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What precautions are required after a hip joint dislocation?

Q: I am a 22 years old girl and I had an accident 4 months back in which my left hip joint was dislocated. The joint was tracked within five hours after the mishap. I was kept on a bed for 45 days with 1 kg weight hanging on the same foot. X-rays and CT scans showed fracture of acetabulum - a hairline fracture. Then I was on crutches for about 1 & half month following which I was taking physiotherapy. I started walking and doctor gave me a stick. I came to Delhi and consulted an Orthopaedic surgeon here who took X- rays and detected a fracture in the head of femur. He said that it is in a non-weight bearing area and would not heal up now. He advised me not to sit in a yoga position ever and suggested swimming & cycling. Please tell me whether my treatment was right or not and what precautions I have to take? Any diet restrictions or exercises? Can I have any other problem in future like arthritis or osteoporosis?

A:Dislocation of the hip is a very serious injury. Serious not because it is life threatening or because the limb is at risk but because of the fact that you could develop arthritis of the hip and a life time of pain in the hip. It is considered an emergency and as far as possible treatment should be as early as possible. Every hour of delay compromises the outcome. One of the major problems that can occur in such an injury is that the blood supply to the head of femur can get damaged and the patient develops arthritis of the hip. This is difficult to diagnose early and till about a decade back diagnosis could be made only after 6 months to one year. These days with MRI it is far easier. If you have a fracture of the head the risk for arthritis is higher. This arthritis is different from the conventional arthritis most people know of. This is because unlike the other arthritis this affects the only injured hip. Osteoporosis, if it occurs in this, is secondary to reduced activity of the limb. From your description the treatment given seems to have been right. As far as the restriction of the activities is concerned sitting on the floor places a higher stress on the hip joints. Therefore, it is better to avoid it. I would recommend that you stay active. Swimming is a good exercise and you could continue it. I don't think you need to be in a dilemma. Continue with your life and see if the pain deteriorates. If it does surgery may be required at a stage when pain is unbearable. You should have a regular follow-up with you surgeon.

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