Why do hip replacements dislocate?
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- čas přidán 10. 08. 2021
- Sometimes a hip replacement comes out of the socket. This is called a dislocation. It's a horrible complication because it's painful and sometimes requires surgery to fix it. It also undermines your confidence and makes you wary of doing anything. In this video I talk about a hip replacement that I did 20 years ago, which has worn out and started to dislocate. If you would like to know more about hip surgery, please get in touch.
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I’d 7 dislocations of my right hip last year and my surgeon was quite happy for it to dislocate a couple of more times before he’d even look at it! On the 7th dislocation I was told I was going nowhere by another surgeon because he was going to fit a dual mobility hip replacement. Nine and a half hours of surgery later it was done. So far that’s nearly a year without any complications. Hip dislocations are flipping agony yet the 1st surgeon decided “he was happy with it to do it a couple of more times” thankfully the new surgeon stepped in and solved the problem.
Dislocations are terrible because they have such a bad effect on your confidence. If a hip dislocates 3 times then in my experience, it needs to be revised. Good to hear that yours has been sorted out.
@@scottsymington176 did your hip completely dislocate each time? And did you need to go to the hospital each time. I’ve been having my hip pop out the socket and thump back in to place on several occasions now since my THR 14 weeks ago. Really distressing when it happens.
@@tkd4 yeah I was hospitalised each time it dislocated and my confidence went down hill fast but thankfully this new dual mobility hip it’s never dislocated since I got it fixed
@@scottsymington176 one more question. How painful was it when fully dislocated and were you able to move after it. I’m asking because I’m really worried it might happen to me.
@@tkd4 ohhhh it’s really very painful when it dislocates! It’s horrendously painful!!! It took a 91/2 hours operation to fix the damage done by the dislocations.
Undermines my confidence most definitely. I’m terrified of every move I make and will remain feeling that way until my surgeon tells me why it happened at all? It really is terrifying and if mine went again for no reason, again, I’m afraid of landing on my shoulder that’s been replaced, or my other shoulder that’s been repaired or my knee that’s been replaced,…….. it’s absolutely horrifying to prepare mentally to take a shower especially. I can’t do it without my husband in the bathroom too, or my son outside the door if my hubby can’t be there. I hate feeling this way, it’s wearing me down, absolutely mentally exhausting to say the least.
Very interesting about not haveing to replace the whole hip if most of the components are stable.I can see it means alot to you jeramy to get it right.And helping people seems to be at the top of your list.Thanks for another great informative video.Keep up the good work.
Thanks Lee. Good to hear from you and thanks as always for your positive comments.
@@Lathamhipsurgery Bizzy week ahead for you jeramy.?Do you ever get nervous going into theater like a great pianist might do before a performance.?
@@leemcdermott1770 Good evening Lee. I'm off for a couple of weeks, which is nice! The day I don't get anxious about doing surgery, is the day I give up TBH Lee. Once I'm in theatre, I channel the anxiety into focus and concentration on what I have to do. Trouble is never very far away in surgery. The trick is to avoid it at all costs. Sometimes it just comes and bites you though. Surgery is a cruel mistress sometimes.
@@Lathamhipsurgery Thats a great analogy jeramy.Its going to be nice weather the nx 10 days at least.So enjoy your time off.Am still saving jeramy.I will see you.Take good care of those hands until then.
@@leemcdermott1770 will do! 🤞🙏
Update: 4 days after my sudden dislocation, my surgeon went over my scans and x-rays. I was told it looked fine and to go on doing my thing. It dislocated again while I was home alone. I fell to the floor immediately. I had to call out to my phone, to call my family/ambulace. I ended up having a hip revision a week later, this May. My first hip surgery was only in March! My surgeons partner found the problem. The angle of the ball and joint was incorrect for my body. Now I’m healing all over again and it’s much worse this time, I pray to turn a corner soon. I want to have my life back and forget this ever happened, though I know I’ll never forget, it was too traumatic and will take a long time to heal physically and emotionally. I found out that the first dislocation caused me a compression fracture in my spine as well, when I landed on the concrete the first time. That pain is the worst right now. I heard it’ll take months to heal. I cry a lot these days.
Sorry to hear about this. Take each day as it comes and try not to think too far ahead. Take plenty of rest.
