Chronic hip dislocations: a rarity. How should we treat them?

Combined Anterolateral and Posterior Approach in Total Hip Arthroplasty for Chronic Post-traumatic Hip Dislocation: A Case Report

Hip dislocation is rare, and it typically results from high-energy trauma such as traffic accidents. Its management involves prompt reduction of the dislocated hip to minimize the risk of subsequent femoral head necrosis. Consequently, cases of chronic hip dislocation are extremely rare. This report presents a case of a 33-year-old male with chronic posterior hip dislocation due to a traffic accident 13 years ago. The left femoral head was completely dislocated posteriorly from the acetabulum, forming a false acetabulum with an arthritic change. The patient experienced difficulty walking and performing daily activities due to pain. We performed a total hip arthroplasty (THA) using a combined anterolateral and posterior approach. The outcome was favorable, with no complications during the two-year follow-up period. THA using a combined anterolateral and posterior approach is a valuable option for patients with chronic post-traumatic hip dislocation because it offers the advantages of optical visibility and the management of the adhered soft tissues.

Chronic posterior dislocation of the right hip treated with bipolar hemiarthroplasty in resource limited environment- a case report

INTRODUCTION AND IMPORTANCE

Chronic traumatic posterior dislocation of the hip is one of the uncommon conditions that surgeons in developing countries have to treat due to continued unvetted patronage of traditional bone setters by patients. It usually treatment challenges due to limitation in option available because resource constraints.

CASE PRESENTATION

We present the case of 42-year-old male patient who presented to our hospital one and half years after sustaining road traffic accident. He had initial failed treatment with the traditional bone setters that left him with persistent right hip pain, limp, shortening and limitation of movement. He had initial heavy skeletal traction before an uneventful right bipolar hemiarthroplasty was done. His Harris hip score improved from 40.6 (preoperative) to 90.4 (postoperative).

CLINICAL DISCUSSION

Chronic posterior dislocation is a rarity in developed countries but is gradually becoming a common occurrence in developing countries. While total hip replacement is advocated in developed countries this may not be readily available due to financial constraints, poor access to the hospital, and fewer Orthopaedic surgeons to population ratios. This makes bipolar hemiarthroplasty used in this a readily available option that yielded a comparatively good outcome.

CONCLUSION

We propose that bipolar hemiarthroplasty is viable alternative to total Hip replacement in chronic posterior hip dislocation in resource limited environment where access to this procedure may not be easily available.

The curious case of a 75-year-long dislocated hip causing abdominal pain

We present a case of abdominal pain due to chronic hip dislocation of 75 years duration. Hip dislocations are not uncommon, but long-term, unreduced dislocations are vanishingly rare in the developed world. This 80-year-old female, who emigrated to the United States as an adult, presented to the emergency department for acute abdominal pain. Workup showed no intra-abdominal cause for her pain. History revealed she had suffered a traumatic hip dislocation at 5 years of age that was unable to receive adequate treatment because of limited health care access. After several years, she regained functional ability because of anatomic and compensatory musculoskeletal changes in the pelvis. The adaptations likely caused excessive muscular strain resulting in muscle spasm at the location of her abdominal pain. To our knowledge, this is the only reported case of a hip that remained dislocated for 75 years.

Traumatic Hip Dislocations in an Orthopedic Center in Lagos

Background:

Hip dislocations are one of the orthopedic emergencies. They may result from a high-energy transfer as in a road traffic crash. Prompt recognition and treatment can reduce the long-term morbidity associated with delayed reduction. The goal of this study was to evaluate the epidemiology and outcome of treatment.

Patients and Methods:

This was a retrospective study that involved cases of traumatic hip dislocations seen at the National Orthopedic Hospital, Lagos, Nigeria, between January 1, 2010 and June 30, 2014. Biodemographic characteristics, mechanism of injury, and type of dislocations were retrieved from case files. Thompson and Epstein type of the dislocated hips as well as the presence of pre- and post-reduction complications was noted.

Results:

Forty-five patients had hip dislocations in the study period. Only 27 had the relevant information to be included in the study. All cases were posterior hip dislocations. The median follow-up was 9 months (range 6–30 months). More dislocations occurred on the left [18 (67.0%)] than on the right [9 (33.0%)]. The median age of patients was 37 years (range 21–73 years). Twenty-six dislocations (96.3%) were due to road traffic crash and a case (3.7%) was due to an industrial accident. Grade IV Epstein was the most common injury recorded. Twenty-four (89.0%) cases were managed with closed reduction, whereas the remaining 3 (11.0%) cases had open reduction. The associated complications observed were sciatic nerve injury, avascular necrosis of the head of the femur, and protrusio acetabuli.

Conclusion:

Road traffic crash remains a leading cause of traumatic hip dislocation. Severity of injury and delay in reduction contributes to the complications of treatment.