Three and a half hours in the E.R.: Jack's hip dislocation (and reduction)

By Jack Brummet, Medical Editor

It's impossible to describe the magnitude of pain that flows from this seemingly minor misalignment

I dislocated my (prosthetic) left hip [1]  at 1:30 Sunday morning.   It is by far the most painful thing I've  experienced. . .by orders of magnitude (I had another dislocation five years ago and it was just the same). I was leaning down in a chair, picking something up, and my stainless steel hip bone popped right out of the [ceramic] socket.   I knew instantly what had happened.  I slid myself across the room to a taller chair, using a chest to keep my left foot from touching the floor.  And then I had to figure out how to get help.  Keelin was in our bedroom downstairs.  I tried calling her cell phone, which was silenced or turned off.  Eventually, I tried yelling, which worked. She came upstairs suitably alarmed, but she had been through this once before.   She called an ambulance for me.  The last time it happened, we called 911 and they roared up to our house at 2 AM with sirens and lights on.  I wanted a lower key approach this time (one in which the neighbors didn't all come out, assuming I'd croaked).  The private ambulance came about 40 minutes later.  The first time, I was in our basement and it took about six firemen to lift me onto a stretcher and carry me up the steep stairs.  This time, two EMTs had a space age chair that could take me down to the street, without bumping me too much (every bump is like a knife being driven through your leg) and then putting me on a gurney.  

I'm not quite sure why this happened [2].  I generally follow the "hip replacement precautions."  I didn't seem to be doing anything un-kosher, or trefe, but I somehow just leaned my leg out too much and it popped. This reminds me to be really careful...medically it's no big deal, and they fix it in a few seconds (unless the act of popping it damages the socket). But that intense wave of pain for hours really gets to you, and as you're being transferred from ambulance gurney to hospital gurney to x ray gurney, each transfer is agonizing. Once they pumped me full of fentanyl and morphine, I could prop my leg a little so it wouldn't move, and it was almost tolerable. The doctors and nurses liked me because once I was doped up I started telling jokes, and four of them just sat around talking as we waited for an anesthesiologist to free up. When they gave me the Propofol [the drug that eventually killed Michael Jackson], they kept laughing because I wasn't falling asleep. I said "I'm fine. Do you want me to recite a poem?" I was about to start reciting a Dylan Thomas poem. . .and then I woke up three minutes later feeling much much better.  Of course until it pops back in there is always some slight doubt it won't stay in and you'll have to have a revision surgery; fortunately, it's stayed in. 

Moving even 1/4" was excruciating. You find a position that hurts the least, but it usually starts hurting in a few minutes, when you have to painfully find a new position.  Every move you make is total agony. Breathing can hurt. Muscle twitches feel like fire. 

The Doctor said relocating and replacing a hip is more like carpentry than surgery ("we use the same tools...chisels, saws, screws, cement, hammers"). 

Before the surgery, still in pain, but smiling because the narcotics have kicked in (Fentanyl). The reduction surgery (e.g., slamming your stainless steel femur into the ceramic socket) only takes fifteen seconds, once they knock you out. 

 After - ahh, sweet relief.  I woke up three minutes after being 
put to sleep and the pain was gone (leaving just extreme soreness).

They put me under and wrestled my hip back to its rightful home [3]. Keelin was in the room and said the whole procedure really does only take a few seconds. I woke up three minutes after they knocked me out, and my hip was back in place. I'm still hurting, but they gave me plenty of Vicoden, which helps a little.

Waking up after this agony is a shimmering moment of joy. . .in these three minutes I was asleep they had changed my life!  How did they do that??!! That is maybe the most amazing part of this story. They can put you under for three minutes, perform their maneuvers, and bring you conscious instantly! My hip was home and I was sore all over, but I could move my leg under my own volition. The absence of pain was a joy.   Getting through this now, I start to worry about about every movement I make.  If you live on the west coast, you may have experienced a major earthquake sometime in your life. The residual affects are something like that--after an earthquake, you get nervous anytime you feel a deep rumble, or a heavy truck passes by. . .and every time I move now, I am calculating whether or not that is a risky move or has the potential to lay me low.  I know from experience that the pain goes away in a few days; it takes much longer for the heebie-jeebies to dissipate. 


OK. . .enough. . .I'm feeling pretty good, how are you feeling? /jack

[1]  Dislocations of a prosthetic hip can happen without any trauma since the ligaments that support the hip joint are no longer working properly. However, nationwide, only about 1 percent of all hip replacement patients will suffer a dislocation. The dislocation can occur when the leg is put in positions that can manually pop the ball from the hip socket, like crossing your legs at your knees or squatting. Additionally, for preventive reasons, physicians advise against bringing your knees to your chest if you have a prosthesis.


[2] "After hip replacement surgery, patients must restrict certain activities to prevent problems with the hip replacement implant. The concern is that hip replacement implants are not as stable as a normal hip joint. This means that it is possible for the ball of the ball-and-socket hip replacement to dislocate. "In order to prevent the chance of a hip replacement dislocation, certain positions should be avoided. These positions place the implant in a position where dislocation is more likely. These restrictions are known as 'hip precautions.'"


[3] "Two common techniques for performing a posterior hip reduction (the most common kind of hip dislocation) are the Allis Maneuver and the Stimson Maneuver. In addition to those two techniques, there are several other options available to an orthopedic surgeon depending on the individual case. Both maneuvers require the use of physical force to push the hip back into place and are performed with the patient sedated. The hip and knee are flexed to a 90-degree angle when a surgeon applies the Allis Maneuver. The Stimson Maneuver has the dislocated leg hanging over the edge of the bed with the hip and knee also flexed at a 90-degree angle."

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