@@Lathamhipsurgery Thank you for your advice. Will it hurt me to skip my PT excersises on occasion when I’m very tired/painful? I’ve been doing them since day one. Some days, like today, I’m so exhausted and sore. I just want to sleep.
@@audnbob1surrender to the tiredness. Rest is good and a very important part of your recovery.
@@Lathamhipsurgery Thank you so much. My regular Dr called me yesterday and did an evaluation. After it was all said and done, she said I definitely have PTSD, anxiety, depression etc from all of it, by now he answers I’d given to the tests. She’s called me in meds for the pain in my spine, feeling it’s nerve pain, anxiety meds, something else with serotonin to help me sleep etc and she will monitor me very closely to see how it works and for any side effects etc. I’m praying for some relief, I think it will help me greatly. Thank you again!!!! I so appreciate all your feedback🙏
Thank you dear great video you’re kind and handsome. my client falls a lot she’s fairly young and she landed on her hip replacement and it made a pop sound said it was extremely painful. She wants massage, I sent her to a chiropractor she won’t go? What would you suggest?
Thank you for your kind comments. I really appreciate them. I’m sorry to hear about your client’s problem. I would advise her to see her surgeon for an assessment and further investigations as necessary.
Thank you for this video; your "bedside manner" and clarity are reassuring. Personally, I've had four dislocations since my NHS operation about a year ago (TRH, posterior), which has left me feeling in a state of limbo, constantly worried and uncertain about my future. I'm now terrified of doing even the simplest of things, even to the extent of picking up my young grandchildren, just in case my hip dislocates again. My surgeon has now referred me to a hip revision specialist but I'm not entirely sure what to expect. My life seems to be on hold and it's certainly not what I'd expected. I've even mentioned the "captive cup" to my surgeon, but he's against these as they apparently wear out quicker, and any potential injury in the future could lead to far more extensive hip/pelvic damage. Any input, comment or advise would be welcome. Again, thank you sir.
Thank you for your comments. I am pleased to hear that you find the video helpful, but very sorry to hear about your dislocations. It is a horrible complication. Four of them in a year means that there is a mechanical problem with the hip replacement. It's good that your surgeon has referred you to a revision specialist. You will need to have a careful clinical assessment and appropriate investigations such as a CT scan to identify the problem. It is likely that you will need to have the hip revised, so that any technical issues can be remedied. I will often use a dual mobility socket in revision surgery because it is more stable, and doesn't have the problems of a constrained, captive bearing. I hope that it all works out for you so that you can get on with your life again.
@@Lathamhipsurgery Thanks for replying so quickly, and for your kind words. In cases where a dual mobility cup is used as a replacement, is it also necessary to replace the femoral stem as well, or can the existing implant be adapted to suit the new cup?
@@chuck1outzz no problem. If the stem of the hip replacement is solidly fixed in place and its position is satisfactory then you can leave it in place. If there’s a problem with the length/offset/rotation then it will probably need to be removed and a new one inserted. There are adapters that can be used to overcome technical problems but your surgeon will discuss all of this with you. Hopefully this information will help with that discussion.
@@Lathamhipsurgery Thank you so much. I'll remember to have this conversation when I see my specialist in a few weeks time.
@@Lathamhipsurgery Hello there. I trust you are keeping safe and well. Further to my comment about a month ago, my specialist has now recommended revision surgery using the dual mobility cup; I'm just waiting for an operation date. Basically, my understanding is that although this is a more complex operation with a longer recovery period than that with a 'standard' replacement, the outcome is a far more stable and flexible hip joint, but the risk of dislocation remains, albeit a far lower risk than that with my existing (i.e. standard) hip joint. Would you agree that this is an accurate summary? Thanks for your time, as usual.
hello doctor, i did my left side hip replacement operation, can you see the X-ray report because i doubt my socket is dislocated.
My advice to you is that you should speak to your surgeon if you have concerns.
