Dislocated Hip

Does Hip Dislocation Cause Hip Pain?

Doctors believe that the hip continues as one of the most secure joints in the body. It takes a lot to dislocate a hip joint unless someone has a prosthetic hip or hip dysplasia. As previously written, a dislocated hip causes excruciating pain, and it usually occurs after a significant injury. However, if your child has a minor injury or his or her hip has been subjected to a lot of wear and tear, your child could have a subluxation. If your child’s hip snaps in the socket when moved, or if it’s difficult to bear weight on the leg, take note. Our orthopedic doctors who specialize in children can assist parents in determining the source of their child’s hip pain and recommend the appropriate treatment.

Understanding Hip Pain and Dislocation

Hip pain can be concerning, but it doesn’t always indicate a dislocated hip. Your hip joint is one of the most stable joints in your body. Due to its robust design, a dislocation typically occurs only after a significant trauma or injury.

If you’re experiencing severe, disabling pain following a high-impact incident, you might have a dislocated hip. Such dislocations are often accompanied by an inability to move your leg or bear weight on it.

However, if your pain arose without a substantial injury—or if your hip seems to click or pop while moving—it might be something less severe, like a subluxation. This is where the joint is partially out of place, and is often seen in cases of overuse or minor injuries.

What to Look Out For

• Severe pain: Intense pain particularly from an injury could mean a dislocation.
• Joint instability: Sensation of the hip snapping or clicking during movement.
• Limited mobility: Difficulty in moving without discomfort or pain.

For an accurate diagnosis, consulting with a healthcare provider is crucial. They can pinpoint the reason for your hip pain and suggest appropriate treatments, which might range from rest and physical therapy to more advanced interventions.

What Causes Hip Dislocation?

A traumatic injury commonly causes injuries like a hip dislocation. Pushing a hip joint out of its socket requires typically a lot of force.  As doctors, we see car accidents as the most typical cause. A severe fall, an injury sustained while playing sports, or an accident at work might potentially cause the dislocation too. If your child has developmental hip dislocation (hip dysplasia), dislocating a joint may require much less force. People who have received a hip replacement are also more likely to dislocate again during everyday activities.

What Does a Dislocated Hip Look Like?

Hip dislocations in children, while relatively rare compared to adults, are serious orthopedic conditions that require prompt diagnosis and management to prevent long-term complications such as avascular necrosis, growth disturbances, and chronic pain. The pediatric hip joint, still developing and more flexible than in adults, presents unique challenges and considerations in diagnosis. This article provides a thorough and insightful exploration of the diagnosis of hip dislocations in children, covering etiology, clinical presentation, diagnostic methods, differential diagnoses, and the importance of multidisciplinary care.

1. Understanding Hip Dislocations in Children

A hip dislocation occurs when the femoral head is forced out of the acetabulum, the socket of the pelvis that forms the hip joint. In children, hip dislocations can be classified as congenital (present at birth) or acquired (resulting from trauma or other causes). The most common type in children is traumatic dislocation, often due to high-energy injuries such as motor vehicle accidents or falls from significant heights. However, congenital hip dysplasia (developmental dysplasia of the hip, or DDH) can also lead to dislocation if not addressed early.

The pediatric hip is particularly vulnerable due to its ongoing development. The soft tissues, including ligaments and cartilage, are more elastic, and the bony structures are less ossified, making dislocations possible even with moderate force. Additionally, conditions such as cerebral palsy, neuromuscular disorders, or connective tissue diseases can predispose children to hip instability and dislocations.

2. Etiology and Risk Factors

Congenital Causes

• Developmental Dysplasia of the Hip (DDH): This is the most common congenital cause of hip instability, where the femoral head is not properly seated in the acetabulum. If untreated, DDH can lead to dislocation over time.
• Teratologic Dislocations: These occur in utero or shortly after birth and are often associated with neuromuscular conditions like spina bifida or arthrogryposis.

