Closed Reduction of Hip Dislocation

⚙️What This Procedure Involves

Under general anaesthesia or deep sedation with full muscle relaxation, the surgeon applies traction and specific rotational manoeuvres to reduce (relocate) the hip. For posterior dislocations (most common): the Allis or Bigelow manoeuvre is used — longitudinal traction with flexion, adduction, and internal rotation. For anterior dislocations: extension and external rotation. A 'clunk' is felt as the hip reduces. X-ray or CT confirms concentric reduction. The procedure takes 15–30 minutes.

💡Why It May Be Recommended

Traumatic hip dislocation is an orthopaedic emergency. The femoral head must be reduced within six hours to minimise the risk of avascular necrosis (loss of blood supply to the femoral head). Every hour of delay increases the AVN risk. Prosthetic hip dislocations also require urgent reduction.

⚖️Non-Operative Alternatives

There are no non-operative alternatives. A dislocated hip cannot reduce spontaneously and causes severe pain and neurovascular compromise.

📋Preparing for Surgery

Emergency procedure. X-ray confirms the dislocation and excludes associated fractures. Assessment of sciatic nerve function (foot dorsiflexion, sensation) before reduction. CT after reduction to assess for loose fragments and fractures.

✅Expected Benefits

Restoration of hip joint congruity. When reduced within six hours, the AVN rate is approximately 5–10%. After six hours, the risk increases significantly.

⚠️Common Risks

• Sciatic nerve palsyCommon

  Present in approximately 10–20% of posterior dislocations before reduction. May improve after reduction.

• Recurrent instabilityUncommon

  The hip may be prone to re-dislocation, particularly if there are associated fractures.

• Post-traumatic arthritisLong-term

  Cartilage damage from the dislocation.

🔴Less Common but Serious Risks

• Avascular necrosisUncommon

  Loss of blood supply to the femoral head. Risk related to time to reduction — approximately 5% if reduced within six hours, up to 50% if delayed beyond twelve hours.

• Irreducible dislocationUncommon

  Soft tissue or bone fragments may block reduction, requiring open surgery.

• Iatrogenic fractureRare

  Fracture during the reduction manoeuvre. Rare with proper technique and muscle relaxation.

• Femoral head fractureUncommon

  May be missed before reduction — CT after reduction is essential.

💉Anaesthetic Considerations

General anaesthesia with full muscle relaxation is preferred for safe reduction. Deep procedural sedation (e.g., propofol) may be used in the emergency department for experienced teams.

🏃Recovery and Rehabilitation

Non-weight-bearing or partial weight-bearing for four to six weeks. CT scan after reduction to assess for fractures and loose bodies. Physiotherapy for hip range of motion and strengthening. MRI at three to six months to screen for AVN. Full recovery two to six months depending on associated injuries.

📅Follow-Up

CT immediately after reduction. X-ray at six weeks. MRI at three to six months to screen for AVN. Long-term monitoring for post-traumatic arthritis.

❓Frequently Asked Questions