I'm 64 yrs old and had both my hips replaced about 6 years ago using the anterior method. Its been great but recently they have become stiff and difficult to stretch out. I'm very active. I bike to my gym a few times a week. I work out for 45 minutes with weights but I'm careful not to use heavy weights so I do not put pressure on the hips (no squats or anything like that). The only exercise I do standing is curls with about a 100 lb curling bar. I then use an elliptical for about 20 minutes and bike back home (2.5 miles). I play in a softball league where we play every other day and have practices in between. I play the outfield so I'm running down fly balls. Its all been good and no dislocations or anything like that. Just very stiff recently to the point where its uncomfortable. I was also doing yoga and I do stretch out before practicing or playing softball. Not sure why its suddenly feeling stiff and like a block in my hip.
You should have a check up with your surgeon.
I’m having this issue right now they went back into my replaced hip in 18 and ever since that leg was shorter and now it’s 2” plus and no big deal . My PCP took X-rays and saw it’s coming loose . Ok go to my surgeon in Boston yea that’s cause your compensating cause of the severe arthritis in your right hip . Yea you guys where suppose to replace that 3 years ago . If they mess up n appointment you wait like 8 months for another . They don’t seem to care the reason it’s coming loose is because it’s 2” shorter and yes double compensating jeeze Louise
Sorry to hear about this. I hope you get it sorted out asap.
Hello i had a hip replacement 8 weeks ago due to osteoarthritis but sadly after 6 weeks it dislocated, the pain was unbearable, i was rushed to hospital and it was maniplicated back into the socket, after my first operation i still had pain although the Xray was perfect at the time of surgery? Since it has been popped back in i have to wear a body brace for another 4 weeks, apparently my bones are excellent and very hard but my joints are bad. There is no difference in my leg length but i have a terrible limp, i dont know if its because im frightened to put weight on it or its psychological, I'm 60 years old and feel like my life will never be the same again as i have to have the other hip replaced plus my knee, i see other people who are older than me back to normal after a few weeks! My implant is ceramic with some kind of plastic cup. I would really appreciate your knowledge of my situation and whether in your opinion i will ever be back to normal again? Thankyou.
I’m sorry to hear about your dislocation. It is very traumatic physically and mentally. I can’t offer specific advice without a thorough clinical assessment and review of the imaging. Your surgeon will guide you through the next few weeks. Physiotherapy is very important once the brace is removed. A single, early dislocation will usually be an isolated event. If you have recurrent dislocations then revision surgery will be needed. My rule of thumb is if it happens 3 times then it’s time for surgery. I hope that everything settles down without further trouble for you.
@TheHipSurgeon Thankyou for replying back to me, my physio starts next week so fingers crossed it will help my limp.
Omg! That surgeon shouldn’t practice! That’s beyond appalling!!! It’s criminal! My 7th week post-op anterior replacement dislocated a few days ago for no reason any of us can find. It was mortifying to say the least and my surgeons beside himself trying to find answers having never personally having this happen in his years. Hes consulting with his partner to see if he missed anything etc,…. His words. He’s set me up for scans, and x-rays tomorrow as I fell full force backward onto concrete, after it suddenly just popped out with no warning as I was simply standing with my husband. My back pain is terrible as is my whole body from the fall and the re-set. I’m full of PTSD. I can’t imagine going through it again. It affected my husband and son who saw it ALL. Ambulance scene, E/R, O/R, 6 attempts to get it back in which did happen but,……. Omg, a terrifying ordeal for everyone! My surgeons great and did my knee replacement in 2019, I trust him. He’s empathetic, warm, genuinely caring. I hope we find answers together?🙏 I totally have faith in him and trust him because he’s earned it.
Which surgeon shouldn’t practice? What is it that’s beyond appalling? Please explain.
@@Lathamhipsurgery I’m referring to the surgeon that knew her hip dislocated 7 times. Her surgeon from what I understood?
I had my total hip replacement 14 weeks ago and although I've not had a dislocation Ive had it move out of the socket and pop back in about 9 times. Just yesterday it popped again when I went to tie my show lace and today at the gym on the seated calf raise machine it also popped. When it happens Its really distressing because If its moving out of place this easily then it might not be far from dislocation.The first few times it happened I put it down to the muscles not being properly healed but Its now becoming a concern that my mobility will be really restricted. I am a martial arts instructor and was very flexible before the operation. Each time it pops out and in the front of my hip is sore for days.
@@tkd4 you should speak to your surgeon about this.
Hello, Do you see any down sides to dual mobility hip joints?