Acquired Causes

• Trauma: High-energy injuries, such as those from sports, falls, or motor vehicle accidents, are the leading cause of acute hip dislocations in children. The mechanism typically involves a force that drives the femur out of the acetabulum, often posteriorly.
• Pathologic Conditions: Diseases like Legg-Calvé-Perthes disease, slipped capital femoral epiphysis (SCFE), or juvenile idiopathic arthritis can weaken the hip joint, increasing dislocation risk.
• Iatrogenic Causes: Surgical procedures or improper positioning during anesthesia can rarely result in hip dislocation.

Risk factors include a history of prematurity, breech presentation at birth, family history of DDH, and conditions affecting muscle tone or joint stability.

3. Clinical Presentation

The presentation of hip dislocations in children varies depending on the cause, age, and severity. Key signs and symptoms include:

• Pain: Children often present with severe pain in the hip or groin area, which may radiate to the knee or thigh. In younger children or those with cognitive impairments, pain may be expressed through irritability or refusal to bear weight.
• Deformity: The affected leg may appear shortened, externally rotated, and abducted (in posterior dislocations) or internally rotated and adducted (in anterior dislocations). Asymmetry between the legs is a common finding.
• Limited Range of Motion: Attempted movement of the hip may be severely restricted or impossible due to pain and joint instability.
• Swelling and Bruising: Trauma-related dislocations may show ecchymosis or swelling around the hip or thigh.
• Neurologic or Vascular Symptoms: In rare cases, dislocation can compress nearby nerves (e.g., sciatic nerve) or blood vessels, leading to numbness, weakness, or diminished pulses in the affected leg.

In congenital cases, such as untreated DDH, symptoms may be subtler and include asymmetric skin folds, a limp, or a positive Ortolani or Barlow maneuver during infancy. Older children may develop a waddling gait or leg length discrepancy.

4. Diagnostic Methods

Diagnosing hip dislocations in children requires a combination of clinical evaluation, imaging studies, and, in some cases, laboratory tests. The goal is to confirm the dislocation, assess for associated injuries, and rule out differential diagnoses.

Physical Examination

• Inspection: Look for leg length discrepancy, asymmetry, or abnormal positioning. Palpate for crepitus, tenderness, or abnormal joint movement.
• Range of Motion: Assess hip flexibility, noting any pain or limitation. Special tests like the Ortolani maneuver (for infants) can help identify instability.
• Neurovascular Assessment: Check for pulses, sensation, and motor function in the affected leg to rule out nerve or vessel injury.

Imaging Studies

• X-rays: The first-line imaging modality, X-rays provide a clear view of bone alignment and can confirm dislocation. Anteroposterior and lateral views of the pelvis and hip are standard. In children, care must be taken to minimize radiation exposure.
• Ultrasound: Particularly useful in infants under six months, ultrasound can assess soft tissue structures and cartilage not visible on X-ray. It’s the preferred method for evaluating DDH.
• MRI or CT Scan: These are used in complex cases or when soft tissue injury, fractures, or neurovascular compromise is suspected. MRI is superior for evaluating cartilage and soft tissues, while CT provides detailed bony anatomy and is helpful for preoperative planning.
• Arthrography: In some cases, injecting contrast into the joint can help visualize the joint space and assess for labral tears or other soft tissue injuries.

Laboratory Tests

While not routinely required, blood tests may be ordered if infection (septic arthritis) or inflammatory conditions are suspected. Elevated inflammatory markers (e.g., C-reactive protein, erythrocyte sedimentation rate) or white blood cell count could indicate an underlying pathology.

