What to do if a hip implant dislocates: symptoms and reduction

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X-rays of the hip joint are performed in two projections: direct and lateral. The duration of the study is about 15 minutes. No preparation is required for a hip x-ray. X-rays show the proximal femur, hip joint, and parts of the pelvic bone (ischium, ilium, and pubis).

What does a hip x-ray help identify?

An x-ray of the hip joint is used to diagnose:

• congenital pathology of the hip joints (dislocation, dysplasia, fracture);
• hip joint injuries (dislocation, fracture);
• cysts, tumors and metastases in the joint;
• inflammatory diseases (arthritis, osteomyelitis);
• tuberculosis focus in the bones of the hip joint;
• metabolic diseases (gout, osteoporosis);
• degenerative processes (osteoarthrosis - coxarthrosis)
• aseptic necrosis.

How is a CT scan performed?

The procedure itself for computed tomography of the hip joint is painless and does not cause significant discomfort. The tomograph is located in a special room, separated by glass from the center staff. During a short preliminary briefing, the specialist will tell you how a CT examination is performed, then ask you to take a comfortable position on the retractable table of the device. If necessary, the lower limb will be secured with special belts.

The scanning procedure is painless, but it is important to remain still during the procedure.

During the scanning procedure, the table will move smoothly in the ring of the device. It is important to lie still and not make even the slightest movements. The scanning duration does not exceed 1-2 minutes.

If a CT scan of the hip joint is performed with contrast, the examination time will be from 15 to 20 minutes. This is due to the need to perform native images, introduce a contrast agent and repeat scanning.

The image slices obtained during scanning are subjected to computer processing and reconstruction. After this, they are analyzed by a diagnostic radiologist. The specialists of our medical institution have extensive experience in interpreting the results of CT scans of the hip joint; their opinions are listened to by fellow radiologists and doctors of other specialties.

Tomography results are returned, on average, in one and a half to two hours. The patient receives a printed report and a disk with the scanning protocol. If you have any questions regarding the results of a CT scan, a free consultation with a doctor is provided. You will be able to get answers to all your questions and clarifications regarding the identified pathology.

The radiologist analyzes the data obtained and draws up his expert opinion.

Indications

X-rays of the hip joint are performed according to the following indications:

• joint deformity;
• shortening of the leg;
• swelling and redness in the hip area;
• pain during movement, after physical activity and at rest;
• suspicion of fractures of the bones forming the joint;
• before and after surgery (localization and comparison of fragments, reduction of dislocation, endoprosthetics, monitoring the effectiveness of drug treatment);
• suspected tumors, joint metastases, cysts, degenerative and metabolic diseases.

Research methodology

Before conducting the study, the person removes clothing and accessories from the body that may cause distortion of the X-ray image, and also informs the laboratory assistant about the presence of metal or other implants in his body. In order to reduce the negative impact of X-ray radiation on the body, all patients are given a special leaded collar on the thyroid gland area, and women are given a protective plate on the mammary gland area.

X-rays of the pelvic bones are performed in a strictly horizontal position. The patient is placed on a special couch with legs bent at the knees and arms extended straight along the body. Do not move or talk while the x-ray is being taken.

Alternative Methods

• MRI is an effective diagnosis of pathology of non-bone structures (cartilage, ligaments and tendons), the presence of effusion/blood in the joint capsule;
• — obtaining high-quality layer-by-layer images with the possibility of 3-dimensional modeling, the most accurate diagnosis of bone tissue diseases;
• Ultrasound - diagnosis of pathology of periarticular structures, inflammation of the hip joint, is indispensable when performing joint puncture, before and after surgery.

What to take with you for a CT scan

If your attending physician has given you a referral for a CT scan of the hip joint, then, first of all, you need to call the diagnostic department and agree on a diagnostic time. At the same time, a center employee will answer any questions regarding the features and cost of the procedure.

There is no need to prepare specially before tomography of the joints; you can eat as usual and adhere to your usual rhythm of life. It is better to wear looser clothing for the diagnosis; it will allow you to sit more comfortably on the tomograph table.