Thanks for an excellent question. Short answer, no as long as it's done for the right patient. I use them routinely in patients >75y, and anyone with neurological/anatomical factors that increase the risk of dislocation. The downsides are potentially increased wear in younger active patients, and the possibility of corrosion between the bearing liner and the titanium socket. Monobloc implants eliminate this risk but are less versatile.
@@Lathamhipsurgery thanks! Yeah I have a condition that has a high risk of dislocation, so I guess the potential joint life expectancy decrease is worth the decrease dislocation risk.
@@Soljarag5 Agreed. Your surgeon will no doubt have a good plan for you.
Im 13 years old and i got hip diclocation for about around 2 years and now everytime i walk its hurt so much but because its been around 2 year never got medical treatment now its got a lotta of meat in the dislocation im considering to do surgery but theres a 50/50 change i can be normal again or i can never walk forever whats your suggestion?
Sorry to hear about your problem. My advice is for you to see a specialist paediatric orthopaedic hip surgeon.
Hello, I have left leg joint Displacement from my childhood, I want treatment but here in my country surgeons scared me that.. may be i will not able to run, I cannot play football and never ride on bicycle. help me and also Guide me what should i have to do. Please
Sorry to hear about your problem. I can’t offer specific advice without doing a formal assessment of you.
@@Lathamhipsurgery can i get your email address?
Could you suggest what components in your opinion are the safest and most durable for hip replacement? I.E, ceramic on polyethylene, ceramic on ceramic or metal on ceramic?
Thanks for the question. For most people, a bearing made of ceramic on highly cross-linked polyethylene seems to be the best compromise between good function and durability. It's also very safe in terms of biocompatibility. I use metal on metal resurfacing in selected cases - men under the age of 55, with big hard bones. The safest and most successful materials for the cup and stem of the hip replacement are titanium alloy and stainless steel. I did a lot of ceramic on ceramic hips back in the day. The advantage of these is that they have very low rates of wear, but they can squeak. If they break, then revision (re-do) surgery is sometimes difficult because of all the debris that's produced. Hardly anyone is using metal on ceramic hips these days; there's no advantage compared to ceramic on polyethylene.
Thank you very much for your expert opinion. Its good to have
the opinion of a very experienced surgeon in a matter as complex as this and who strives to do the the best for his patients. Much appreciated and thanks again.
@@leeindention7493 Thanks! Happy to help.
@@Lathamhipsurgery
I had my consultation with my surgeon. He was very impressed when I enquired what type of components and their various constituents he would be using in my surgery. He confirmed he would be using the components you suggested in my surgery. He also recommended that I have a bilateral hip replacement as my other hip is bad as well. I am a bit apprehensive about having both done together as I think I would be very vulnerable and unsteady after the surgery. The reason my surgeon suggested a bilateral is, I would need the other one done in about six months so he suggested doing both as the recovery time would be the same. Anyway, thanks again for your most helpful advice .
@@leeindention7493 Thanks for your feedback. It's good to hear that things are moving along with your treatment. I quite often do bilateral surgery. It makes a lot of sense if both hips are as bad as each other; one anaesthetic, one admission and one period of rehab. Hope it works out well for you.
Lol I have a titanium hip I work hard to keep the muscles around it strong still mine has dislocated twelve times just all of a sudden it decides to go so horrible because it's so painful and you cannot move
I’m sorry to hear about your multiple dislocations. It must be very difficult for you. Normally one would recommend revision surgery after 3 dislocations to address any technical problems.
Thanks that's life
I have titanium. Done 6 years ago. Mine has been coming out on a regular basis. Started occasionally..little by little it's now happens ALL the time. I I can hear it. Getting more painful.
I have arthritis. I also have osteoporosis. 2:35
Appointment this week.
Little nervous.
It would seem from an engineering standpoint, that a larger ball would be more stable.
Is there not enough room to enlarge that component, along with the required increase in socket size, or is the overall ball diameter not a factor???