5. Differential Diagnoses

Several conditions can mimic hip dislocation in children, making accurate diagnosis crucial:

• Slipped Capital Femoral Epiphysis (SCFE): A condition where the femoral head slips off the neck, often seen in adolescents. It presents with hip or knee pain and limited range of motion.
• Legg-Calvé-Perthes Disease: Avascular necrosis of the femoral head, common in children aged 4–10, causing hip pain and limping.
• Septic Arthritis: A bacterial infection of the hip joint, which can cause acute pain, fever, and refusal to bear weight.
• Transient Synovitis: A benign, self-limiting condition causing hip pain and limp, often following a viral infection.
• Fractures: Pelvic or femoral fractures can present similarly to dislocations, especially in trauma cases.

6. Challenges in Diagnosis

Diagnosing hip dislocations in children can be challenging due to several factors:

• Non-Specific Symptoms: Young children may not localize pain well, and nonverbal children or those with developmental delays may not communicate symptoms effectively.
• Overlapping Conditions: The pediatric hip is susceptible to multiple conditions (e.g., DDH, SCFE, Perthes), which can confuse the clinical picture.
• Growth Plate Concerns: The proximity of the growth plate (physis) to the joint increases the risk of injury during dislocation, necessitating careful imaging and management.

What Indications and Symptoms Point to a Hip Dislocation?

Looking at the injury from the outside, you’ll notice that the leg is locked in place, rotated either inward or outward. Approximately 90% of the time, a hip joint is pushed backward out of its socket (posterior dislocation), causing the knee and foot to point inward. A knee and foot will point outward if the hip is pushed forward out of its socket (anterior dislocation). In addition, a rotated leg may appear shorter or longer than the other. You might notice that your child’s hip isn’t aligned, or you might notice swelling or discoloration at the hip.

• Severe pain.
• Muscular spasms
• Hip joint swelling or discoloration.
• Rotation of either the inside or outside leg
• Impossibility of moving a leg.
• Impossibility of bearing weight on a leg.
• Loss of sensation in a hip or foot
• The hip remains clearly out of place.

Hip Dislocation Risks

A displaced hip joint might require separate treatment if it damages adjacent nerves, blood vessels, or tissues. This damage can sometimes produce long-term consequences, such as the following:

• Nerve injury to the sciatic nerve, which travels from the lower back through the hip and down the leg. Compression of the nerve results in chronic pain, often known as sciatica. A sciatic nerve injury can impair the ability to flex a foot and toes.
• Damage to the femoral artery, which runs in front of the joint, can impair blood flow to the bone. When a blood supply is interrupted, the bone tissue begins to die and tiny fractures form, destroying the structural integrity of the bone. Osteonecrosis or avascular necrosis are the terms used to describe this.
• Damage to the cartilage that cushions the ball joint in its socket and the ring of cartilage that surrounds the joint is known as the labrum. This frequently results in arthritis and raises the likelihood of requiring a hip replacement later in life.

What Causes a Dislocated Hip?

Our pediatric orthopedic doctors typically just need to glance at a dislocated hip to make the diagnosis. They will, however, want to perform a full physical examination to rule out any other injuries. Before attempting to correct any fractures, they may order imaging tests such as X-rays or a CT scan to better see the position of the bones and screen for any fractures.

Dislocated Hip Treatment

Urgent care

Don’t try to move the hip if you think your child has suffered a dislocation. Take your child immediately to an Emergency Clinic.  The injury is excruciatingly painful and the child should quickly see a doctor to avoid long-term harm. It’s only safe to conduct hip correction once other linked injuries have been detected, which involves training, medicine, and help. Upon examination, doctors may find that surgical intervention is needed to repair secondary damage. Correction becomes most effective when done a few hours after the incident.

Hip reduction

The emergency room doctors or our doctors will physically relocate the joint back into position to treat the dislocated hip. It is referred to as a decrease. External (“closed reduction”) repair is possible when there are no subsequent injuries. To repair hip joints, doctors must force the hip both out of alignment and back into alignment. To lessen discomfort and muscle spasms during the treatment, our doctors will likely suggest a mix of anesthetic and sedative medications. Sometimes the procedure is carried out while your child is sleeping.

