Inveterate (42-year-old) Hip Dislocation Treated with Arthroplasty. A Case Study.

Dislocation of the hip usually results from a high-energy injury sustained during a road accident. Inveterate dislocations persisting for many months or years are extremely rare. Selection of an appropriate treatment method is not easy and is always associated with the risk of serious complications. The present authors hope that a description of the course of diagnostic work-up and treatment of a patient in whom a hip dislocation persisted for 42 years will prove interesting and helpful for orthopaedists who may encounter such a case in their practice. The patient sustained a dislocation of the right hip in 1974. He did not agree to undergo reduction immediately after the injury. Initially, he experienced extremely severe pain and difficulty walking, but gradually learned to walk without crutches and even took up a job. The limb was considerably shortened with only minimal movement in the hip joint. The pelvic geometry was altered and spinal scoliosis developed. In the last several years, the patient experienced a significant increase in pain and a decrease in function that prevented him from walking unassisted. Following a thorough physical examination, and based on computed tomography images, the patient was qualified for hip arthroplasty. An analysis of the available literature prompted the present authors to use a cemented implant and not to use bone grafts. Early treatment outcomes are good.