Functional outcome after total hip replacement following 30 years neglected posterior hip dislocation: a rare case report

Abstract

Neglected traumatic dislocations of the hip is one of disabling condition in lower extremity which are seldom found in adults. However, in developing countries, neglected-unreduced traumatic dislocations are not uncommon. Total hip replacement (THR) still remains a recommendation for the treatment of neglected hip dislocation which occurs more than 3 months. A 45- years-old female came to the outpatient clinic complaining pain on her right hip with history of trauma 30 years before, but instead of seeking medical treatment, she went to bonesetter instead. On physical examination, there is 5 cm leg length discrepancy, and the patient walked with limping gait. Conventional x-ray confirmed persistent dislocation of the right hip. A soft tissue release procedure and femoral neck osteotomy with skeletal traction was done before, followed by delayed THR two months after. The patient’s functional status was improved, and the HHS score increased from 48 to 87. The patient had no pain or significant complaints, except for a finding of mild residual Trendelenburg gait.

Restoring a near anatomical hip joint in an 18 year old neglected hip fracture dislocation – A rare case report

“…Purvance et al reported a case of 45 year old female who came with a neglected posterior hip dislocation of 30 years. 4 Patient had a shortening of around 5 cms and radiographs showed persistent dislocation with pseudo-acetabulum formation. She underwent femoral neck osteotomy followed by skeletal traction for next 8 weeks, before a constrained total hip replacement as definitive procedure.…”

“…Neglected dislocation of hip in developing countries is mainly precipitated by the unwillingness of the patients to look after appropriate medical care, who have more belief in traditional healers instead. 4 Numerous treatment options have been mentioned for treatment of neglected hip dislocations including-sub-trochanteric osteotomy, Girdlestone procedure, hip arthrodesis, hemiarthroplasty and total hip replacement. 7 Among all these procedures mentioned, total hip replacement is still considered the best option for treatment of neglected hip dislocations.…”

“…To add to this, most of these patients have a high pain tolerance, decreased cognitive ability to understand or communicate the pain and prefer traditional bone setters to a better health care facility in the hospitals. 3,4 The seriousness of their disability is not comprehended and it makes a missed diagnosis of hip dislocation, turn into a chronic disabling neglected condition. Ideally, all dislocated hips should be treated as an emergency.…”