Management of Chronic Hip Dislocation with Ligamentous Tears

Primary Treatment Recommendation

Total hip replacement is the primary intervention for chronic hip dislocations with ligamentous injury, addressing mechanical instability and cartilage destruction, with 43-84% pain-free outcomes at 9.4-year follow-up in patients with advanced hip pathology, as recommended by the American Academy of Orthopaedic Surgeons 1, 2
Revision rates are acceptable at 0.18-2.04 per 100 person-years, according to the American Academy of Orthopaedic Surgeons 1, 2
Current treatments cannot reverse hip osteoarthritis or restore damaged cartilage—they only control symptoms, as stated by the American College of Rheumatology 2

Joint-preserving procedures are contraindicated in chronic dislocations because osteotomy and arthroscopic procedures only redistribute mechanical forces; they do not reverse existing damage, as recommended by the American Academy of Orthopaedic Surgeons 1, 2
Mosaicplasty is indicated only for focal lesions <3 cm² in patients <45 years old without signs of OA—criteria that chronic dislocations do not meet, according to the American Academy of Orthopaedic Surgeons 3, 4

Use cemented femoral stems, as recommended by the American Academy of Orthopaedic Surgeons guidelines for hip fractures with compromised bone quality 5

Obtain CT without IV contrast before surgery to assess joint congruence and component positioning requirements, intraarticular fracture fragments, acetabular wall fractures, and bony impingement mechanisms, as recommended by the American College of Radiology 6
Add MRI without IV contrast if soft tissue pathology assessment is needed, particularly for evaluating abductor tendon integrity and muscle injuries that may compromise stability, according to the American College of Radiology 6

Multimodal analgesia with preoperative nerve blocks facilitates early mobilization while maintaining hip precautions, as recommended by the American Academy of Orthopaedic Surgeons 5