Dislocation of Hip Joint

1. DISLOCATION OF
HIP JOINT
SHAHUL HAMMEED
MBBS

2.  Hip Joint is a ball and socket variety of synovial joint.
 In normal hip, the head of femur articulates with the
acetabulum of hip bone to form hip joint.
Normal neck-shaft angle of Femur:
Child - 150°
Adult - 127°
Coxa Valga – Condition increase in angle - normal value
Coxa Vara - Condition in decrease in angle - normal value

3.  TYPES:
 Dislocation in hip joint is of two types -
 Congenital dislocation
 Acquired dislocation

4. CONGENITAL DISLOCATION
 SYN: Developmental dysplasia of hip(DDH)
 Present from birth.
 TYPES:Dep.up causes
1. Genetic Factors
- Causes gen. joint relaxation & thus easy
displacement
2. Hormonal Factors
- Causes ligamentous relaxation & dislocation
3. Intrauterine Malpostion
- Caused by extension of lower limb of fetus
within womb.

5. Congenital dislocation is more common in hip joint
 Upper margin of acetabulum is developmentally
deficient
Thus head of femur slips upward on gluteal surface of
acetabulum
This causes Lurching gait(unsteady
movements/walking)
Trendelenburg ‘s test is positive(indicates muscle
weakness).
If the dislocation is undetected & untreated, the hip jt
will be permanently affected.

6. ACQUIRED DISLOCATION
 TRANSITORY COXITIS
 PERTHES’ DISEASE
 MUSCLE IMBALANCE
 SLIPPED EPIPHYSIS
 TRAUMA/INJURY
 TUBERCULOSIS OF HIP
 RHEUMATOID ARTHRITIS
 ACUTE SUPPURATIVE ARTHRITIS
 OSTEOARTHRITIS

7. Transitory Coxitis
Syn : Irritable hip
Acute onset of hip pain & limping w/o any
systemic illness
Boys of age group 6 to12 years - commonly
affected
Exact etiology is not known
Non-specific upper RTI is associated in 70%
cases

8. Perthes’ Disease
Syn: Pseudocoxalgia
Described by 3 Doctors
-Calvé
-Legg
-Perthes
Thus also called Calvé-Legg-Perthes’ disease
There’s destruction or flattening of head of femur due to
poor or no blood supply, however acetabulum remains
unaffected.

9. Age group - age 2 up to teenage years (4-8 year olds
commonly affected)
Boys: Girls - 5:1
Signs & Symptoms:
Complain of hip and groin pain
Or pain in thigh/knee(referred pain – common nerve supply)
Limping gait (difficulty in walking)
Reduced range of motion of affected hip
Atrophy(muscle wasting) in hip and thigh
Detection:
Palpation (physical examination)
X-Ray
MRI scan
Bone scan(scanning using radioactive chemicals)

10. Treatment:
Aim- Promote healing with good hip motion and
containment of femoral head in acetabulum(to mold shape
of femoral head)
Restriction of long walks, sports, running, and jumping
activities.
Weight relief of the affected leg using walker or
wheelchair.
Bed rest for few days, if severe.
Surgery
- Brace for containment.
Success rate:
Thirty to forty years after the onset, as high as 90% of the
children are active and pain free.

12. Muscle Imbalance
Less used hip adductors become weaker due to
unbalanced paralysis
Eg: Poliomyelitis

13. Slipped Epiphysis
Upper femoral epiphysis is displaced from its
normal position upon the femoral neck.
Often associated with over weight.

14. Trauma/Injury
Trauma may cause dislocation of hip joint
Very uncommon – Greater stablity of hip joint
Trauma may cause femoral neck fracture.
Usually in elderly woman – osteoporosis.
common injury - fall on the greater trachanter

15. Subdivisions:
 Anterior dislocation - Less common
 Posterior dislocation - Most common
 Central dislocation - Rare

16. Anterior Dislocation
Less Common
Hip jt. - flexed, internally rotated and adducted
Cause: Weight falls on to the back - road accident, air
crash etc
Dislocation of one or both hips
Upward dislocation is prevented by Rectus femoris
muscle thus Lower limb is/are not shorted
Dislocation is prominent & easy to feel

17. Posterior Dislocation
Most common
Hip jt. - minimally flexed, externally rotated and
markedly abducted
Cause: Sudden powerful jerk – Road accident: Eg. Car
is rammed from behind, person is pushed forward –
posterior dislocation
Shortening of lower limb, length is measured from
ant.sup. Iliac spine to medial malleolus
(ankle jt. Protuberance).
Acetabular margin is also fractured

18. Central Dislocation
Rare
Cause: Falling on side or Inj. over greater trochanter
Little movements are possible
Femoral head is displaced medially
Acetabular floor is fractured

19. Tuberculosis Of Hip
Tuberculosis
Infectious disease – Mycobacterium tuberculosis
Causes - Inflammation, tubercle(nodule) formation, abscesses
etc
Tuberculosis of hip generally causes coxa vara (decr.
from normal neck – shaft angle of Femur)
The patient may have a history of active pulmonary
tuberculosis.

20. Rheumatoid arthritis
Arthritis : Painful inflammation and stiffness of
synovial joints.
Damaged parts looks worm-like.
Rare disorder of hip joint
More common in women.

21. Acute Suppurative Arthritis
Suppurative – Pus forming/discharging
Syn: Septic arthrits, pyogenic(pus forming) arthritis
In this type of arthritis, pus is formed and thus affects the hip
joint leading to hip pain and its displacement.
More common in childrens than any other age groups.
Infants - Femur may be infected via femoral vein puncture.
Older children – Inflammation of head of the femur and
complete destruction results in dislocation.

22. Osteoarthritis
Degeneration of cartilage and underlying bones in hip joint
More common in elderly women
Signs & Symptoms:
-pain and stiffness
-inflammation
-enlarged joint
-reduced range of motion
It may lead to fracture of femoral neck when accompanied with
trauma/ injury.

23. Symptoms
Hip Pain
Muscle Weakness
Inability To Move Leg
Numbness And Tingling
Clicking Sound Of Hip Joint