Recommended Position After Hip Dislocation
After successful closed reduction of a hip dislocation, patients should begin early mobilization with partial weight-bearing at an average of 9 days post-reduction, progressing to full weight-bearing at 3 months, rather than prolonged immobilization or traction. 1
Immediate Post-Reduction Protocol
Imaging Confirmation
- Obtain pelvic radiographs immediately after reduction to confirm concentric reduction and detect intra-articular fragments or associated fractures 1
- Consider non-contrast CT scan if posterior acetabular wall fractures are visible, closed reduction failed, or radiographs show joint incongruity 1
- CT has 87.3% sensitivity for detecting intra-articular fragments, though up to 43.3% of patients with negative CT may still have small fragments 1
Rest Period and Pain Management
- Provide relative rest for 3-9 days with multimodal analgesia 1
- Consider nerve blocks to facilitate early mobilization 1
Mobilization Strategy
Early Mobilization Protocol (Preferred Approach)
Early mobilization (average 9 days) with partial weight-bearing reduces complications from prolonged immobility without increasing early complications compared to prolonged traction. 1
- Begin partial weight-bearing at approximately 9 days post-reduction 1
- Progress to full weight-bearing at 3 months 1
- This approach allows faster return to work and reduces immobility-related complications 1
Contraindications to Early Mobilization
Early mobilization should NOT be initiated if:
- Unstable acetabular fractures requiring surgery are present 1
- Post-reduction images show non-concentric reduction 1
- Large intra-articular fragments prevent stable reduction 1
Special Considerations for Prosthetic Hip Dislocations
If the dislocation involves a total hip arthroplasty rather than native hip:
Positioning Devices After Reduction
- Use an abduction pillow or brace to prevent extremes of flexion, adduction, and rotation, though evidence supporting these interventions is limited 2
- Consider a knee immobilizer, which has been shown to prevent redislocation in 98 patients who underwent arthroplasty using the posterior approach 3
- A special chair-back brace with lateral joint and thigh cuff can be locked at specific positions to control hip movement, worn for 6-9 months after second dislocation 4
Positions to Avoid
- Avoid extremes of flexion, adduction, and internal rotation 2, 4
- Excessive flexion and internal rotation of the hip should be resisted 5
Common Pitfalls
- Do not routinely use prolonged traction or immobilization beyond the initial 3-9 day rest period for simple dislocations with concentric reduction, as this increases complications without benefit 1
- Do not use bone scintigraphy, contrast-enhanced CT, or contrast-enhanced MRI for routine post-reduction follow-up 1
- Ensure concentric reduction is confirmed before initiating mobilization protocols 1
- Document neurovascular status carefully to avoid missing associated injuries 6