Surgical dislocation of the adult hip

TLDR

Surgical dislocation of the hip is rarely undertaken and its risk to femoral head vascularity is a concern, yet little is known about how to avoid this danger. We describe a technique for operative dislocation of the hip based on detailed anatomical studies of the blood supply. The technique uses an anterior dislocation through a posterior approach with a trochanteric flip osteotomy, preserves external rotators, and protects the medial femoral circumflex artery via the intact obturator externus. In 213 hips over seven years, intraoperative perfusion was confirmed and no cases of avascular necrosis occurred; morbidity was low and the approach enables treatment of conditions not amenable to arthroscopy, offering new insights and potential cartilage transplantation.

Abstract

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.