How Long Does it Take to Recover after Hip Replacement Dislocation?

What is a hip dislocation in concrete terms?

The joints in your body can dislocate. But what does the term “dislocated” actually mean?

It means that the bones forming the joint are no longer aligned, not fitting together as they normally do.

In the case of the hip, we refer to dislocation when the head of the thigh bone (femur) separates from the socket of the hip bone (acetabulum).

This can also happen when you have a hip replacement. In the case of a dislocated hip with a replacement, it means that the replacement itself moves out of its usual location in the bone.

More precisely, the replacement’s ball (replacing the head of the femur) disconnects from the cup (replacing the acetabulum) of the hip implant.

Hip dislocations with prostheses can occur with both total and partial replacement. Total hip replacement tend to have a slightly higher risk of dislocation.

However, replacement dislocation remains relatively rare. Most people who undergo hip surgery will never experience a dislocation.

Symptoms of dislocated hip replacement

The symptoms and signs are:

• You experience very intense pain (even if you may have had some pain, it was much less severe since the operation).
• Your operated lower limb is locked in a position, the foot turned completely inward, making the leg appear shorter.
• You cannot put your foot on the ground, and moving the leg is nearly impossible.
• Sometimes, you observe a deformation or asymmetry where the replacement appears displaced or misaligned from its normal position.

A doctor confirms the diagnosis with an X-ray.

A dislocated hip is hard to miss. It is very painful, you cannot put your foot on the ground, and the leg is stuck in an unusual position.

How to be sure you have dislocated your hip?

Often, people in rehabilitation whom I have encountered are afraid they may have dislocated their hip. This fear may arise from making a sudden movement and experiencing some pain at the moment or the next day. Or simply because they have pain that concerns them. They think it’s a sign of a problem.

Perhaps you find yourself in a similar situation?

Rest assured: these signs are not sufficient to suggest a replacement dislocation. When a replacement is dislocated:

• the pain is extremely severe,
• the leg is visually deformed;
• it can hardly move;
• or you can really no longer walk.

It’s also worth noting that you can experience very intense pain without necessarily having dislocated your hip. That’s why your hip is visually examined before sending you for an X-ray if a dislocation is suspected, as pain alone is not a reliable indicator.

What is the risk of dislocation with a hip replacement?

Dislocation can happen at any time with a hip replacement, but the risk is higher in the first few days and the first 3 weeks (Tamaki 2016). This is because the tissues and muscles have not had enough time to heal properly, and they may not provide sufficient support to keep the prosthesis in place.

You have a higher risk of dislocating your replacement if (Guo 2017; Faldini 2018):

• your hip replacement has been revised or changed multiple times (at least 2 times);
• you have had a hip dislocation before having a replacement;
• you have a history of osteonecrosis of the femoral head;
• you have bone loss at the femoral head (this can happen, for example, in the case of a significant femur fracture);
• you are elderly.

However, dislocation remains very rare, even if you have multiple risk factors.

Hip dislocation after a replacement occurs in 0 to 2% of patients according to studies (Weegen 2016), and probably even less frequently with current procedures and materials.

If you are operated on both hips at the same time, you are no more at risk of dislocation than if only one hip had been operated on (Rowan 2018).

What causes a hip replacement dislocation?

I’ve already outlined the risk factors for hip replacement dislocation: what about your history or current issues makes you more prone to dislocation.

But you might also be wondering how hip dislocation occurs concretely when you have a replacement?

As a precaution, your surgeon or physical therapist has probably talked to you about movements to avoid after a hip operation. I’ve already covered this topic in a full article, and here’s a summary in two sentences:

1. From a biomechanical perspective, it makes sense to limit certain movements to avoid hip replacement dislocation.
2. People educated by their healthcare professionals about these “forbidden” movements do not seem to have a lower dislocation rate than others!

It’s observed that in 24% of cases, hip replacement dislocation occurs after a fall (Reimert 2020). For the remaining 3/4 of people, well… we haven’t specifically identified THE thing that caused the dislocation.

So, practically, what you can do to minimize the risk of dislocation (which, let’s remember, is rare!): adapt your lifestyle to avoid situations at risk of falling.

And if this makes sense to you and doesn’t seem too restrictive, also be aware of movements more prone to dislocation based on the anterior or posterior surgical approach you had.

The causes of dislocations also differ depending on whether they occur between 0 and 3 months after the operation or 5 years or more after the operation (Lu 2019):

• Early dislocations (within 0 to 3 months following the intervention) are generally due to a lack of mature scar tissue, insufficient tension of soft tissues, or patient-related factors.
• Dislocations that occur after 5 years are mainly due to improper component positioning and polyethylene wear.

What is the treatment for a dislocated hip replacement?

The treatment of a replacement hip dislocation is a procedure performed by an orthopedic surgeon under general anesthesia. However, you don’t need to undergo surgery again: the incision does not need to be reopened if (Lu 2019):

• the dislocation occurs within 3 months after the operation,
• it’s your first dislocation.

The surgical team simply reduces the dislocation, meaning they realign the hip manually.

You are anesthetized to make it painless and ensure you are relaxed for the maneuver.

Sometimes, your surgeon may prescribe a brace to wear for a few days or weeks to try to limit movements. Physical therapy sessions are also often prescribed, either at home, in the clinic, or at a rehabilitation center.

Personally, I am quite skeptical about the usefulness of this brace. I believe it is at best there to remind you to “be careful” with your hip, especially in people with cognitive disorders who move a lot. Several studies also conclude that the brace is ineffective (Lu 2019).

In this case, one person out of three will have a recurrence of dislocation, and 60% of people who dislocate between 5 weeks and 3 months after the initial placement of the replacement will experience a recurrence of dislocation.

The treatment may be different in the case of a recurrence or if the dislocation occurs more than 3 months after the replacement is in place. It may involve surgical intervention, but this is rare. In such cases, it is referred to as an open reduction or replacemet revision.

A dislocated replacement must be realigned under general anesthesia without the need for re-opening.

What is the recovery time for a dislocated hip?

In the case of a first episode of dislocation with a replacement, you have a 2 in 3 chance of recovering without a new dislocation and without any particular complications.

Recovering from a dislocation reduction is generally much quicker than recovering from the initial hip replacement surgery because there is no reopening, and the tissues have not been torn.

If everything goes well, the dislocation episode does not significantly delay the overall recovery time of a hip replacement, whether with or without dislocation. You can resume walking without a cane, driving, and other activities approximately as quickly as if you had not experienced a dislocation, just with a bit more caution and care.

In two-thirds of cases, a hip dislocation does not increase the overall recovery time for a hip replacement. It takes approximately six months to regain about 80% of functional capacity on average.

If you are one of the one-third of people who need to undergo re-operation due to multiple dislocations, your recovery time will likely be longer.