You will need to take with you the following medical documents:

• referral from a doctor;
• advisory opinions;
• laboratory test results;
• conclusions of ultrasound, arthroscopy;
• X-ray pictures.

Before a CT scan of the hip joint with contrast, you will additionally need to take a creatinine test (at your place of residence or directly at the medical center).

X-ray of the hip joint at the Yauza Clinical Hospital

X-rays of the hip joint in our hospital are performed by experienced radiology specialists using the Digital diagnost digital radiographic system (Philips, the Netherlands), which provides:

• high-quality image at maximum research speed due to digital signal transmission;
• convenience of the procedure (flat panel detectors allow you to obtain images in the required projection without moving the patient);
• instant availability of the received images to the doctors treating the patient (all images are sent immediately via Wi-Fi to the hospital server).

The results of our radiation diagnostics comply with all strict international protocols and are accepted in any medical institution in the world.

You can see prices for services

The article was checked by radiologist M.A. Petrova. , is for general informational purposes only and does not replace specialist advice. For recommendations on diagnosis and treatment, consultation with a doctor is necessary.

Preparing for X-ray of the pelvic bones

In emergency cases, when an immediate diagnostic procedure is required, an x-ray of the pelvic bones is performed without prior preparation. If the patient undergoes the examination as planned, then it is recommended that, for two days before the x-ray, he temporarily exclude from his diet foods that can cause activation of fermentation and gas formation processes in the intestines: fresh baked goods, legumes, apples, grapes. In the evening before the test, it is advisable to do a cleansing enema with a weak saline solution and drink a drug that has an adsorbing effect. These preparatory procedures reduce the influence of intestinal contents on the quality of the radiographic image and increase the information content of the resulting image of the pelvic bones.

Reviews

Svetlana

Pre-registration is a convenient thing. No need to spend the whole day waiting in line or waiting for a doctor. I made an appointment by phone, arrived at the appointed time, and within 15 minutes received the finished photographs. No inconvenience or queues

Fedor

Not all clinics in our city can boast of X-ray equipment of this level. The quality of the pictures is simply amazing. It is very convenient that they are provided in digital format. No need to carry bulky envelopes with film.

Anna

Thanks to the doctors for my healthy and strong child. If they had not promptly identified my gestational diabetes, it is unknown how this would have affected the baby. As far as I understand, this pathology can lead to serious consequences for the child. Thanks to the attention of the doctors, I was able to avoid trouble. However, everything was corrected with the help of a regular diet.

Olga

I had a severe form of gestational diabetes, and together with the doctor at your medical center, we worked almost throughout my pregnancy to prevent a significant increase in blood glucose levels. Nutritional correction was not effective enough. The doctor carefully selected medications for me so that I could carry and give birth to a healthy child, for which I am very grateful to him.

Causes of hip implant dislocation

Dislocation is a violation of the contact of the femoral head component with the acetabular element (cup). That is, the implanted spherical body emerges from the acetabulum. This often becomes a direct reason for prescribing revision surgery. Thus, after aseptic instability, it is the second most common cause of re-interventions. It has been established that 3 causal categories lead to the loss of relationship between artificial articular surfaces.

1. Patient-dependent factors:

• previous surgical interventions on the hip joint;
• non-compliance by the patient with the orthopedic regimen;
• deviation from the established limitation of range of motion;
• weakness of the hip abductors;
• injuries (falls, local impacts, etc.);
• old age (people over 60 years old fall into the risk category);
• gross anatomical defects in the structure of the musculoskeletal system;
• excess body weight.

1. Implant dependent reasons:

• use of unipolar implants with a bipolar head;
• use of small femoral heads (D ≤ 28 mm);
• destruction of the polymer liner;
• failure (loosening) of the implanted structure.

1. Surgeon dependent factors:

• According to some data, the posterior approach is associated with a higher risk of dislocation;
• incorrect positioning of the cup with an abduction angle of less than 30° and more than 50°, an anterversion angle of less than 5° or more than 25°;
• incorrect orientation of the femoral stem of the implant with an antetorsion angle below 5°;
• repeated reduction of a dislocated endoprosthesis conservatively, that is, in a closed, non-surgical manner.

