Hip Disorders

Treatment Options

Surgical Hip Dislocation
One of the great challenges in the treatment of disease of the hip has been limited access to the joint. Due to the multiple powerful muscles that cross the hip and the depth of the joint, dislocation of the hip is usually the only way to access the inner portion of the joint. However, dislocation of the hip can be quite hazardous due to the tenuous blood supply of the femoral head through an artery known as the medial femoral circumflex artery (MFCA). Damage to this blood supply is a major risk factor in the development of avascular necrosis.

Professor Reinhold Ganz developed a procedure for safe access to the hip through studies of the anatomy of the MFCA. This artery has been shown to travel up the back part of the neck of the femur and enter the bone at the junction of the head and neck of the femur. Surgical hip dislocation allows access to the joint by using this anatomical information and entering through the front of the joint. In this procedure, an osteotomy (surgical bone cut) is performed on the outer aspect of the femur allowing the joint to be dislocated relatively easily.

This procedure provides unlimited access to all aspects of the hip and has made the treatment of cartilage damage to the hip a real possibility. Currently, the procedure has been applied to the treatment of slipped capital femoral epiphysis (SCFE), hip impingement, avascular necrosis, and severe cartilage injuries of the hip

FAQ - Surgical Hip Dislocation

• I have hip pain, would I be a candidate for surgical hip dislocation?
• Surgical hip dislocation is a major surgical procedure that allows unrestricted access to the entire hip joint. Patient’s who have major bony abnormalities such as overhanging bone spurs, an excessively large femoral head, or other sources of abnormal bone contact may benefit for surgical hip dislocation in order to eliminate these abnormalities.
  
  
• What is the hip “labrum”?
• The labrum is a soft-tissue structure at the margin of the hip socket. It is a highly innervated tissue with a tenuous blood supply which predisposes it to painful tears. It’s main physiological role is currently not fully understood. However, it has been demonstrated that the labrum is critical to sealing the hip joint and maintaining the important lubricating layer between the femoral head and the hip socket.
  
  
• How do you remove the bone from the head?
• After dislocating the femoral head, excess bone on the femoral head which is noted to contact abnormally within the hip socket is removed. This is performed using small chisels of a motorized burring device.
  
  
• Why would I have a surgical dislocation instead of an arthroscopy of the hip?
• This is an ongoing area of controversy. Surgical hip dislocation requires an extensive surgical incision and approach, the dissection of several large muscles, and a substantial blood loss (300 to 400 cc). Arthroscopy can be performed on an outpatient basis with minimal blood loss and surgical dissection. The disadvantage of hip arthroscopy is the limited access to the various portions of the hip joint, the inability to reshape the hip socket, and a decreased ability to precisely reshape the femoral head compared to surgical hip dislocation.
  
  
• What are the complications of the surgical hip dislocation procedure?
• The most feared complication of the procedure is damage to the blood supply of the femoral head. The entire blood supply of this critical region is carried by one artery (the medial femoral circumflex artery). If this artery is damaged, the femoral head can gradually undergo necrosis (cell death of bone cells), collapse, and ultimately go on to hip arthritis. Other complications include infection, blood loss, and nerve injury. Additionally, part of the bone of the femur is cut as part of the approach and repaired at the end of the surgery (trochanteric osteotomy). One possible complication of the surgery is a problem with the healing of this bone back to the femur.
  
  
• How long will I need to be on crutches?
• Patients are kept on crutches for 6 weeks to minimize stress on the trochanteric osteotomy until healing has occurred.
  
  
• When can I return to work?
• Usually in 4 to 6 weeks.
  
  
• When can I return to sports?
• Usually no sooner than 4 months after the surgery.
  
  
• Are the long term results of this procedure known?
• No. The longest term results of the procedure were published from Bern, Switzerland with an improvement in the pain score at an average of 5 years from 2.9 to 5.1 (on a scale of 1 to 6). The results were less optimal in patients with preexisting osteoarthritis of the hip