PICTURE THIS:
So that’s why they tell you not to bend after a hip op
THIS eye-watering image shows a patient whose hip replacement has dislocated — the ball has popped out of the socket.
More than 70,000 hip replacements are performed in the UK each year. The vast majority of patients will make a good recovery, but in a small number of cases — between 2 and 4 per cent — the joint dislocates.
‘Dislocation usually occurs within the first three months of surgery while everything is settling down,’ says Professor Robert Middleton, a consultant orthopaedic surgeon at the Royal Bournemouth Hospital.
‘The ball and socket are held together by the muscles, ligaments and soft tissues around the hip. These provide stability to the hip joint and stop it dislocating.’
However, these need time to heal after surgery, so the patient’s activities are normally restricted for the first three months. This means not bending your hips more than 90 degrees (this is why a high chair is recommended after surgery) and not crossing your legs, touching your toes or bending down to pick things off the floor.
In the majority of cases, dislocations occur because patients have not followed these aftercare rules, says Professor Middleton, who adds: ‘This is more likely among dementia patients and those who are weak and frail.’
Dislocation may also occur if there is a problem with the design of the implant, although this is rare.
Another possible cause is that the angle at which the hip replacement was inserted wasn’t quite right.
The image seen here was posted on Figure 1, a website where doctors around the world share medical images and canvass their colleagues’ opinions.
The paramedic who posted the picture explains that the patient was an 80-yearold woman who had undergone the hip replacement 60 days previously and had dislocated the joint while sitting down. A dislocation can be very painful — in fact, the paramedic had to give this patient fentanyl, an extremely strong opioid painkiller. As well as feeling pain, the patient will be unable to move, says Professor Middleton. ‘Their leg is also likely to be shorter by around an inch because of the rotation of the joint during the dislocation. ‘It would be a case of calling 999, taking the patient to A&E, giving them a sedative and putting the implant back in the correct place.’ Usually this requires only manipulation by the surgeon.