Consequences on X-ray.

About 60% of all dislocations occur in the early postoperative phase - within 3 months after endoprosthetics. Up to 75% of cases occur in the first 12 months; after 1 year, their number decreases significantly.

Contraindications

There are both indications and contraindications for this diagnostic procedure. Thus, if there are installed metal components or devices in the body of the subject - vascular clips, pacemakers, neurostimulators, implants, MRI examination may be prohibited. The magnet may interfere with the operation of electronic life support devices. The magnetic field can cause metal structures to move and thereby damage nearby tissue or organ, which in turn will negatively affect the patient’s health. Therefore, before starting a diagnostic study, it is necessary to inform the attending physician about all objects implanted in the body so that the tomography does not cause harm to the body.

Sometimes it is difficult to conduct research for a person who suffers from a lack of control over his movements. These can be various diseases of the nervous system and epilepsy. For high-quality tomography, complete immobility of the pelvic region is required during the entire screening process.

Sometimes claustrophobia (fear of closed spaces) can become a limitation.

The patient’s large weight or dimensions can become an obstacle to the procedure, since the devices have limitations on the table’s load capacity and chamber volume.

Features of the event

X-ray of the pelvis in men

For men, a pelvic x-ray, as practice shows, can be prescribed as the main procedure for diagnosing prostatitis. In this case, the pathology can be of any type - acute, chronic, bacterial or non-bacterial. The main symptoms of this disease are: pain in the scrotum and perineum, problems with urination, deterioration in sex life, changes in seminal fluid and difficulty in ejaculation.

X-ray of the pelvis in women

For women, a pelvic x-ray can be prescribed as an additional diagnosis of infertility and to identify the causes of disturbances in the functioning of the organs of the reproductive system.

Treatment and reduction of dislocation

If an X-ray examination shows separation of the implant head and the acetabular component, emergency measures are taken to hospitalize the patient and correct the unfortunate phenomenon. If a complication occurs for the first time, and radiographs do not reveal serious technical violations of the installation of the prosthesis, the joint is usually reduced using a closed method of manual reduction.

Closed manipulations are usually performed under epidural or intravenous anesthesia. Under the control of the image intensifier, the limb is distracted, displacing the head to the level of the pelvic component, then the thigh is abducted and rotated medially. Thus, the dislocated head returns to its place. Next, the limb is immobilized, bed rest is prescribed for about 10 days, then walking on crutches is prescribed for at least 2 weeks. In parallel with this, they are intensively working on the development of the anterior muscle group and hip abductors.

If, after the initial closed reduction, despite full adherence to the rules of safe locomotion, the dislocation recurs, the doctor should reconsider the previously undertaken concept of non-surgical treatment. It may still make sense to perform an open reduction with reorientation or replacement of the cup, restoration of muscle tension in combination with lengthening of the neck of the stem and/or replacement of the spherical element with a larger implant.

Any gross errors detected on an x-ray when a complication occurs for the first time are an absolute indication for partial or total re-endoprosthetics. Revision intervention is also necessary if wear, breakage of any of the components of the prosthesis, deep purulent infection, or violation of the integrity of bone tissue and ligaments is detected. These signs lead to instability and, as a consequence, incongruence of the functional segments of the endoprosthesis.

After primary closed reduction, on average, 35% of patients experience a recurrence in the future; with each repeat conservative treatment, the risks increase. Moreover, frequent attempts to close the position of the implant are fraught with damage to the artificial head and failure of the entire structure.

Preparation

In many ways, preparation for magnetic resonance imaging of a pair of hip joints depends on the need to use a contrast agent. If a patient is scheduled for an MRI of the hip joints with contrast and suffers from renal failure, it is recommended to undergo blood tests for creatinine.

When undergoing a procedure with contrast, you will need to refrain from eating 2 hours before the examination.

If there are medications that are taken on an ongoing basis, you must inform the radiologist about this.

All jewelry, watches, cell phones and other items and gadgets are not allowed into the MRI room. Therefore, it is better to leave unnecessary accessories at home. If you feel nervous being in a confined space, you can take a sedative in advance or invite a loved one with you to the study to be nearby and support you.