reduction
- Immediate reduction is attempted only when radiography and magnetic resonance imaging suggest that hip dislocation is not associated with fracture of the femur or acetabulum.
- Intraoperative non-surgical reduction of the dislocated hip joint Neurological examination is performed when dislocation of the hip joint is diagnosed after X-ray and magnetic resonance imaging. Dislocation of the hip joint causes damage to the sciatic nerve in 20% of cases. If the sciatic nerve is intact, reduction of the hip joint is attempted under general anesthesia.
- “Allis’ technique is the safest and easiest method of reducing dislocation of the hip joint. The procedure is performed under anesthesia. The leg is pulled away from the hip joint while the assistant is holding the pelvis and tries to flex the hip joint, followed by adduction and external rotation to bring the leg into normal anatomical positions.
Conservative treatment for hip joint dislocation
- Intravenous Fluid – If Needed.
- Vitamin supplement.
Specific treatment for dislocation of the hip joint
Hip pain due to dislocation of the hip joint
- NSAIDs – Motrin, Naproxen and Celebrex
- Opioids – Morphine, Oxycodone and Hydrocodone.
- Antidepressant analgesics – prescribed to treat hip neuropathic pain after hip dislocation and pain that does not respond to opioids. eg Cymbalta and Elavil.
- Antiepileptic analgesics – It is an alternative treatment to antidepressant analgesics for pain in the neuropathic hip joint. Ex: Neurontin and Lyrica.
Rehabilitation after hip dislocation surgery
Rehabilitation for the first 48 to 72 hours
- Hospital admission to the rehabilitation clinic for 2 to 3 days.
- Training for safe ambulation
- Training to get in and out of bed.
- Training to use cane, walker or wheelchair for ambulation.
- Physiotherapy in inpatients
- Objective: to improve the range of motion.
- Joint and muscular strengthening.
Prolonged rehabilitation after 48 to 72 hours
- Fisioterapia – Em casa ou cuidados de enfermagem.
- Terapia Ocupacional – O paciente é ensinado e supervisionado para o desempenho das seguintes atividades:
- Tomando banho
- Funções higiênico
Terapia Intervencionista para Luxação da Articulação do Quadril
- Injeção de corticosteróide da articulação do quadril, ponto de gatilho e músculos.
Opções cirúrgicas para luxação da articulação do quadril
- Artroscopia – artroscopia do quadril diagnóstico
- Redução Aberta – O tratamento cirúrgico é indicado se o tratamento conservador e a redução não cirúrgica próxima do quadril falharem. A cirurgia também é realizada o mais cedo possível se houver suspeita de lesão do nervo ciático.
- Exploração da articulação – A cirurgia também é indicada se fragmentos ósseos ou cartilaginosos forem observados na articulação do quadril após uma lesão ou após uma redução próxima.
Redução Aberta: para o tratamento da luxação da articulação do quadril
- Abordagem – A abordagem posterior é preferida, uma vez que a taxa de necrose avascular é relativamente baixa em comparação com a abordagem anterior.
- Parafuso e Placas – Use para reparar uma seção do osso fraturado.
- Inserção de bastonetes – Para reparar o eixo quebrado do fêmur.
- Substituição Parcial – Substituição da cabeça e pescoço do fêmur dentro das cavidades intactas.
- Substituição Total da Articulação do Quadril – Cabeça, pescoço e parte superior 1/3 do fêmur é substituído. O soquete é substituído por uma prótese de metal artificial.
Prognóstico da luxação da articulação do quadril
- A necrose avascular é prevenida se o tratamento for realizado dentro de 6 horas após a luxação da articulação do quadril.
- Artrite precoce é vista após a conclusão dos tratamentos de luxação da articulação do quadril.
Complicações após luxação da articulação do quadril causando dor no quadril
A seguir, a complicação comum observada em todo tipo de luxação articular
- Dor no quadril
- Formigamento e Dormência da Perna Ferida.
- Fraqueza da perna ferida.
- Necrose Avascular .
- Osteoartrite Secundária.
- Miosite ossificante
- Osteoartrite .
- A imobilização pós-operatória pode causar trombose venosa profunda, embolia pulmonar e pneumonia.
Luxação Posterior do Quadril
- Lesão do Nervo Isquiático
- Fratura da borda transversal ou posterior.
Luxação Anterior do Quadril
- Lesão da artéria femoral
- Lesão do Nervo Femoral
- Hemorragia Severa
Luxação Central do Quadril – Fratura da Borda Capsular.
Traumatismos Ligamentos da Articulação do Quadril Todos ou um dos cinco ligamentos são susceptíveis de ser ferido
- Ligamento Iliofemoral .
- Ligamento Teres .
- Ligamento Pubofemoral .
- Ligamento Isquiofemoral .
- Ona Orbicularis Ligament.
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