Surgical Hip Dislocation For Treatment Research Articles

Surgical hip dislocation for treatment of femoral head chondroblastoma: efficacy and safety.

Femoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications. Ten patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7years (range: 14-20) and a mean follow-up of 34 ± 12months (range: 17-57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients. We had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16-28) to a post-operative median of 29 (range: 26-30) (P = 0.005). This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.

Surgical hip dislocation for treatment of synovial chondromatosis of the hip.

In the present study, we aimed to evaluate the clinical outcomes of surgical hip dislocation in patients with synovial chondromatosis (SC) of the hip. Seven patients with primary SC of the hip treated with open synovectomy and removal of loose bodies by surgical hip dislocation from 2016 to 2019 were retrospectively reviewed. All patients had numerous and widespread loose bodies based on pre-operative images, including routine radiographs, CT, and MRI. The visual analog scale (VAS) score and Harris hip score (HHS) were collected and analyzed before and after surgery. The post-operative radiographs were reviewed to evaluate disease recurrence and osteoarthritis progression. The mean operative time was 61 minutes(range, 42-75min). An average of 33 loose bodies in each patient (range, 16-67) was removed, and extra-articular pathology was found in one patient. Patients were followed up for a mean duration of 30months (range, 18-42months). The average VAS scores were decreased from 3.7 (range, 2-6) pre-operatively to 0.9 (range, 0-2) at the last follow-up, and the HHS was improved from 60.1 (range, 50-73) to 90.1 (range, 82-95). All results demonstrated significant improvements (P < 0.05). Post-operative radiographs showed no recurrence, osteoarthritis progression, or osteonecrosis of the femoral head in all hips. Surgical hip dislocation was a practical approach for managing both intra-articular and extra-articular pathologic lesions around the hip. It was an effective treatment for SC of the hip with short surgical time, good joint functions, a lower recurrence rate, and few complications.

Surgical Hip Dislocation for the Treatment of Slipped Upper Femoral Epiphysis Demonstration of Surgical Technique

Surgical hip dislocation for treatment of hip intra-articular pathology has been popularized by the Bernese group over the last few years. This approach provides excellent and safe exposure of the hip joint without compromising the femoral head blood supply. It is, however a very demanding approach and requires surgical experience and attention to detail.

Treatment of chronic, stable slipped capital femoral epiphysis via surgical hip dislocation with combined osteochondroplasty and Imhauser osteotomy.

PurposeTreatment of slipped capital femoral epiphysis (SCFE), including the modified Dunn procedure, restores anatomy with significant risk for avascular necrosis (AVN), if performed in the setting of moderate to severe, stable SCFE. The Imhauser osteotomy has been shown to be an effective way to correct residual deformity without the risk of AVN. We sought to evaluate the effectiveness and safety of a combined Imhauser osteotomy and osteochondroplasty, performed via a surgical hip dislocation approach for the acute and delayed treatment of stable SCFE.MethodsA retrospective review was performed on a series of patients who underwent Imhauser osteotomy and osteochondroplasty via surgical hip dislocation for treatment of chronic, stable SCFE. Patients were divided into acute or delayed treatment groups based on whether osteotomy was performed as the initial slip treatment.ResultsIn total 19 patients (15 male, four female, average age 13.7 years) were reviewed. Six osteotomies were performed acutely in combination with in situ pinning, 13 were delayed at least six months after in situ pinning (average 21.7 months). Two hips had labral tears that required repair. The mean follow-up was 61 months (23 to 120) (delayed) and 53 months (27 to 61) (acute). The average improvement in slip angle was 40.7° (delayed) and 50.2° (acute) (p = 0.0916), final post-operative slip angle averaged 15.8° (delayed) and 17.8° (acute) (p = 0.544). Femoral neck length and greater trochanteric height were similar between both groups. Average alpha angle at final follow-up measured 55.8° (delayed) and 60.8° (acute) (p = 0.542). No cases of AVN were identified.ConclusionImhauser osteotomy combined with osteochondroplasty via surgical hip dislocation approach is a safe and effective treatment of moderate to severe, stable SCFE performed in both the acute and delayed setting.

