Interviewer:
Hey Dr. Amanatullah! How are you doing today?
Dr. Derek Amanatullah:
I’m doing great thanks for having me again.
Interviewer:
Thank you for coming on again! We’re gonna talk today about dislocations with joints, so first and just as simply as you can explain it, what is a dislocation?
Dr. Derek Amanatullah:
Dislocation is when the hip joints comes out of the socket, so little ball separates from the socket. This is a pretty nerve-racking, despite not being that devastating, complication that normally can managed after surgery, and it really comes because at the time of surgery there’s actually three goals that need to occur. You’ve got to have implants be fixed in the bone, they have to be fixed in the bone in the right positions so that they have all come out socket or it doesn’t impinge. That means it touches anything else, like the metal or a soft tissues so that it doesn’t come out. And then we try to make your legs as equal. So really dislocations can be caused by lots of different things and they’re really something we worry about a lot. But there’s something that we can be managed at the components are really good.
Interviewer:
How often does this location occur? How worried should I be about that?
Dr. Derek Amanatullah:
Dislocations are in general quite rare. The data would say they range from about 0.5 percent or even lower to around seven percent, so there are some things that we do now to prevent dislocation.
Some of those are the approach. So lots of people have cited the approach is decreasing the dislocation. But now even with approaches that were at risk, specifically the post year approach, some soft tissue repairs and how we handle the tissues have decreased that dislocation right down to the point we can’t tell the difference across the approach.
So I’d say historically the way the surgeon did your hip replacement made a difference. In modern hip replacement it doesn’t make a huge difference at all. There are some things related to the patient, meaning obesity, maybe utilization of narcotic drugs, or other things might increase your risk.
And then there are things outside of the patient’s hands. The position of the components themselves can lead to them touching each other. So you want to make sure you have a surgeon that you trust that’s going to put the components in the position that’s gonna work and function correctly.
Interviewer:
If my hip gets dislocated — I feel that like high-intensity pain — what are my steps? What should I do, who should I call, what do I do?
Dr. Derek Amanatullah:
So lots of people talk about clicking or other things being a dislocation. They’re probably not. What you want to imagine is that your hip has large muscles around it — your quadriceps muscle, your gluteus muscle, and if the hip were actually come out of the socket, those muscles would fire really hard trying to put it back in the socket. And unfortunately because the ball will have slipped out of the socket, they’ll actually push it out, and so it’ll be unfortunately unbelievably painful and probably won’t be able to walk.
And so what I would say is this is not a thing where you would go and wait for a visit doctors. This is something you would go to the emergency department treated because it’s not tenable to have a hip that’s short, rotated funny, painful, and maybe not able to be walked on.
The good part is that this gets treated, about two thirds of the patients never have another dislocation. But it is possible that it becomes a chronic issue, meaning you have more than one location. In that case, we’re gonna have to pace really really particular attention to the components to make sure they don’t need to be changed, make sure there’s no infection, and then we might need a surgery to do some extra things to the hip replacement make it more stable.
Interviewer:
Besides the things you mentioned earlier about, you know, keeping your weight in check and not using narcotics, is there anything that I can do to make sure that my hip doesn’t get dislocated?
Dr. Derek Amanatullah:
I would say in general, there’s not a lot of things that the patient can do, but some doctors, there’s not a lot of evidence for this, will give you precautions. Precautions are places you shouldn’t move your hip because it would place it at high risk for impingement or dislocation, and that the directions of those precautions really depend upon the approach.
So if you had an anteriorly based approach, you’re gonna wanna wait extension and external rotation. What does that really mean? The time extension external rotation really occurs is reaching above our heads to get something like a can of soup or something from a cupboard.What happens is we put our operating leg back, we pivot on an operative leg, and that puts us at risk for dislocation. So any anterior approach, you can consider not doing anything that placed your hip in extension.
The opposite is true of a posterior hip approach. In a posterior hip approach, the way we take the hip out of the sockets is with flexion of the leg and internal rotation. So when does that occur? That occurs when you’re sitting in a chair and an object falls on the ground, and we reach to our side to pick up the object. That places the hip in that position of flexion and internal rotation.
The other time it occurs is similarly sitting in a sofa or a recliner chair with no arms. So most of us the way we get out of that chair is to squeeze our knees together (that’s internal rotation) and lunge our body forward (and that’s flexion).
The other way the hips come out of the socket is normally with sexual intercourse. So the leg can be placed in odd positions and the patient’s not necessarily paying attention to those positions. There’s some publications about that about specific positions that are safer than others for our patients after hip replacement.
Interviewer:
Alright well thank you so much for answering my questions today Dr. Amanatullah! I really appreciate it!
Dr. Derek Amanatullah:
Always have great day.