Surgery

It is really important for parents to bring their children to us after the emergency room.  If there are major secondary injuries, surgical procedures can fix blood vessels and nerves in the operating room. The preferred course of therapy for newborns who have experienced hip dislocation, particularly as a result of hip dysplasia, is surgery. Our surgeons can also stabilize the joint during surgery to avoid dislocation in the future. With newborns, this works 90% of the time.

How can I Prevent my Child from Dislocating a Hip?

Safety

Since hip dislocation typically comes from an accident, following general safety recommendations is the best way to prevent it. When driving you should always buckle your seat and your child’s.  When your child is playing contact sports, you should always ensure that he or she is using the proper equipment and shoes.

Conditioning

Hip dislocations are likely to occur again if your child has already had one. You can preserve and grow your child’s hip joint simply by strengthening the tendons and muscles around it through regular exercise and physical therapy.

Hip Dysplasia Care

To avoid further harm, doctors should treat hip dysplasia in children while their bones are still developing.

How Long Does a Hip Dislocation Take to Heal

Even once a joint has been surgically made better, it may still take a hip two to three months to fully recover. Our doctor might advise minimizing hip motion for the first several weeks and then introducing physical therapy. Additionally, your child might require crutches for the first week or two to walk.

Dislocated Hip Recovery

Timely treatments can lead to a full recovery. After a high-force trauma causes a hip to dislocate, further injuries are common. If nerves and blood vessels become harmed and not treated within hours, there is a greater chance of long-term consequences.

All hip dislocations damage the ligaments and muscles that keep a hip joint stable as well as the cartilage that protects the joint from slipping out of its socket. The longer a joint remains unstable and untreated, the more destabilized it becomes, increasing the likelihood of future dislocation injuries.

In roughly 50% of instances, a dislocated hip can result in the gradual onset of arthritis. This arthritis might eventually necessitate a hip replacement, which, despite advancements, is still more likely to dislocate.

Key Considerations:

• Immediate Treatment: The sooner treatment is administered, the better the chances of avoiding long-term complications. Quick intervention can mitigate damage to nerves and blood vessels.
• Secondary Injuries: High-force traumas not only dislocate the hip but often lead to additional injuries that need attention.
• Long-Term Outlook: While short-term recovery may seem successful, untreated or improperly treated dislocations can lead to arthritis and potential hip replacements.

Although replacement hips resulting from arthritis are improving, it is crucial that children, and indeed all individuals, receive prompt treatment for any hip problems to ensure the best possible prognosis.

Particulars Regarding Dislocated Hip

With a dislocated hip, take it seriously. Given the nature of the situation, immediate medical attention is necessary for both immediate alleviation and long-term rehabilitation. Even if your child does not have any further injuries, parents still need to get the dislocated hip fixed as soon as possible to get rid of the discomfort and get the hip back to normal. Your child will benefit from receiving high-quality medical treatment from us for decades into the future. Call us today to schedule an appointment for a routine examination if you believe a problem may exist.

Why call the Medical City Children’s Orthopedics and Spine Specialists

Many doctors consider Medical City Children’s Orthopedics and Spine Specialists, with offices in Arlington, Dallas, Flower Mound,  Frisco, and McKinney, TX as one of the best children’s orthopedic practices in the World. The practice has earned an international and national reputation as it successfully treats children with a variety of musculoskeletal conditions.

The doctors provide individualized care to allow children to return as quickly as possible to an active life.  To fulfill this strategy, we combine doctors, surgeons specialists, nurses, technicians, physical therapists, and sports medicine doctors with advanced facilities that harness the power of cutting-edge technology and techniques. We can accurately diagnose a variety of excruciating conditions.  In addition, the doctors have the depth of experience to provide cutting-edge surgical treatments.  The doctors treat children in state-of-the-art operating facilities.  However, they also have a variety of efficient and comprehensive non-surgical treatments.

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Footnote:

 American Academy of Orthopaedic Surgeons: Hip Dislocation