Surgical Hip Dislocation for Treatment of Slipped Capital Femoral Epiphysis

BACKGROUND: Surgical procedures with use of traditional techniques to relocate the proximal femoral epiphysis in the treatment of slipped upper femoral epiphysis are allied with a high rate of femoral head osteonecrosis. Therefore, most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement. OBJECTIVE: The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function. PATIENTS AND METHODS: This prospective case series study included thirty patients (32 hips, 13 Lt hip, 19 Rt hip) with stable chronic slipped capital femoral epiphysis after surgical correction with a modified Dunn procedure. This study included 22 males and 8 females. The mean age of our patients was 14 years (10-18 years). The mean duration of symptoms before the operation was 4.56 ± 2.5 month. Mean follow up period was 14.5 month (6- 36 months).The mean preoperative Alpha angle was 97.850 ± 13. The mean preoperative Slip angle was 52.50 ± 14.6. Harris hip score was done for all patients pre operatively and its mean was 67 ± 9.3, mean WOMAC score was 88.4 ± 3.8, mean Merle d'Aubigne score was 12 ± 1. RESULTS: 30 hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. 2 patients had fair to poor clinical outcome including 3 patients who developed AVN. The difference between those who developed AVN and those who didn’t develop AVN was statistically significant in postoperative clinical scores (p = 0.000). The mean slip angle of the femoral head was 52.50 ± 14.6 preoperatively and was corrected to a mean value of 5.6 0 ± 8.20 with mean correction 46.850 ± 14.90 (p = 0.000). Mean postoperative Alpha angle was 51.150 ± 4.2 0 with mean correction of 46.70 ±14.20 (p = 0.000). Post operative flexion was 111.90 ±19.050. Post operative IR in 90 degree flexion was 41.60±9.6. Post operative ER in 90 0 flexion was 45.60 ± 9.97. In our series mean postoperative HHS was (96.16 ± 9.7) and mean improvement was (29.6 ± 9.6) (p = 0.000). Mean WOMAC score was (3.3 ± 3.5) and mean improvement was (85.12 ± 4.7) (p = 0.000). Mean Merle d'Aubigne score was (16.8 ± 2.4) and mean improvement was (4.8 ± 2.4) (p = 0.000) and as regard to Haymann and Hernodon score 30/32 hips were good and excellent results. CONCLUSIONS: the modified Dunn procedure allows to restor the normal proximal femoral anatomy by complete correction of the slip angle. This tecnique may reduce the probability of secondary osteoarthritis and femoroacetabular cam impingement.

Surgical Hip Dislocation for Treatment of Slipped Capital Femoral Epiphysis

Surgical Hip Dislocation for Treatment of Slipped Capital Femoral Epiphysis

Surgical hip dislocation for treatment of cam femoroacetabular impingement.

Background:Cam femoroacetabular impingement is caused by a misshapen femoral head with a reduced head neck offset, commonly in the anterolateral quadrant. Friction in flexion, adduction and internal rotation causes limitation of the hip movements and pain progressively leading to labral and chondral damage and osteoarthritis. Surgical hip dislocation described by Ganz permits full exposure of the hip without damaging its blood supply. An osteochondroplasty removes the bump at the femoral head neck junction to recreate the offset for impingement free movement.Materials and Methods:Sixteen patients underwent surgery with surgical hip dislocation for the treatment of cam femoroacetabular impingement by open osteochondroplasty over last 6 years. Eight patients suffered from sequelae of avascular necrosis (AVN). Three had a painful dysplastic hip. Two had sequelae of Perthes disease. Three had combined cam and pincer impingement caused by retroversion of acetabulum. All patients were operated by the trochanteric flip osteotomy with attachments of gluteus medius and vastus lateralis, dissection was between the piriformis and gluteus minimus preserving the external rotators. Z-shaped capsular incision and dislocation of the hip was done in external rotation. Three cases also had subtrochanteric osteotomy. Two cases of AVN also had an intraarticular femoral head reshaping osteotomy.Results:Goals of treatment were achieved in all patients. No AVN was detected after a 6 month followup. There were no trochanteric nonunions. Hip range of motion improved in all and Harris hip score improved significantly in 15 of 16 cases. Mean alpha angle reduced from 86.13° (range 66°–108°) to 46.35° (range 39°–58°).Conclusion:Cam femoroacetabular Impingement causing pain and limitation of hip movements was treated by open osteochondroplasty after surgical hip dislocation. This reduced pain, improved hip motion and gave good to excellent results in the short term.

Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement Which are the Red Lights for Poor Results

Background: Femoroacetabular impingement is a common source of hip pain and dysfunction, especially in young and active patients. It is considered to be the main cause of early hip osteoarthritis. We set the purpose to identify poor prognosis factors in the surgical treatment of femoroacetabular impingement. Methods: We realized a prospective observational study in a case series of 50 hips in 44 patients with femoroacetabular impingement operated with surgical hip dislocation between 2001 and 2006. Clinical, radiologic, surgical and functional factors of whole patients were assessed. Clinical outcomes were determined with a subjective scale. Also, functional assessment was performed with a modified Harris Hip Score (HHS). Both evaluations were applied at 6, 9, and 12 months, and so every year once. Finally, the statistical analysis was done with SPSS 15.0 software. Results: With an average of 6.2 post-operative years (5-10.1) of follow-up, 35 patients (70%) were “asymptomatic” (HHS=100), 11 patients (22%) “better” (HHS=94.09), and 4 patients (8%) “the same or worse” (HHS=68.25). 40% of patients older than 45 years old were “asymptomatic”, versus 77% younger than 45 years old (p=0.03). 37% of patients with mixed femoroacetabular impingement were “asymptomatic”, 87% of patients with cam-type and 82% with picer-type (p=0.003). The factors related to a poor prognosis were as follows: age >45 and mixed-type impingement; and other factors such as radiological osteoarthritis, labral injury and prolonged symptomatology were also associated to poor prognosis results in our study, without being statistically significant. Conclusion: Age > 45 years old and mixed type of impingement are significant statistic factors related to a poor prognosis in patients treated with surgical hip dislocation. This data are useful to predict the treatment outcome for each patient.

