Preventing Hip Replacement Dislocation

There are some ways to prevent dislocation of a hip replacement, which is the most common complication of hip replacement surgery.

While the ball and socket of the hip replacement are very tightly fit together, they are not actually connected—and if enough force is applied, they can become separated. A dislocation occurs when the femoral head (the "ball") is separated from the socket.

The risk of complications of hip replacement surgery, including dislocation, has come down over the past decade with preventive strategies. Nevertheless, when it occurs, hip dislocation may require a second procedure, called a revision hip replacement.

Hip Replacement Dislocation

Hip replacement dislocations occur when the ball of the ball-and-socket joint replacement comes out of the socket. It can happen during activities that put unnecessary strain on the hip joint. The risk of dislocation is greater just after surgery, during the healing process.

Dislocation of a hip implant is a medical emergency. If you've had your hip replaced, call your healthcare provider right away if you feel as though your hip is moving out of place, as this could indicate an issue with your implant. Signs of dislocation include:

• Sudden onset of pain (with or without a "snapping" sensation)
• An inability to put weight on the leg
• A difference in leg length when you rotate your replaced hip

To confirm the diagnosis, your practitioner will conduct a physical examination and may order imaging tests such as X-rays (sometimes with fluoroscopy) or a CT scan.

Your healthcare provider will also want to determine why the dislocation occurred. Establishing why the hip joint dislocated is an important factor in determining the appropriate treatment and preventing it from happening again. Factors that can contribute to a hip replacement dislocation include:

• The type of implant used
• The positioning of the implant in the body
• Underlying medical conditions (for example, Parkinson's disease)
• Traumatic injury

Once the cause of the dislocation is identified, your surgeon will discuss your treatment options with you. It may be possible for your surgeon to reposition it without surgery. This is called a "closed reduction" and may be done under anesthesia. In some cases, a revision hip replacement surgery (to replace the implant) may be the best option to prevent another dislocation.

Preventing Hip Replacement Dislocations

Patients with hip replacements can take steps to minimize the risk of dislocation by avoiding situations that put unnecessary strain on the implant. Behavior changes can include avoiding things like side sleeping, sitting in low seats that make it difficult to get up, bending more than 90 degrees at the waist, or crossing the legs. Reducing alcohol consumption and losing weight can also help decrease the risk.

But not all factors can be controlled. For instance, conditions like Parkinson's disease (which causes uncontrolled movement) can be managed, but not cured. Another factor that cannot be controlled is age; patients over the age of 85 have a higher chance of hip replacement dislocation.

However, there are factors that your surgeon will consider in order to reduce the risk of hip replacement dislocation:

• Implant size: Femoral head size options have increased dramatically in the past decade and are no longer a "one size fits all." Femoral head size can be adjusted to help prevent dislocation (larger femoral heads are less likely to dislocate from the socket).
• Implant material: The implants used for hip replacements can be made of combinations of metal, plastic, and ceramic. Sometimes special implants, such as metal-on-metal hip replacements, allow your surgeon to use a larger size femoral head, and thus lower dislocation risk.
• Surgical approach: There are two approaches to consider: anterior and posterior. While a growing number of hip replacements are being performed through an anterior surgical approach, and some surgeons feel the chance of dislocation is lower with this approach, others disagree. One study showed no difference in complication rates by approach.

It's also important to talk to your healthcare provider about their experience doing hip replacement surgeries, and their approach. Studies have demonstrated that surgeons who perform more hip replacements each year have a lower chance of complications such as implant dislocation.

As a patient, it's important to understand which approach is best for your individual anatomy as well as your surgeon's individual experience and preference.

A Word From Verywell

Hip replacement surgery is an effective treatment for hip pain caused by arthritis. If you are planning to have this surgery, you should be aware of the potential risk of dislocation of the hip replacement.

If you are particularly concerned about dislocation, you can talk to your surgeon about how you can try to lower your risk of having a dislocation complication.