A dislocated hip requires emergency medical treatment, and the joint needs to be put back into place within 6 hours of the injury to minimize the risk of serious complications. This is not something you can fix yourself. The ball of the thighbone has been forced completely out of its socket, and putting it back requires heavy sedation, imaging, and trained physicians applying precise force. If you or someone near you has a dislocated hip, call 911 or get to an emergency room immediately.
Why the 6-Hour Window Matters
The current medical consensus is that a dislocated hip should be reduced (the medical term for putting it back in place) within 6 hours. After that window, the risk of a serious complication called avascular necrosis climbs sharply. Avascular necrosis happens when the blood supply to the head of the thighbone is cut off, causing the bone to gradually die. Delayed reduction also increases the chance of developing early-onset arthritis in the joint. This time pressure is why hip dislocations are treated as true orthopedic emergencies, not injuries that can wait for a scheduled appointment.
What Happens at the Emergency Room
Before anything else, the medical team will take X-rays of your pelvis to check for fractures around the hip socket or the top of the thighbone. These fractures are common alongside dislocations and change the treatment plan entirely. If a fracture is present, a simple manual reduction could make things worse by displacing the broken bone. For a “simple” dislocation, meaning no fractures visible on X-ray, closed reduction (putting the joint back without surgery) is the standard next step.
You will receive strong pain medication almost immediately upon arrival, typically an opioid delivered through an IV. For the actual reduction, you’ll be placed under procedural sedation, which means you’ll be in a deep, controlled sleep but won’t need a breathing tube. The sedation serves two purposes: it eliminates pain, and it relaxes the powerful muscles around the hip that are actively fighting to hold the bone in its displaced position. Without that muscle relaxation, the joint often can’t be moved back.
How Doctors Put the Hip Back in Place
About 90% of hip dislocations are posterior, meaning the thighbone has been pushed backward out of the socket. This typically happens in car accidents when the knee strikes the dashboard, driving the thighbone straight back. The remaining cases are anterior dislocations, where the bone shifts forward.
For a posterior dislocation, the most common technique involves the physician applying steady traction along the length of the thigh while gently rotating the leg inward. You’re lying on your back, and the doctor pulls the leg upward and toward them with controlled force. In another approach, the physician sits on the bed at your feet and flexes your hip as far as possible to move the ball of the thighbone into a better position for sliding back over the rim of the socket. A third method uses a bedsheet wrapped around your inner thigh: one person pulls along the length of the leg while an assistant uses the sheet to pull the thigh outward until the joint clicks back into place.
For anterior dislocations, the approach is reversed. The physician applies traction along the leg with outward rotation instead of inward rotation, sometimes with an assistant pushing directly on the displaced bone to guide it home.
When Surgery Is Needed
If manual reduction fails, surgery becomes necessary. Open reduction (putting the joint back through an incision) is also required when the hip has been dislocated for a long time, when the thighbone or hip socket is fractured, when bone fragments are blocking the joint from seating properly, or when the hip keeps slipping back out after being reduced. The decision isn’t always made before the first attempt. Sometimes doctors try a closed reduction, get the joint back in, and then find on follow-up imaging that something isn’t right.
Post-Reduction Imaging
After the joint is back in the socket, you’ll get another round of X-rays to confirm it’s properly seated. The standard follow-up imaging is a CT scan with thin, detailed slices. This scan checks two things: that the ball is sitting concentrically (evenly centered) in the socket, and that no small bone or cartilage fragments are floating inside the joint. Loose fragments can grind against the joint surface and accelerate cartilage damage if left in place. Doctors typically compare both hips on the X-ray to judge whether the joint spacing looks normal relative to your uninjured side.
Recovery After Reduction
For the first four weeks, you’ll be limited to very minimal weight on the affected leg, using crutches or a walker. During this phase, there’s no formal physical therapy. Instead, you’ll follow a home exercise program focused on gentle range-of-motion movements to prevent stiffness without stressing the healing joint.
Around the four-week mark, you’ll see your surgeon for a follow-up. If healing is on track, you’ll gradually transition to bearing weight as tolerated, still using crutches for support. Formal physical therapy typically begins at this point to rebuild strength in the muscles around the hip, particularly the deep stabilizers that help hold the joint in place. Full recovery timelines vary, but most people are looking at two to three months before returning to normal daily activities, and longer before high-impact exercise or sports.
Complications and Long-Term Risks
The two most concerning complications are avascular necrosis and nerve damage. Across published studies, the rate of avascular necrosis ranges widely, from about 3% to as high as 28% depending on the severity of the injury and how quickly the hip was reduced. In one long-term study following patients for at least 10 years, 11% developed avascular necrosis. If it occurs, the bone gradually weakens and may eventually collapse, sometimes requiring a hip replacement.
Sciatic nerve injury is the other major risk. The sciatic nerve runs directly behind the hip joint, and a posterior dislocation can stretch or crush it. In the same 10-year study, six of the patients had sciatic nerve damage at the time of injury, and four of those (67%) still had persistent nerve problems at follow-up. Sciatic nerve damage can cause numbness, weakness, or pain radiating down the back of the leg and into the foot.
Arthritis is the most common long-term consequence. People who have had a hip dislocation carry roughly 7 times the risk of developing hip osteoarthritis compared to someone who hasn’t, and the arthritis tends to progress faster. This isn’t something that shows up immediately. It develops over years as the damaged cartilage wears down, which is why long-term follow-up with imaging is important even if the hip feels fine in the months after the injury.
Dislocated Hip Replacements
If you’ve had a total hip replacement, the rules are somewhat different. Artificial hips dislocate more easily than natural ones because the ball and socket components are smaller and there’s less soft tissue holding them together. The reduction process uses the same general techniques, with the physician applying traction and rotation under sedation, but the forces required are often lower. The bigger concern with a prosthetic hip dislocation is recurrence. If the hip keeps dislocating, the solution may involve revision surgery to reposition or replace the implant components, add a larger ball, or use a constrained liner that physically locks the ball into the socket.