Houston Methodist. Leading Medicine

Hip FAQ

Question:

My mother fell and dislocated her new hip replacement. They took her back into surgery and put the joint back in place. She'll be going to a step-down transition unit. What should we expect for a prognosis? Will it hold? What happens if it doesn't?

Answer:

Dislocation is every patient's fear after getting a new hip replacement. The surgeons call it instability. No matter what name you give it, the problem is troublesome for the patient and a complex challenge for the surgeon. Conservative (nonoperative) care is usually tried first. Once the hip is back in the socket, a brace may be applied and the patient is sent to physical therapy. Not all surgeons use bracing in these situations. If they do, the brace used is called an abduction brace. It holds the hips apart and in a neutral position (not turned in or rotated out). The physical therapist will help your mother learn how to move safely while strengthening the muscles around the hip. A special focus of treatment is to restore normal joint proprioception (sense of joint position) and kinesthesia (awareness of movement). Balance training is also very important. Before discharging her to home, the therapist will interview the family to find out what kind of changes need to be made at home. For example, throw rugs will have to be removed, additional lighting (especially for at night) may be needed, grab bars installed in and around the bathroom, and so on. If a conservative approach doesn't work and the hip dislocates again and again, then surgery may be needed. The surgeon may have to tighten up loose tissue and restore a balance to soft-tissue tension on all sides of the hip joint. If the implant is improperly positioned, it must be removed and realigned. The surgeon may need to replace the femoral head with a larger one. The goal is to prevent a recurrent (second) hip dislocation. The good news is that only 10 per cent of patients who dislocate the hip after receiving a total hip replacement will dislocate it a second time. Your surgeon and the rehab team will help you navigate through this difficult time. Don't hesitate to bring up your concerns and questions. They have knowledge of your mother's health and hip condition that they can draw on to provide you with answers. Clifford W. Colwell, Jr. Hip Reconstruction. Instability After Total Hip Arthroplasty. Current Orthopaedic Practice. January/February 2009. Vol. 20. No. 1. Pp. 8-14.

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