Hip Dislocation in Football - Tua Tagovailoa's Injury

Last Saturday, November 16, University of Alabama's quarterback Tua Tagovailoa was severely injured just three minutes before half-time against Mississippi State in the SEC's Western Division of NCAA football. Still recovering from a right ankle surgery performed less a month ago, the possible #1 pick in the next NFL draft was tackled from behind by two opponents on a third-down play. As a result of the contact, Alabama's QB violently crashed his right knee onto the turf, sustaining a hip dislocation and a fracture of the posterior wall of the socket (acetabulum). See video here

Alabama's team physician reduced (put back in place) his wounded hip still at the stadium. Once the care team understood the severity of the lesion, the athlete was transported to Birmingham, AL, for further diagnostic studies (CT scan and MRI). The outcome of these tests led the QB into Hip surgery the following Monday in Houston, TX. Operative intervention is often required to achieve perfect bone restoration and, hopefully, a favorable outcome.

While neither I or Michigan Orthopaedic Surgeons was part of Tagovailoa's care team, the goal of this article is to give an insight into hip dislocation injuries in Sports. Moreover, we will also talk about possible complications, and time to return to play after such season-ending and possible career-ending injury.

First, I would like to explain what the term "dislocation" stands for. Dislocation, in general terms, means the loss of contact and congruity between two bones that makes a joint. In other words, when the bones from an articulation are separated from each other. Specifically, for the hip, is when the head of the femur (thighbone), which is essentially a ball, is separated from the acetabulum (socket). The problem is that every time a dislocation happens, it does at the cost injuring stabilizing structures, such as the capsule, ligaments, tendon, or even the bone. In Tagovailoa's case, the ball was separated from the socket by breaking (fracturing) a portion of the bone socket, the posterior wall of the acetabulum.

Hip dislocations are extremely rare injuries in the NFL, falling far behind from contusions, sprains, or strains in the thigh, knee, and ankle. Hip dislocation in sports accounts for approximately 2% of hip dislocations from all causes. Nonetheless, this is the same injury that ended the career of all-star football player Bo Jackson, forcing him to migrate to baseball (which he also became an all-star player as well). Going back to Tugovailoa's injury, it is likely that the QB will reach full recovery and will return to play next year, after 6 to 12 months of recovery and rehabilitation.

What is the most concerning about hip dislocation is that it can lead to critical complications such as nerve injuries, avascular necrosis, or osteoarthritis.

Avascular Necrosis (AVN), the complication that affected Bo Jackson, can occur in 10 to 20% of traumatic hip dislocations. AVN occurs because the blood supply to the femoral head is disturbed or damaged during the injury and can become insufficient to provide nutrients and oxygen to all sections of the bone of the femoral head. When this happens, the portion of the bone in which blood does not reach anymore dies, leading to collapse, incongruity, and arthritis. We know that the incidence of AVN increases when the reduction (the orthopedic maneuver to put the joint back into place) is delayed from the time of injury. Considering that we know that Alabama's team physician reduced Tagovailoa not long after the trauma, the likelihood that the athlete will have AVN will fall into the lower end.

Another major complication related to hip dislocation is osteoarthritis of the hip. Some studies reported that long-term degenerative hip arthritis occurs in up to 88% of hip dislocations that are associated with fractures, the very one that Tagovailoa suffered. The good news is that, if this eventually happens, it usually does only after several years after the lesion.