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Techniques and Results for Open Hip Preservation.

Levy DM, Hellman MD, Haughom B, Stover MD, Nho SJ - Front Surg (2015)

Bottom Line: Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy.Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum.Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA.

ABSTRACT
While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is the most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum. Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

No MeSH data available.


Related in: MedlinePlus

A postoperative radiograph of a surgical hip dislocation secured with screws.
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Figure 1: A postoperative radiograph of a surgical hip dislocation secured with screws.

Mentions: Surgical hip dislocation has traditionally been the gold standard for treating FAI. Ganz et al. (10) was first to describe the currently accepted surgical technique. With the patient in a lateral decubitus position, the surgeon initiates the approach using either a Kocher–Langenbeck (KL) type or straight lateral incision. The fascial interval is developed by splitting the gluteus maximus (KL) or the Gibson interval, which spares the anterior half of the gluteus maximus (11). The anterior capsule is then accessed by a trigastric trochanteric osteotomy. The osteotomy can be performed with a step cut, which provides for greater stability and earlier progression of weight bearing (12). As the greater trochanter is osteotomized, the obturator externus muscle remains attached to the intact femur, protecting the deep branch of the MFCA, which is the primary blood supply to the femoral head (10, 12). An anterior Z-shaped capsulotomy followed by a transection of the round ligament facilitates an atraumatic anterior hip dislocation. Laser Doppler flowmetry has confirmed that perfusion to the femoral head is maintained after a trochanteric osteotomy and dislocation (12). The surgeon is left with a 360° view of both the acetabulum and the femur to perform osteochondroplasty and labral repair, debridement, or reconstruction. At the end of the procedure, the trochanter is reapproximated and stabilized with screws (see Figure 1). After surgery, patients must follow toe-touch weight-bearing restrictions for 4–8 weeks to allow for osteotomy healing.


Techniques and Results for Open Hip Preservation.

Levy DM, Hellman MD, Haughom B, Stover MD, Nho SJ - Front Surg (2015)

A postoperative radiograph of a surgical hip dislocation secured with screws.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664697&req=5

Figure 1: A postoperative radiograph of a surgical hip dislocation secured with screws.
Mentions: Surgical hip dislocation has traditionally been the gold standard for treating FAI. Ganz et al. (10) was first to describe the currently accepted surgical technique. With the patient in a lateral decubitus position, the surgeon initiates the approach using either a Kocher–Langenbeck (KL) type or straight lateral incision. The fascial interval is developed by splitting the gluteus maximus (KL) or the Gibson interval, which spares the anterior half of the gluteus maximus (11). The anterior capsule is then accessed by a trigastric trochanteric osteotomy. The osteotomy can be performed with a step cut, which provides for greater stability and earlier progression of weight bearing (12). As the greater trochanter is osteotomized, the obturator externus muscle remains attached to the intact femur, protecting the deep branch of the MFCA, which is the primary blood supply to the femoral head (10, 12). An anterior Z-shaped capsulotomy followed by a transection of the round ligament facilitates an atraumatic anterior hip dislocation. Laser Doppler flowmetry has confirmed that perfusion to the femoral head is maintained after a trochanteric osteotomy and dislocation (12). The surgeon is left with a 360° view of both the acetabulum and the femur to perform osteochondroplasty and labral repair, debridement, or reconstruction. At the end of the procedure, the trochanter is reapproximated and stabilized with screws (see Figure 1). After surgery, patients must follow toe-touch weight-bearing restrictions for 4–8 weeks to allow for osteotomy healing.

Bottom Line: Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy.Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum.Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center , Chicago, IL , USA.

ABSTRACT
While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is the most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg-Calve-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/or acetabulum. Chronic slipped capital femoral epiphysis may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

No MeSH data available.


Related in: MedlinePlus