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What Is the Treatment for a Dislocated Hip Replacement?
Dislocated hip replacement treatment starts with closed reduction. You are given sedation, and a doctor guides the ball of the implant back into the socket without opening the hip. It takes minutes, and the pain stops as soon as the ball is seated.
Surgery is the exception, not the rule. It enters the conversation when a hip keeps coming out, or when imaging shows a reason the hip will not stay in on its own.
After more than twenty years doing nothing but hip and knee replacement, and more than 700 joint replacements a year at the Bone and Joint Institute of Tennessee, this is how I walk patients through it.
Here is the part to hold onto. One dislocation does not mean your hip replacement failed.
How Do You Know if Your Hip Replacement Has Dislocated?
A hip dislocation announces itself. There is sudden severe pain in the hip or groin, the leg will not hold weight, and the leg often looks shorter or twisted.
Warning signs of a dislocated hip replacement
- Sudden sharp pain in the hip, groin, or thigh, often right after a twist, a fall, or a reach toward the floor
- Being unable to stand or put weight on that leg
- A leg that suddenly looks shorter, or a foot that turns in or out on its own
- A sense that something shifted or gave way inside the joint
- New numbness or weakness running down the leg
This is an emergency. Call your surgeon and go to the nearest emergency department. Do not wait to see if it settles down overnight.
One practical tip I give my own patients: do not eat or drink on the way. Reduction is done under sedation, and an empty stomach means it can happen sooner.
How Is a Dislocated Hip Replacement Put Back Into Place?
An X-ray confirms the dislocation and shows which way the ball came out. The hip is then reduced under sedation or light anesthesia, and a second X-ray confirms the ball is seated.
Most dislocations go backward, which doctors call posterior. Those usually happen with the hip bent and rotated inward. A smaller share go forward, or anterior, with the hip straightened and rotated outward.
Direction matters. It tells your surgeon which positions your hip cannot tolerate yet.
What happens in the days after a reduction
Most patients walk on the leg the same day. Soreness lasts a few days, much like a deep bruise, then fades.
Your surgeon may add a walker for a short stretch, set temporary position limits, and hold off driving until the leg feels steady. Some patients are given a brace. Bracing has not been shown to prevent the next dislocation, so I use it selectively.
The more useful step is the workup that follows. That means careful X-rays, sometimes a CT scan to measure implant position, and an honest look at what the hip was doing when it came out.
How Likely Is a Hip Replacement to Dislocate Again?
About one in three hips that dislocate once will dislocate again. That also means roughly two thirds settle down and never do it a second time.
Timing carries real information. Between 50 and 70 percent of dislocations happen in the first three months, while the soft tissue around the new hip is still knitting together.
Those early ones behave the best. The tissue heals, the scar matures, and the hip usually settles into place for good.
A hip that comes out years later is a different conversation. Time has usually changed something: the plastic liner has worn, the capsule has stretched, or the muscles have weakened.
What Makes a Hip Replacement Keep Dislocating?
Repeat dislocation almost always has a cause. The causes fall into three groups: implant position, soft tissue support, and how your body moves.
Implant and surgical factors
- A socket that sits too vertical, or turned too far forward or backward
- A thigh bone component with too much or too little rotation
- A small implant ball, which has less distance to travel before it slips out
- Implant impingement, where the neck of the implant levers against the socket rim
- Worn plastic in a hip that is many years old
Patient factors
- Previous hip surgery, which roughly doubles the risk compared with a first-time replacement
- Weak or damaged abductor muscles on the side of the hip
- Lumbar spine fusion, which can about double dislocation risk
- Neurologic conditions, cognitive impairment, or heavy alcohol use
- Repeated deep bending in the months right after surgery
The spine and hip connection
This one surprises people. Your pelvis tilts when you sit and stand, and that tilt changes where your hip socket points.
If the lower back is fused or very stiff, the pelvis stops tilting. The socket then has to do all the work at the ends of motion.
That is why a fused spine shows up so often in the history of a hip that keeps coming out. It is also why I ask about back surgery before I ever plan a hip.
When Does a Dislocated Hip Replacement Need Revision Surgery?
