Femoroacetabular impingement is treated with arthroscopic surgery or with open surgical dislocation and debridement.
Signs You May Need Surgical Hip Dislocation
The surgical hip dislocation is a unique procedure typically reserved in elective cases for people suffering from femoroacetabular impingement, a labral tear in a location that would be exceptionally difficult to access through arthroscopic means, abnormal femoroacetabular anatomy requiring extensive osteoplasty, and in some cases large osteochondral defects. It is also performed in the trauma setting for patients who sustain fractures of the femoral head.
Patients who suffer from symptoms related to femoroacetabular impingement will typically experience hip pain that is usually activity related, particularly with deep squatting or repeated circumduction of the hip. There may be a catching or pinching sensation followed by a period of soreness or burning pain in the hip itself.
Who Is A Good Candidate For Surgical Hip Dislocation?
Although femoroacetabular impingement is becoming more frequently treated with hip arthroscopy, there are certain patients for whom hip arthroscopy is not a viable option to treat their femoroacetabular impingement surgically. This patient group includes patients with labral tears in areas that are inaccessible via arthroscopic surgery and that are truly symptomatic (these are rare, but can include posteroinferior labral tears). Some patients also have extensive abnormal anatomy (a large cam or pincer deformity or mixture of both) that extends beyond the accessible areas of hip arthroscopy.
Patients who also have an associated osteochondral defect or large chondro-labral flap may require open surgical hip dislocation to treat this, and as such given that the surgical hip dislocation is already necessary, they will also receive treatment for the femoroacetabular impingement via this means even if their labral tear or major deformity is located in an area amenable to hip arthroscopy.
Alternatives To Surgical Hip Dislocation
There are some instances where the abnormal anatomy responsible for femoroacetabular impingement is treatable via hip arthroscopy. This is the most common alternative to surgical hip dislocation – if you think you might be a candidate for hip arthroscopy and would wish to proceed with this line of treatment instead of an open surgical hip dislocation then please mention this to your surgeon and they can counsel you with regards to your options and refer you to an accomplished hip arthroscopist if necessary.
Surgical Hip Dislocation Procedure
The procedure itself can either be done with the patient in the lateral position or prone – different surgeons will have different preferences as to the position the patient is placed in for the procedure. Once the patient receives a general anesthetic (which is usually the preferred anesthetic for this procedure type), the patient will then have their hip exposed surgically and an osteotomy of the greater trochanter of the hip is performed, separating the attachments of the important muscle groups from the femoral neck and head itself.
Once these have been exposed, the hip capsule is opened and the hip can be surgically dislocated, and the femoral head in its entirety (as well as the acetabular labrum and articular surface) can be inspected and the necessary surgical procedures can be carried out, whether they involve replacement or augmentation of an osteochondral defect, repair of a labral tear, osteoplasty of the femoral neck and/or acetabular rim and any fixation of any fractures or osteochondral fragments that is deemed feasible.
Once these parts of the procedure have been completed, the hip is then relocated and the osteotomy is fixed, usually with two screws, back to its anatomical location. The surgical approach is then carefully closed and a dressing is applied.
After the surgery, the patient is typically kept nonweightbearing on the affected side for six weeks and at this point, provided that the six-week postoperative radiographs are reassuring, they can begin to 50% weight bear using crutches to aid in ambulation with the patient being able to fully ambulate with 100% weight bearing at about 3 months post surgery.
Postsurgical pain will persist for two to three weeks and will subside significantly thereafter. The protected weightbearing is principally to allow the osteotomy to heal fully and is not designed to limit postoperative pain.
Surgical Hip Dislocation Success Rate
Although a more invasive procedure than hip arthroscopy for treating femoroacetabular impingement, the success rate of treating femoroacetabular impingement through this technique is significant, with success rates of 90% reported in the existing literature.
The main concern postoperatively is nonunion of the osteotomy, and provided that this is judiciously monitored for and the patient is compliant with their post-operative restrictions, the osteotomy will likely heal uneventfully in the majority of cases.
A number of other risks also exist, including infection and neurovascular injury, but these are no more common in a surgical hip dislocation than they are in any other procedure about the hip including fracture fixation and total hip replacement.
Surgical Hip Dislocation Recovery In Timeframe
As previously mentioned, the patient can be expected to be non-weight bearing for a period of 6 weeks immediately after the surgery, and they will be able to ambulate on the nonoperative leg with the aid of crutches. At 6 weeks, provided the postoperative radiograph is reassuring, partial weightbearing on that side will be permitted for a further 6 weeks and, at 3 months post surgery, the crutches can be removed all together as the patient will be allowed to fully weight bear at that time.
Return to work will depend on the level of strenuous activity required in the patient’s occupation. Deskwork or office work can be returned to usually within 2 to 3 weeks once the incision has fully healed. Jobs that require a high level of activity are usually not returned to until after the three month mark when full weightbearing without the aid of crutches is permitted. In particular, jobs that require high levels of strenuous activity and are quite physically demanding will also require graduated return to work protocol at 3-month period, which will begin with modified duties and extend for approximately a month or so whilst the muscular strength in the muscle surrounding the hip recovers.
Usually by 6 months after the treatment, the patient has achieved a baseline level of both pain and strength and should be symptom free at that point.
Surgical Hip Dislocation Cost
Given that this procedure does not usually require a great deal of specialist equipment, the cost is usually relatively much lower as compared to a hip arthroscopy which does require numerous specialties of equipment and in most cases, a specially designed surgical table. The cost will essentially be related to the hardware required to fix the osteotomy and any equipment used during the procedure itself whether that may be a fixation of the labral tear, an osteoplasty or a combination of the two.
For a full breakdown of the cost of the procedure to your insurance provider and subsequently to you, please arrange to see one of our specialist orthopedic surgeons who can counsel you with regards to the specifics of the case costings.
Although considered an invasive procedure as compared to the alternative of hip arthroscopy, surgical hip dislocation does have very favorable results. The restrictions are often very similar to patients who have undergone osteoplasty via hip arthroscopy, as limited weightbearing is necessary in both cases. Patients widely report overall satisfaction with their surgical hip dislocation and it is considered a successful procedure, albeit one that is less common due to more advanced and less invasive techniques.
I provide Orthopaedic patient care at several different locations, including a Regional Joint Assessment Centre, a Level 1 Trauma Centre and a District General Hospital. My scope of practice is broad and includes Trauma, Arthroplasty and Sports Orthopaedics.
My areas of special interest include Primary and Revision Arthroplasty, Periprosthetic Fracture Management and general orthopaedic trauma management in isolation and in the context of complex polytrauma patients. I also have clinical research interests in these areas, as well the development of interprofessional relationships between trauma team members and fellow healthcare professionals.
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