Surgical hip dislocation does not result in atrophy or fatty infiltration of periarticular hip muscles.

Surgical hip dislocation is the gold standard for treatment of femoroacetabular impingement (FAI). It utilizes an intermuscular and internervous approach to the hip. Concerns have been expressed that this approach causes soft tissue trauma resulting in post-operative muscle weakness of patients undergoing this procedure. We therefore asked whether surgical hip dislocation leads to (i) atrophy (decreased muscle diameter or cross-sectional area [CSA]) and (ii) degeneration (fatty infiltration) of 18 evaluated periarticular hip muscles. We retrospectively evaluated 32 patients (34 hips) following surgical hip dislocation for the treatment of FAI using pre and post-operative magnetic resonance (MR) arthrography of the hip. We evaluated muscle diameter, CSA and degree of fatty infiltration according to Goutallier for 18 periarticular hip muscles on axial and sagittal views. The mean interval between pre and post-operative MR was 1.9 ± 1.5 years (range, 0.4–6.1 years). Pre and post-operative muscle diameter and CSA of all 18 evaluated hip muscles did not differ. There was no post-operative change in the Goutallier classification for any of the evaluated 18 muscles. No muscle had post-operative degeneration higher than Grade 1 according to Goutallier. No atrophy or degeneration of periarticular hip muscles could be found following surgical hip dislocation for treatment of FAI. Any raised concerns about the invasiveness and potential muscle trauma for this type of surgery are unfounded. Level III, retrospective comparative study. See guidelines for authors for a complete description of levels of evidence.

Erratum to: Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Erratum to: Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Surgical Hip Dislocation for Treatment of Femoroacetabular Impingement: Factors Predicting 5-year Survivorship

Patients with femoroacetabular impingement (FAI) often develop pain, impaired function, and progression of osteoarthritis (OA); this is commonly treated using surgical hip dislocation, femoral neck and acetabular rim osteoplasty, and labral reattachment. However, results with these approaches, in particular risk factors for OA progression and conversion to THA, have varied. We asked if patients undergoing surgical hip dislocation with labral reattachment to treat FAI experienced (1) improved hip pain and function; and (2) prevention of OA progression; we then determined (3) the survival of the hip at 5-year followup with the end points defined as the need for conversion to THA, progression of OA by at least one Tönnis grade, and/or a Merle d'Aubigné-Postel score less than 15; and calculated (4) factors predicting these end points. Between July 2001 and March 2003, we performed 146 of these procedures in 121 patients. After excluding 35 patients (37 hips) who had prior open surgery and 11 patients (12 hips) who had a diagnosis of Perthes disease, this study evaluated the 75 patients (97 hips, 66% of the procedures we performed during that time) who had a mean followup of 6 years (range, 5-7 years). We used the anterior impingement test to assess pain, the Merle d'Aubigné-Postel score to assess function, and the Tönnis grade to assess OA. Survival and predictive factors were calculated using the method of Kaplan and Meier and Cox regression, respectively. The proportion of patients with anterior impingement decreased from 95% to 17% (p < 0.001); the Merle d'Aubigné-Postel score improved from a mean of 15 to 17 (p < 0.001). Seven hips (7%) showed progression of OA and another seven hips (7%) converted to THA Survival free from any end point (THA, progression of OA, or a Merle d'Aubigné-Postel < 15) of well-functioning joints at 5 years was 91%; and excessive acetabular rim trimming, preoperative OA, increased age at operation, and weight were predictive factors for the end points. At 5-year followup, 91% of patients with FAI treated with surgical hip dislocation, osteoplasty, and labral reattachment showed no THA, progression of OA, or an insufficient clinical result, but excessive acetabular trimming, OA, increased age, and weight were associated with early failure. To prevent early deterioration of the joint, excessive rim trimming or trimming of borderline dysplastic hips has to be avoided.

Surgical hip dislocation for treatment of primary aneurysmal bone cysts in the femoral neck and head

Surgical hip dislocation for treatment of primary aneurysmal bone cysts in the femoral neck and head