Surgery is usually considered after a second or third dislocation. It can come sooner if imaging shows a clear mechanical cause, such as a socket in a poor position or a failed abductor muscle group.
The goal is never to reopen the hip and hope. It is to find the reason and fix that reason.
Surgical options for recurrent hip instability
- Repositioning or replacing the socket. If the socket is the problem, moving it into a better position is the most direct fix.
- A larger implant ball. Bigger balls travel farther before they can escape. One randomized trial found dislocation five times more common with 28 mm balls than with 36 mm balls.
- A dual mobility bearing. A ball inside a mobile plastic liner adds stability for high-risk hips. Reported dislocation rates are near 1 percent in first-time replacements and about 3 percent in revisions.
- A constrained liner. This locks the ball into the socket. It is a salvage option, because the constraint stresses the socket and long-term failure rates are higher.
- Soft tissue repair or tensioning. Repairing the capsule, restoring leg length and offset, or advancing the hip bone attachment can restore the tension that holds the hip in place.
This is one reason robotic-assisted joint replacement matters. Instability is so often a positioning problem, and positioning is the most controllable factor in this entire topic.
What Can You Do to Protect a Hip That Has Come Out Once?
Follow the position limits your surgeon gives you, strengthen the muscles around the hip, and get seen quickly if the hip ever feels like it is slipping again.
The exact limits depend on your surgery. Patients who had an anterior hip replacement usually avoid extremes of straightening and outward rotation. A posterior hip replacement often calls for the classic hip precautions: no bending past ninety degrees, no low chairs, no crossing the legs.
Your surgeon’s protocol beats anything you read online, including this article.
A few habits do most of the work. Use a raised toilet seat and a firm chair with arms, and keep a pillow between your knees when you sleep on your side. Reach with a grabber tool instead of bending to the floor.
Take physical therapy seriously here. Strong hip abductors are part of what holds the ball in the socket, and they weaken faster than most people expect.
For the prevention side of this topic, including how surgical approach changes the odds, see our article on hip replacement dislocation risk by approach. The American Academy of Orthopaedic Surgeons also publishes a plain-language patient overview.
Hip Instability Care in Franklin, Nashville, and Middle Tennessee
If your hip replacement has dislocated, get a second opinion from a surgeon who does this volume of work. Instability is a solvable problem once the cause is identified correctly.
I see patients from Franklin, Nashville, Brentwood, Spring Hill, Columbia, and across Middle Tennessee at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067. You can schedule a consultation online or call (615) 791-2630.
Bring your operative report and your most recent X-rays if you have them. They shorten the path to an answer.
This article reflects Dr. Calendine’s independent clinical perspective and is provided for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment from your own orthopaedic surgeon. A suspected hip dislocation is a medical emergency; seek care immediately and follow the protocol given by your surgical team.
Watch: My Hip Replacement Came Out of Socket. Now What?
In this short video, Dr. Cory Calendine answers the question patients ask first after a dislocated hip replacement: what happens now. He walks through closed reduction, why most hips settle down afterward, and the point at which repeated dislocation calls for revision surgery.
Prefer to watch on YouTube? View the full video here.
References
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- Charissoux JL, Asloum Y, Marcheix PS. Surgical management of recurrent dislocation after total hip arthroplasty. Orthop Traumatol Surg Res. 2014;100(1 Suppl):S25-S34.
- Kunutsor SK, Barrett MC, Beswick AD, Judge A, Blom AW, Wylde V, Whitehouse MR. Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements. Lancet Rheumatol. 2019;1(2):e111-e121. PMID 35079707.
- An VVG, Phan K, Sivakumar BS, Mobbs RJ, Bruce WJ. Prior lumbar spinal fusion is associated with an increased risk of dislocation and revision in total hip arthroplasty: a meta-analysis. J Arthroplasty. 2018;33(1):297-300.
- Howie DW, Holubowycz OT, Middleton R. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94(12):1095-1102.
- De Martino I, D’Apolito R, Soranoglou VG, Poultsides LA, Sculco PK, Sculco TP. Dislocation following total hip arthroplasty using dual mobility acetabular components: a systematic review. Bone Joint J. 2017;99-B(1 Suppl A):18-24.
