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HSS Journal ®
Published in: HSS Journal ® 1/2013

01-02-2013 | Review Article

Surgical Dislocation of the Hip: Evolving Indications

Authors: James R. Ross, MD, Perry L. Schoenecker, MD, John C. Clohisy, MD

Published in: HSS Journal ® | Issue 1/2013

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Abstract

Background

Femoroacetabular impingement (FAI) is a condition that has become increasingly identified as abnormal, repetitive abutment of the proximal femur and acetabular rim. Safe surgical dislocation of the hip has been popularized as a technique that allows surgeons to not only improve joint preservation procedures but also understand disease patterns more clearly.

Questions/Purposes

We describe the technique of surgical dislocation as well as review the indications, results, and complications that are associated with the procedure. We also present various case examples to highlight this technique.

Search Strategies

We performed a systematic review of the literature to define the indications, clinical outcomes, and complications associated with surgical dislocation of the hip for the treatment of FAI.

Results

Clinical success rates vary in the literature between 64% and 96% of patients with good results, and conversion to total hip arthroplasty ranging between 0% and 30% in patients who underwent FAI treatment with surgical dislocation. Reported major complication rates have ranged from 3.3% to 6%, most commonly in the form of trochanteric nonunion, neurapraxia, or heterotopic ossification.

Conclusions

FAI deformities encompass a wide spectrum of disease patterns. Surgical dislocation allows full access to the hip in addition to observing its pathomechanics. Strict adherence to proper technique allows the surgeon to minimize complication rates while treating the deformity at hand.
Appendix
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Literature
1.
Anderson LA, Erickson JA, Severson EP, Peters CL. Sequelae of Perthes disease: treatment with surgical dislocation and relative femoral neck lengthening. JPO. 2010;30(8):758-766.
2.
Bastian JD, Wolf AT, Wyss TF, Notzli HP. Stepped osteotomy of the trochanter for stable, anatomic refixation. Clin Orthop Relat Res. 2009;467:732-738.PubMedCrossRef
3.
Beaule PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head–neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg. 2007;89(4):773-779.PubMedCrossRef
4.
Beaule PE, Zaragoza E, Copelan N. Magnetic resonance imaging with gadolinium arthrography to assess acetabular cartilage delamination. A report of four cases. J Bone Joint Surg. 2004;86:2294-2298.PubMed
5.
Beck M, Buchler L. Prevalence and impact of pain at the greater trochanter after open surgery for the treatment of femoro-acetabular impingement. J Bone Joint Surg. 2011;93(Suppl 2):66-69.PubMedCrossRef
6.
Beck M, Kalhor M, Leunig Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012-1018.PubMedCrossRef
7.
Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67-73.PubMedCrossRef
8.
Bedi A, Zaltz I, De La Torre K, Kelly BT. Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement. AJSM. 2011;39(Suppl):20S-28S.
9.
Botser IB, Smith TW, Nasser R, Domb BG. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 2011;27(2):270-278.PubMedCrossRef
10.
Chung SM. The arterial supply of the developing proximal end of the human femur. J Bone Joint Surg. 1976;58:961-970.PubMed
11.
Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, et al. A systematic approach to the plan radiographic evaluation of the young adult hip. J Bone Joint Surg. 2008;90(suppl 4):47-66.PubMedCrossRef
12.
Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467:638-644.PubMedCrossRef
13.
Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res. 2010;468(2):555-564.PubMedCrossRef
14.
Dudda M, Mamisch TC, Krueger A, Werlen S, Siebenrock KA, Beck M. Hip arthroscopy after surgical hip dislocation: is predictive imaging possible? Arthroscopy. 2011;27(4):486-492.PubMedCrossRef
15.
Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg. 2006;88:925-935.PubMedCrossRef
16.
Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U. Surgical dislocation of the adult hip. A technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001;83(8):1119-1124.PubMedCrossRef
17.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112-120.PubMed
18.
Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82:679-683.PubMedCrossRef
19.
Graves ML, Mast JW. Femoroacetabular impingement: do outcomes reliably improve with surgical dislocations? Clin Orthop Relat Res. 2009;467(3):717-723.PubMedCrossRef
20.
Hunt D, Clohisy JC, Prather H. Acetabular labral tears of the hip in women. Phys Med Rehabil Clin N Am. 2007;18:497-520.PubMedCrossRef
21.
