INTRODUCTION: Traumatic hip dislocations (THD) often result from high-energy trauma and are frequently associated with fractures of the femoral head, shaft, or acetabulum. Effective management, including timely hip relocation, is essential for favorable outcomes. However, limited literature exists on the functional outcomes of THD, especially in resource-limited settings like Nepal. This study aimed to evaluate the functional outcomes of patients with complex THDs treated at a tertiary care centre in Nepal. METHODS: This descriptive observational study included 80 patients with complex THDs treated between October 2012 and July 2023. Eligible patients had follow-ups ranging from 6 months to over five years. Data on patient demographics, injury characteristics, treatment details, and functional outcomes were collected. The Harris Hip Score (HHS) was used to assess functional outcomes, with scores categorized as "good" (≥ 80) or "poor" (<
80). Statistical analysis used logistic regression to identify factors associated with better functional outcomes. RESULTS: In this study of 80 patients with traumatic hip dislocations (THD), the majority were male (82.5%) and aged under 40 years (53.8%), with road traffic accidents being the predominant cause (73.8%). Most injuries involved posterior dislocations (87.5%), and 76.3% had associated acetabular fractures. Good functional outcomes, defined as a Harris Hip Score (HHS) ≥ 80, were achieved in 83.8% of cases, while 16.3% had poor outcomes. Logistic regression analysis revealed several significant factors associated with better outcomes: a hospital stays of less than three weeks (OR 4.67, 95% CI 1.08-20.21, p = 0.04), anterior dislocation (OR 12.17, 95% CI 1.12-131.70, p = 0.04), and follow-up duration of less than five years (OR 0.07, 95% CI 0.01-0.43, p = 0.00). However, acetabular fractures had a significantly lower likelihood of good outcomes (OR 0.28, 95% CI 0.08-0.96, p = 0.04). CONCLUSION: Timely management of traumatic hip dislocations, such as early discharge and treatment of associated fractures, is vital for achieving favorable functional outcomes, as reflected in the Harris Hip Score. These findings offer valuable insights for optimizing care in resource-limited settings and highlight the necessity for long-term follow-up, especially for patients with more complex injuries.