Safe Surgical Dislocation Of Hip Research Articles

Outcomes of Intra-Articular Procedures through Safe Surgical Hip Dislocation Approach to Manage Residual Hip Deformities Secondary to Legg-Calv-Perthes Disease: A Systematic Review and Meta-Analysis

Abstract Background Legg-Calve-Perthes disease (LCPD) is a childhood condition characterized by femoral head osteonecrosis. The osteonecrotic lesion eventually heals, but persistent deformity to the proximal femur and acetabulum might induce hip discomfort and dysfunction following recovery. Previous reports have noted that between 30% and 50% of individuals affected by LCPD to have residual hip symptoms that persist and a frequent precursor to hip osteoarthritis in young adulthood. Aim of the Work The aim of the present study is to review the efficacy of intra-articular procedures through surgical hip dislocation approach to residual hip deformity secondary to Legg- Calve-perthes disease. Patients and Methods A Systematic Review and Meta-Analysis, We will include: Randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies and we will exclude: case reports, case series studies, cross sectional studies and non English studies. Results The surgical hip dislocation approach allows the surgeon to dynamically evaluate the hip, identify sources of impingement, and treat intraarticular and extraarticular abnormalities. Conclusion Head and neck osteochondroplasty performed through the surgical dislocation approach, combined with other procedures such as FHRO, RFNL, ITO and acetubular osteotomies relieved pain, improved ROM and restored function in most patients with no major complications.

Сompletely slipped capital femoral epiphysis in an 11 year old girl successfully treated bu DUNN’s open reduction through GANZ’ surgical dislocation of the hip (clinical case)

Slipped capital femoral epiphysis (SCFE) is a hip condition that occurs in teens and preteens who are still growing. Treatment for SCFE involves surgery to stop the head of the femur from slipping any further. Without early detection and proper treatment, SCFE can lead to potentially serious complications, including rapid degeneration of the femoral head and/or painful arthritis in the hip joint. Objective. Our case is presented to familiarize with the technique of safe surgical hip dislocation for the treatment of intraarticular hip pathologies. Case report and Methods. After collision while playing the 11 year old girl developed left hippain still allowing to walk. Imaging documented an acute slipped femoral capital epiphysis with the metaphysis articulating against the acetabulum. The patient was underwent open reduction could be performed using the DUNN procedure modified by GANZ. 6 weeks later prophylactic screw stabilization of the healthy right hip followed. Results. At 9 months follow-up the patient walks painfree with symmetric range of motion. Conclusion. The goal of treatment is to prevent the mildly displaced femoral head from slipping any further. This is always accomplished through surgery. Early diagnosis of SCFE provides the best chance of stabilizing the hip and avoiding complications. When treated early and appropriately, long-term hip function can be expected to be very good. Once SCFE is confirmed, the child will not be allowed to put weight on their hip and will be admitted to the hospital. In most cases, surgery is performed within 24 to 48 hours. In patients with unstable SCFE, the surgeon may first make an open incision in the hip, then gently manipulate (reduce) the head of the femur back into its normal anatomic position. The surgeon will then insert one or two metal screws to hold the bone in place until the growth plate closes. Sometimes surgeon may recommend inserting a screw into the unaffected hip at the same time to reduce the risk of SCFE. Our case demonstrates the value of open reduction of a severely dislocated femoral capital epiphysis in a case otherwise probably needing endoprosthetic hip replacement for restitution of hip function or hip arthrodesis at short-term follow-up

How Safe and Technical Is Modified Dunn Osteotomy in the Management of Patients with SCFE: A Clinical Trial with Short-Term Follow-Up

Objective. Over the last decade, modified Dunn osteotomy has been widely used in the management of slipped capital femoral epiphysis (SCFE) with varying degrees of complications. Different conclusions have been adopted. Our study represented our experience in using such a technique in stable and unstable SCFE and tried to determine its safety and applicability for routine practice. Methods. Our study adopted an interventional prospective design performed on 24 hips divided evenly between both sexes with a mean age of 13.25. On the Southwick classification, the cases were distributed between moderate and severe, which constituted 41.7% and 58.33%, respectively. Three quarters of the study subjects were stable according to the Loder classification. Each underwent modified Dunn osteotomy after a safe surgical hip dislocation. Results. Over the period of about 1-year follow-up, clinical evaluation was performed by examining the surgical site and assessing the legs’ length, range of hip movement, Harris hip score, and iHOT-12 score. Radiological assessment was performed by calculation of slip angle from the frog lateral view, assessment of union, and occurrence of any complications. The study showed that there was significant improvement in patients in terms of radiological and clinical outcomes, with the occurrence of AVN in 16.7% of cases (4 out of 24). All cases of AVN occurred in unstable hips. Conclusion. Despite the complication of AVN, we believe the results of this study add to the current literature which suggests that modified Dunn osteotomy is an effective and safe technique for the management of moderate and severe SCFE. This trial is registered with PACTR202312819351504.

