Neglected traumatic hip dislocation: a systematic review of case reports and case series on management, outcomes, and...

Neglected traumatic hip dislocation (NTHD) is a challenging orthopaedic condition predominantly encountered in developing countries, where delayed presentation is attributable to socioeconomic barriers, lack of awareness, and reliance on traditional bone setters. Unlike acute hip dislocations, which demand emergent reduction within 6 h, neglected cases present unique reconstructive challenges including soft-tissue contracture, acetabular fibrous tissue in-growth, neo-acetabulum formation, avascular necrosis (AVN), and limb-length discrepancy. The objective of this work was to systematically review the available literature on the management strategies, functional outcomes, and complications associated with NTHD in both adults and children.

A systematic search of five electronic databases (PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Google Scholar) was conducted from inception through March 2026 using predefined search strings, and the review was reported in accordance with the PRISMA 2020 guidelines. Studies reporting the management of traumatic hip dislocations presenting more than 3 weeks after the index injury were included. Data were extracted on patient demographics, duration of neglect, type of dislocation, surgical technique, functional outcomes [Harris Hip Score (HHS), modified Merle d'Aubigne score], and complications. Methodological quality was appraised using the Joanna Briggs Institute (JBI) critical appraisal checklists, and the certainty of evidence was assessed narratively. Owing to clinical and methodological heterogeneity, a quantitative meta-analysis was not undertaken.

Twenty-one studies comprising a total of 200 patients met the inclusion criteria. Management strategies included closed reduction with heavy skeletal traction, open reduction with or without osteotomy, external fixation-assisted reduction, total hip arthroplasty (THA) with or without sub-trochanteric shortening osteotomy (STSO), Girdlestone excision arthroplasty, and hip arthrodesis. THA was the most consistently reliable procedure for chronic neglected dislocations (> 3 months), yielding mean postoperative HHS of 81-91 and modified Merle d'Aubigne scores of 14.3-14.4. AVN was the most prevalent complication (reported in up to 100% of chronic series), followed by post-operative dislocation (8-25%), pre-existing sciatic nerve palsy (up to 25%), limb-length discrepancy, and heterotopic ossification. The overall certainty of evidence was low to very low.

Management of NTHD must be individualized based on the duration of neglect, patient age, presence of associated fractures, and condition of the femoral head. For dislocations less than 3 months old, open reduction remains viable, and in children it is the treatment of choice. For chronic dislocations exceeding 3 months, THA with or without STSO is the most consistently reported and reliable option. Because the evidence base is limited to case reports and case series (Level IV-V), the management framework proposed here should be regarded as pragmatic and evidence-informed rather than definitive; prospective multicentre studies are needed.