Hip Dislocation

What is a dislocated hip?

The hip is comprised of a ball and socket joint. The ball (attached to the femur) sits in the acetabulum (socket) connected with the pelvis. The ball is kept in position by a combination of features including:

  • the acetabular dorsal rim (think of this like a roof)
  • the round ligament (think of this like a rope connecting the ball to the centre of the socket
  • joint capsule (think of this like glad wrap enveloping the ball and socket

 

What causes hip dislocation?

Dislocation of the hip occurs due to disruption of the normal connection between the ball and socket, this can occur due to:

  • Trauma
  • Conformation (poor design)

 

How is hip dislocation diagnosed?

Hip dislocation is often suspected based on palpation of the normal bony structures of the hip joint and derangement of these structures. However the diagnosis is always confirmed on radiography (X-Rays).

The direction of the dislocation influences the choice of treatment and includes:

  • Cranio-dorsal (forwards and upwards)
  • Caudal-ventral (backwards and downwards)

 

How do you treat hip dislocation?

The goal of managing hip dislocation is to restore the normal arrangement of the ball and socket, reduce the risk of osteoarthritis development and reduce the risk of subsequent dislocation events.

Options for management include:

  • Closed reduction (no surgery) where the hip is manipulated back into position
  • Open reduction (surgery) where torn tissue is cleaned from the joint, the hip is returned to its position and a synthetic ligament is inserted to maintain it in its new position
  • Femoral head osteotomy (FHO) where the ball is removed surgically
  • Total hip replacement (THR) where a new hip is inserted

The success rates of open vs closed reduction vary depending on the direction of dislocation, how long it has been dislocated for, and severity of the trauma.  We recommend attempting a closed reduction initially as it is minimally invasive and works in 50% of cases.  Costs vary depending on size of dog but generally including initial diagnosis, radiographs, aesthetic and reduction it works out to $1000- $1500.

With closed reduction, unfortunately some are unable to be reduced, and others are able to be reduced but the hip does not ‘stay in’ and thus is unsuccessful at remaining ‘in’ and thus not functional.  If closed reduction is successful there is a high risk period of 10 days where needs to be kept very quiet in order to support it remaining reduced (or in).

If closed reduction is not successful we then proceed to a surgical option.  This costs are in addition to your cost for the closed reduction attempt.  When surgery is necessary there are 3 options to consider

  • Hip Toggle – is an ‘open’ reduction technique. Open Reduction allows exploration of the joint, removal of the haematoma (blood clot) and soft tissue entrapped within the acetabulum (hip socket), and application of an internal stabilization such as a pin and toggle.  Estimated costs are $2600-3300, the advantages of this surgery is that you have a well-functioning hip joint with minimal complications
  • FHO (Femoral head Osteotomy) – surgical procedure that aims to restore a pain free hip with adequate mobility and function by removing the head and neck of the femur (long bone of the thigh). This allows the leg to still be functional (less than a toggled hip but still very good) and is pain free.  Estimated costs are $1600-$1900.  This procedure has minimal complications.
  • Hip Replacement – Gold standard for fully functional hip. Ideal for dogs with poor hip confirmation to get them back to a fully functioning hip.  This technique is only performed by an orthopaedic specialist in the Brisbane area and estimate costs are $8000.  Please refer to https://www.qldvetspecialists.com.au/total-hip-replacement for more indepth information.

When surgery is necessary, and hip conformation is unacceptable, then total hip replacement is recommended. We rarely advocate for FHO due to the unpredictability of this outcome and the potential for ongoing lameness.