A Rare Occurrence of Enchondroma in the Head of Femur in an Adult Male: A Case Report

Introduction: Enchondroma is a solitary, benign, and intramedullary cartilaginous tumor occurring most commonly in small bones of hands and feet contributing to 3–10% of all bone tumors. They originate from the growth plate cartilage which later on proliferates to form enchondroma. Lesions are central or eccentric and metaphyseal involvement is most common for long bones. We report a case of atypical occurrence of enchondroma in the head of femur in a young male. Case Report: A 20-year-old male patient presented with a history of pain in the left groin for 5 months. Radiological examination showed a lytic lesion in the head of femur. The patient was managed by safe surgical dislocation of the hip, curettage with autogenous iliac crest bone graft with countersunk screw fixation. Histopathology confirmed the lesion to be enchondroma. At the latest follow-up after 6 months, the patient was symptom-free and there was no evidence of any recurrence. Conclusion: Lytic lesions in the neck femur can have a good prognosis provided timely diagnosis and interventions are done. The present case of enchondroma in the head of femur represents a very rare differential diagnosis for the same and this must be kept in mind. So far, no such case has been reported in the literature. Magnetic resonance imaging and histopathology are of the essence to confirm this entity. Keywords: Enchondroma, atypical presentation, safe surgical dislocation of hip.

The Modified Dunn Procedure for Unstable Slipped Capital Femoral Epiphysis: A Systematic review and Meta-analysis

Abstract Source of Support None, Conflict of Interest None. Background The management of unstable slipped capital femoral epiphysis is controversial and evolving as insight into the condition develops. Almost half of patients with unstable slip developed femoral head osteonecrosis. The modified Dunn procedure through safe surgical hip dislocation has rapidly gained popularity as a treatment for unstable slipped capital femoral epiphysis. In this review we analyzed the results and complications following this procedure. Materials and Methods We performed a retrospective chart review of 297 consecutive patients (302 hips) who had undergone the modified Dunn procedure through safe surgical hip dislocation from Feb 2009 to Feb 2017. Patients were169 males and 128 females, between the age group of 7 to 18 years (mean age 12.66 years) and BMI ranged from 14.7 to 42.1 Kg/m2 (mean BMI 26.32 Kg/m2). The duration of symptoms among the studied group ranged from 2 to 360 days with mean 84.75days. Regarding site and severity 57% had lesions in left side, 40.9% had lesions in right side, 2.1% had bilateral lesions and 58% had severe lesions. The duration of operation among the studied group ranged from 75 to 162 min with mean 128.19 min. Regarding time of operation 61.1% had operation after more than 24 h from admission. All the patients were assessed with slip angle degree, Harris hip score, alpha angle, flexion degree, internal rotation, external rotation and neck shaft angle. Results At the mean follow up of 26.3 months (range 12 months to 4.5 years), the mean slip angle improved from a preoperative Value10 to 80 degree with mean 55.6 degree and after operation it ranged from 0 to 28 degree with mean 6.7 degree with mean reduction 48.9 degree, the Harris hip score among the studied group after operation ranged from 46 to 100% with mean 90.98%, regarding post-operative range of motion alpha angle ranged from 23.6 to 52.8 degree with mean 44.3 degree, flexion ranged from 80 to 120 degree with mean 105.84 degree, internal rotation ranged from 5 to 60 degree with mean 30.08 degree and external rotation ranged from 10 to 60 degree with mean 42.3 degree and finally neck shaft angle ranged from 128 to 164 degree with mean 137.2 degree. Conclusion Unstable slipped capital femoral epiphysis is associated with a high rate of avascular necrosis. Etiology of the AVN is not completely known and likely multifactorial. The modified Dunn osteotomy through Ganz surgical hip dislocation is the treatment of choice for those with moderate and severe unstable SCFE, allowing anatomical restoration of proximal femur, direct inspection, and preservation of physeal blood supply and inspection of intra-articular pathology which can be evaluated and treated at the time of operation.

Are we failing in hip protrusio treatment?