This is a great question. The Charnley hip, which was the first mass produced hip replacement, had a ball diameter of 22.5mm. Charnley understood that to use anything bigger risked causing rapid wear of the polyethylene socket, leading to early failure, particularly in younger patients.. This was orthopaedic dogma for over 20 years. Improvements in bearing materials (ceramic, highly cross linked polyethylene, metal) encouraged engineers and surgeons to use bigger head sizes to reduce the risk of dislocation. The introduction of the Birmingham Hip Resurfacing in 1996 introduced the world to a large diameter, low wear metal bearing. A few years later, we put this large metal head onto a hip replacement stem. This seemed to be the perfect solution for the majority of patients. The heads were impacted onto the tapered neck (trunnion) of the femoral component. Unfortunately, the small trunnions, which were fine with small diameter heads, weren't big enough to withstand the loads transferred to them with the large heads. The heads moved slightly, setting up a corrosion cell. This caused catastrophic damage to bones and soft tissues around the hip. It was a disaster, and they were all withdrawn. The search continues for the ideal implant; low wear, bio-compatible, low risk of dislocation. Bringing new devices to market is very expensive, and there is little if any appetite to do it, given the history of metal on metal hips.
@@Lathamhipsurgery Thank you for such a detailed reply.
Jeremy I am slightly concerned hip dislocation when I finally get op because I've been like this so long having had a family to support , so the muscles are very weak around my hip. Any advice for first 3 months after first one , I know 90° rule and the basic stuff but I'm a guy who by nature pushes my body , did it in sport ,did it at work and that's the very reason I've no cartlidge in my hips now , anything extra just little precautions you could advise because I'll be called up as soon as surgery restarts
I understand your concerns Mark. All I would say is that the risk is very small. If you follow all of the precautions it's unlikely that the hip will dislocate. The risk is highest in the first few weeks so take it easy during that time, and wait for the soft tissues to heal before you push it. Your surgeon and physio will be able to give you more advice based on your specific pathology/surgery. My general advice is to rest by lying flat for at least an hour twice a day, and don't sit for more than 30 minutes at a time. Use crutches for as long as you need them - it's not a race. Try your best to surrender to the process and enjoy the feeling of being out of pain, whilst getting stronger and fitter every day.
@@Lathamhipsurgery thanks Jeremy , yes I will mate , cheers
@@Lathamhipsurgery surgery done , was done the old way and I was home the next day , 4 days after surgery walking really good and joint is freeing up well when I wake , amazing procedure and a top surgical team , I stayed awake and had spinal and the anethisist talked me through it all. Surgery never a great experience but if it could be that's what I experienced, for my rite hip they said I can do without the catheter because it was god damn worst than op.
@@markpatterson2811 thanks for the update. It must be a great relief to have had it done without any problems. Your new life starts now!
@@Lathamhipsurgery nearly just the right hip which pain wise is worst , I asked the left first because I'd had pain in it as long as I could remember and it just didn't work anymore but now it does , it's hard with one operated and one bad but the deep throbbing pain I had in the left is gone and it's pain free other than the natural swelling etc etc.
Depending on the success of the second hip dr laird said I may well be able to go back to bricklaying but no golden oldies rugby , hahaha
After hip replacement how could we know that our hips are dislocated? Please explain it sir
If a hip dislocates, it will cause a lot of pain, and the leg will be rotated and shortened. You would not be able to walk on it.
@@Lathamhipsurgery thank you
@@LathamhipsurgeryI have s question then. I had hip replacement surgery almost 2 years ago and I have experienced pain in my groin area. Its kite of a discomfort pain. I can't lift my leg to put my sock and shoes on. I hurt when I walk. I hurt when I try to stand up. But everytime I go to the doctor that did my surgery and he takes a Xray everything looks fine. He never goes further than that. I'm tired of hurting what should I do.
@@RedbirdCountry It could be that the psoas or rectus femoris tendons are catching on the socket. When I see someone with these symptoms I order an ultrasound scan to confirm the diagnosis. An injection of local anaesthetic and steroid often helps. Other causes such as infection and loosening of the components have to be considered as well.
How do i tell if it pops out of socket?
It will be painful. The leg will be twisted and shortened. You will struggle to walk.
@Lathamhipsurgery can it partially dislocate? Am i supposed to be able to feel the ball and it clicks when it moves a bit.
Appreciate it
@@SuperKoolDude They can. It's called subluxation. Get it looked at!
It’s designed to fail,sorta like the modern automobile! Then you will have to get it repaired and spend more money ! 🤔😳
Inbuilt obsolescence? Just like life itself. Everything fails sooner or later. 90% of hip replacements will last 20 years before they wear out and need redoing.