Orthopedic surgeon Dr. Jeffrey Budoff provides injury analysis for Albert Wilson. Wilson, a Miami Dolphins wide receiver, suffered a right hip subluxation Week 7. It was later reported that he also had a ‘significant injury’ to his hip’s labrum. So what does that mean?
The hip is a ball and socket joint, much like the shoulder. However, there are important differences between these two articulations. The shoulder relies mainly on soft tissues (ie. ligaments) for stability. In contrast, the hip relies far more on its larger bony socket. The femoral head (ball of the hip joint) is surrounded by bone much more than the humeral head (ball of the shoulder joint) is. In addition, the ligaments surrounding the femoral head are among the strongest in the human body.
Consequently, instability of the hip joint happens far less frequently than instability of the shoulder joint. Meaning that it takes a lot more force/violence to dislocate or subluxate (partially dislocate) a hip joint.
Therefore, hip subluxations are a potentially devastating injury, especially if associated with a fracture (just ask Dennis Pitta). Hip subluxations can also potentially injure the blood supply to the femoral head, leading to its avascular necrosis (death), with subsequent early arthritis.
I could find only one report on NFL players with hip subluxations, from 2003.1 All players also had a small fracture associated with the instability. Six of eight (75 percent) were eventually able to return to play. The other two (25 percent) suffered avascular necrosis of their femoral head, which was career-ending and led to early arthritis and a total hip replacement (see Bo Jackson). Fortunately, there’s been no report of a fracture for Wilson.
And while many players can play football following a shoulder dislocation, that’s far more difficult following an episode of hip instability. Anthony Miller dislocated his shoulder and now plays with a harness, preventing him from reaching up in the air too far. And while this does limit his ability as a wide receiver, he’s at least able to play somewhat until getting his shoulder surgically repaired.
On the other hand, hip subluxation is a multi-week injury. Ask Jack Doyle. The hip can’t really be braced to allow continued play, as another instability episode could easily create further, permanent, often life-changing damage. Following hip subluxation, previously recommended treatment was six weeks on crutches before returning to play. More recently, greater weight-bearing is often allowed, but six weeks before returning to play is not uncommon. Having said that, recommendations vary, by surgeon (it’s often much more of an art than a science) and by the degree of subluxation and injury the player suffered.
A hip subluxation with a labral injury is often season-ending. For purposes of this discussion, the labrum of the hip can be considered roughly similar to the meniscus of the knee. A significant labral lesion (ie. tear) often requires arthroscopic surgical treatment, either debridement (removal of the torn flap) or repair. The ability to play is compromised with a labral tear in the hip. The player can’t “sink his hips” to cut well, and trying to can damage the joint cartilage further, potentially leading to arthritis.
I would expect Wilson to miss at least six weeks and quite possibly the remainder of the season.
- Moorman CT 3rd, Warren RF, Hershman EB, Crowe JF, Potter HG, Barnes R, O’Brien SJ, Guettler JH. Traumatic posterior hip subluxation in American football. J Bone Joint Surg Am 85A:1190-6, 2003.