In a recent article published in Clinical Orthopaedics and Related Research, Hanke and colleagues (1) reported the longest follow up trial available in the literature about the survivorship of hips with protrusio acetabuli treated with circumferential acetabular trimming through surgical hip dislocation. This group of patients was compared with a group of pincer type femoroacetabular impingement (FAI) without severe overcoverage. Severe pincer impingement (protrusio acetabuli) is an established cause of hip pain and osteoarthritis (OA): the acetabular roof is negatively tilted and typically deep with relative global overcoverage of the femoral head that overlaps the ilioischial line medially and protrudes in the true pelvis; therefore the size of the lunate surface is increased and leads to a pincer type FAI. Safe surgical hip dislocation described by Ganz et al .(2) with circumferential rim trimming and labral refixation or reconstruction is the current gold standard treatment for this acetabular morphology. Unfortunately this study underlines a poor expectation of survival in half of the hips with protrusio acetabuli compared with the control group according to Kaplan and Meier method’s endpoints (1): conversion to total hip arthroplasty (THA), radiographic progression of osteoarthritis, and Merle d’Aubigne-Postel score less than 15 points.

Subcapital reorientation for moderate and severe slipped capital femoral epiphysis: early results of Ain Shams University Hospitals

Background Subcapital reorientation for severe slipped capital femoral epiphysis offers the double benefit of immediate restoration of range of motion (ROM), limb length discrepancy (LLD), and long-term hip preservation from premature osteoarthrosis. Patients and methods Modified Dunn’s technique through safe surgical hip dislocation was performed in 12 adolescents who presented with moderate-to-severe slipped capital femoral epiphysis. There were 10 males and only two females, with a mean age of 15 years. The mean Southwick’s slip angle was 47°. Only two slips were clinically unstable. Results After a mean follow-up of 23 months, the mean α angle measured 37°, and the mean slip angle decreased to 4.7°. The mean hip flexion range was 104°; the mean internal rotation in flexion was 33°; and the mean external rotation in flexion was 34°. The mean Harris hip score at the latest follow-up was 99.6. None of the cases developed chondrolysis or osteonecrosis. Conclusion It has been a long-standing orthopedic myth, believed by many surgeons, that the capital epiphysis cannot be realigned for fear of avascular necrosis. On the basis of the present study, we believe that subcapital reorientation through safe surgical hip dislocation approach restores close to normal the proximal femoral anatomy, and thus, presumably, would offer good long-term outcomes for a condition that can have serious lifelong consequences on young adults.

Treatment of mixed type femoroacetabular impingement using safe surgical hip dislocation in adults

This study aims to assess the experience gained in a single institution in the treatment of mixed type femoroacetabular impingement (FAI) using safe surgical hip dislocation (SSHD) technique. In this study, 22 hips of 21 patients (7 males, 14 females; mean age 33.8±10.6 years; range 19-52 years) treated by SSHD technique in our clinic between October 2009 and October 2014 were retrospectively evaluated. Preoperative and final Harris hip scores (HHS) and alpha angles were compared. Age, gender, laterality, impingement tests, preoperative HHS, cam and pincer type FAI radiographic indicators and intraoperative articular findings were assessed in terms of their influence to the final functional outcomes. Mean duration of the symptoms was 29.5 months. Groin pain, activated by flexion and internal rotation of the hip, was the main symptom. A radiographic diagnosis of "mixed type FAI" was made in all hips. Mean follow-up duration of 22 hips was 48 months. The difference between the mean preoperative and latest HHS was statistically significant (60.0 vs. 87.6 points, p<0.001). The treatment was considered satisfactory in 17 of 22 hips (77%) having a mean HHS of 95.0 points. Hips having a preoperative HHS of less than 60 points were more prone to unsatisfactory outcome. Among the investigated patient-dependent, clinical, radiographic variables and intraoperative articular findings, coxa profunda sign in a plain radiograph was found correlated with a higher rate of unsatisfactory outcome (p=0.040). Safe surgical hip dislocation procedure has a success rate of 77% after a mean follow-up of four years. Coxa profunda sign is associated with the unsatisfactory clinical outcome. Preoperative HHS of less than 60 points seems to be a negative predictive variable on the clinical outcome.

Magnetic resonance imaging of hip joint cartilage and labrum

Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.

Magnetic resonance imaging of hip joint cartilage and labrum

Hip joint instability and impingement are the most common biomechanical risk factors that put the hip joint at risk to develop premature osteoarthritis. Several surgical procedures like periacetabular osteotomy for hip dysplasia or hip arthroscopy or safe surgical hip dislocation for femoroacetabular impingement aim at restoring the hip anatomy. However, the success of joint preserving surgical procedures is limited by the amount of pre-existing cartilage damage. Biochemically sensitive MRI techniques like delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) might help to monitor the effect of surgical or non-surgical procedures in the effort to halt or even reverse joint damage.

Surgical dislocation of the adult hip

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 direct lateral approach to the hip.

A direct lateral approach to the hip is described which allows adequate access for orientation of the implant, for the insertion ofthe cement and for the correction ofdiscrepancy in leg length. An anatomical observation was made that the gluteus medius muscle is inserted into the greater trochanter by a tendon and that the axis of the shaft of the femur lies anterior to the main bulk of the muscle which was left