Surgical dislocation of the adult hip

Abstract

Surgical dislocation of the hip is rarely undertaken. The potential danger to the vascularity of the femoral head has been emphasised, but there is little information as to how this danger can be avoided. We describe a technique for operative dislocation of the hip, based on detailed anatomical studies of the blood supply. It combines aspects of approaches which have been reported previously and consists of an anterior dislocation through a posterior approach with a 'trochanteric flip' osteotomy. The external rotator muscles are not divided and the medial femoral circumflex artery is protected by the intact obturator externus. We report our experience using this approach in 213 hips over a period of seven years and include 19 patients who underwent simultaneous intertrochanteric osteotomy. The perfusion of the femoral head was verified intraoperatively and, to date, none has subsequently developed avascular necrosis. There is little morbidity associated with the technique and it allows the treatment of a variety of conditions, which may not respond well to other methods including arthroscopy. Surgical dislocation gives new insight into the pathogenesis of some hip disorders and the possibility of preserving the hip with techniques such as transplantation of cartilage.

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

“…Where there is damage to the labrum or articular cartilage, this can be resected, repaired or reconstructed. Often, these procedures can be done by either arthroscopic or open surgery 2 4. An arthroscopic approach may be preferable in many patients to allow rapid recovery, but some of these procedures will require an open approach.…”

“…Ganz et al 2 discussed femoroacetabular impingement (FAI) in more detail in 2001, reporting a new surgical approach, and then presenting a hypothesis linking FAI with osteoarthritis in 2003 3. This, and the introduction of an arthroscopic approach to surgery in the early 2000s, led to increasing interest in this condition; the number of patients identified with FAI has risen rapidly over the past 10 years 4–6.…”

Analysis of Surgical Treatment Outcomes in Femoroacetabular Impingement Syndrome

“…Bu nedenle, Ganz'ın tanım-ladığı şekilde, trokanterin tepesinin köşesinden itibaren 1,1-1,5 cm'lik mesafeden osteotomize edildi (Şekil 1). 11 Trokanter öne doğru devrildi. Kapsülün ön tarafı diseke edildikten sonra, kapsül kesisi Şekil 2'deki gibi yapıldı.…”

“…11 Altı yüze yakın olgunun hiçbirinde trokanterik kaynamama ve avasküler nekroz gö-rülmemiştir. Bizim olgu serimizde de trokanterik kaynamama ve avasküler nekroz olmamıştır.…”

Surgical Hip Dislocation for Treatment of Slipped Capital Femoral Epiphysis

“…As such, it is believed they offer the best chance of correcting the anatomic deformities that can lead to early osteoarthritis [20] . To reduce the risk for osteonecrosis of the epiphysis during capital reorientation, tension of the posterosuperior retinaculum, containing the end branches of the medial femoral circumflex artery is markedly reduced by wedge resection of varying size and location [21] . The surgical hip dislocation technique, which originally described by Ganz, allow restoration of normal anatomy of proximal femur with complete correction of the slip angle, such that probability of secondary osteoarthritis and cam type FAI may be minimized it also allows direct inspection and preservation of physeal blood supply [22] .…”