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Surgical Dislocation of the Hip: Evolving Indications

  • Review Article
  • Published:
HSS Journal ®

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.

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Disclosures

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. One or more of the authors has or may receive monies from a commercial entity that may be perceived as a potential conflict of interest.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300, West Pavilion, Campus Box 8233, St Louis, MO, 63110, USA

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

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  1. James R. Ross MD
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  2. Perry L. Schoenecker MD
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  3. John C. Clohisy MD
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Correspondence to James R. Ross MD.

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Figure 7

Perthes disease with acetabular dysplasia. a AP pelvic radiograph demonstrated a Perthes-type hip with coxa magna, coxa breva, coxa vara, and a prominent greater trochanter. This also demonstrates acetabular retroversion (cross-over sign) and dysplasia with a diminished lateral center edge angle and elevated acetabular index. b False profile radiograph also demonstrated diminished anterior center edge angle. c, d Dunn view and frog-leg lateral also reveals the aspherical deformity present. Axial (e) and sagittal (f, g) T2 MR arthrogram images demonstrate an anterior and superolateral degenerative labral tear (arrowhead). (JPEG 45 kb)

High Resolution Image (TIFF 7854 kb)

Figure 8

a AP radiograph demonstrating correction of the femoral head–neck offset, trochanteric height, and acetabular dysplasia. b After removal of hardware demonstrating full osseous union of the trochanteric and pelvic osteotomies. (JPEG 24 kb)

High Resolution Image (TIFF 5048 kb)

Figure 9

Post-traumatic avascular necrosis. a, b AP pelvis and false profile radiographs revealed central femoral head collapse and extrusion of an anterolateral femoral head fragment. c, d Frog-leg lateral and Dunn views demonstrate diminished head–neck offset and impingement. Three-dimensional (e) and an axial slice (f) CT scan again demonstrated the central femoral head impaction (asterisk) and lateral extrusion with a preserved posteromedial femoral head (arrowhead). (JPEG 40 kb)

High Resolution Image (TIFF 7676 kb)

Figure 10

a–c Postoperative radiographs demonstrating improvement of the femoral head sphericity and increased femoral head–neck offset. d AP radiograph after removal of prominent hardware demonstrating preservation of the hip joint, 2 years after the reconstruction. (JPEG 29 kb)

High Resolution Image (TIFF 6105 kb)

Figure 11

Residual SCFE. Radiographs demonstrate a posteriorly displaced femoral head with a prominent anterolateral head–neck junction, with an impingement trough (arrow), in addition to a high greater trochanter in relation to the center of the femoral head. (JPEG 27 kb)

High Resolution Image (TIFF 6141 kb)

Figure 12

a, b Restoration of the femoral head–neck offset in addition to the trochanteric height. c Removal of the prominence from the head–neck junction. d Relative femoral neck lengthening. e Labral repair. (JPEG 69 kb)

High Resolution Image (TIFF 10940 kb)

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Ross, J.R., Schoenecker, P.L. & Clohisy, J.C. Surgical Dislocation of the Hip: Evolving Indications. HSS Jrnl 9, 60–69 (2013). https://doi.org/10.1007/s11420-012-9323-7

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