Ito K, Minka MA II, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head–neck offset. J Bone Joint Surg. 2001;83B:171-176.CrossRef
22.
Kempthorne JT, Armour PC, Rietveld JA, Hooper GJ. Surgical dislocation of the hip and management of femoroacetabular impingement: results of the Christchurch experience. ANZ J Surg. 2011;81(6):446-450.PubMedCrossRef
23.
Larson CM, Giveans MR. Arthroscopic debridement versis refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25(4):369-376.PubMedCrossRef
24.
Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61-66.PubMedCrossRef
25.
Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, et al. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Othop Scand. 2000;71:370-375.CrossRef
26.
MacDonald S, Garbuz D, Ganz R. Clinical evaluation of the symptomatic young adult hip. Semin Arthroplasty. 1997;8:3-9.
27.
28.
Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27(2):252-269.PubMedCrossRef
29.
McCarthy J, Noble P, Aluisio FV, Schuck M, Wright J, Lee JA. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003;406:38-47.PubMedCrossRef
30.
McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J. The role of labral lesions to the development of early degenerative hip disease. Clin Orthop Relat Res. 2001;393:25-37.PubMedCrossRef
31.
Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Of the adult hip for femoroacetabular impingment: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178-181.PubMedCrossRef
32.
Naal FD, Miozzari HH, Wyss TF, Notzli HP. Surgical hip dislocation for the treatment of femoroacetabular impingment in high-level athletes. AJSM. 2011;39(3):544-550.
33.
Nepple JJ, Carlisle JC, Nunley RM, Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. AJSM. 2011;39(2):296-303.
34.
Notzli HP, Siebenrock KA, Hempfing A, Ramseier LE, Ganz R. Perfusion of the femoral head during surgical dislocation of the hip. Monitoring by laser Doppler flowmetry. J Bone Joint Surg Br. 2002;84:300-304.PubMedCrossRef
35.
Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head–neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg. 2002;84B:556-560.CrossRef
36.
Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term follow up. Clin Orthop Relat Res. 2010;468:504-510.PubMedCrossRef
37.
Philippon MJ, Schenker M, Briggs Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):908-914.PubMedCrossRef
38.
Philippon MJ, Yen YM, Briggs KK, Kuppersmith DA, Maxwell RB. Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report. JPO. 2008;28(7):705-710.
39.
Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop. 1999;19:419-424.PubMed
40.
Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br. 1999;81:281-288.PubMedCrossRef
41.
Schoenecker PL, Clohisy JC, Millis MB, Wenger DR. Surgical management of the problematic hip in adolescent and young adult patients. JAAOS. 2011;19(5):275-286.
42.
Shore BJ, Novais EN, Millis MB, Kim YJ. Low early failure rates using surgical approach in healed Legg–Calve–Perthes disease. Clin Orthop Relat Res. 2012;470:2441-2449.PubMedCrossRef
43.
Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85:278-286.PubMed
44.
Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;418:54-60.PubMedCrossRef
45.
Sink EL, Beaule PE, Sucato D, Kim YJ, Millis MB, Dayton M, et al. Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg. 2011;93:1132-1136.PubMedCrossRef
46.
Slongo T, Kakaty D, Krause F, Ziebarth K. Treatment of slipped capital femoral epiphysis with a modified Dunn procedure. J Bone Joint Surg. 2010;92(19):2898-2908.PubMedCrossRef
47.
Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clin Anat. 2010;23:8-17.PubMedCrossRef
48.
Snow SW, Keret D, Scarangella S, Bowen JR. Anterior impingement of the femoral head: a late phenomenon of Legg–Calve–Perthes’ disease. J Pediatr Orthop. 1993;13:286-289.PubMedCrossRef
49.
Trueta J, Harrison MJM. The normal vascular anatomy of the femoral head in adult man. J Bone Joint Surg Br. 1953; 442–460.
50.
Yun HH, Shon W, Yun JY. Treatment of femoroacetabular impingement with surgical dislocation. Clin Orthop Surg. 2009;1:146-154.PubMedCrossRef
51.
Ziebarth K, Zilkens C, Spencer S, Leunig M, Ganz R, Kim YJ. Capital realignment for moderate and severe SCFE using a modified Dunn procedure. Clin Orthop Relat Res. 2009;467(3):704-716.PubMedCrossRef
52.
Zlorowicz M, Szczodry M, Czubak J, Ciszek B. Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head. J Bone Joint Surg Br. 2011;93(11):1471-1474.CrossRef
Metadata
Title
Surgical Dislocation of the Hip: Evolving Indications
Authors
James R. Ross, MD
Perry L. Schoenecker, MD
John C. Clohisy, MD
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
HSS Journal ® / Issue 1/2013
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-012-9323-7

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