Multicenter Study of Complications Following Surgical Dislocation of the Hip

The Children’s Hospital, 13123 East 16th Avenue, Aurora, CO 80045, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 05/2011; 93(12):1132-6. DOI: 10.2106/JBJS.J.00794
Source: PubMed


Surgical hip dislocation enables complete exposure of the hip joint for treatment of various hip disorders.There is limited information regarding the complications associated with this procedure. Our purpose is to report the incidence of complications associated with surgical dislocation of the hip in a large, multicenter patient cohort.
A retrospective, multicenter analysis of patients who had undergone surgical hip dislocation was performed.Patients who had undergone a simultaneous osteotomy were excluded. Complications were recorded, with specific assessment for osteonecrosis, trochanteric nonunion, femoral neck fracture, nerve injury, heterotopic ossification, and thromboembolic disease. We graded complications with a validated classification scheme that includes five grades based on the treatment required to manage the complication and any long-term morbidity. With this classification, a Grade-I complication is one that requires no change in the routine postoperative course, Grade II requires a change in outpatient management, Grade III requires invasive surgical or radiologic management, Grade IV is associated with long-term morbidity or is life-threatening,and Grade V results in death.
The study included 334 hips in 302 patients seen at eight different North American centers. There were eighteen complications (5.4%) that were classified as Grade I (not clinically relevant and required no deviation from routine postoperative care). There were six complications (1.8%) classified as Grade II (treated on an outpatient basis or with close observation and resolved). There were nine complications (2.7%) classified as Grade III (treatable and resolved with surgery or inpatient management). There was one complication (0.3%) classified as Grade IV (resulting in a long-term deficit). A total of thirty hips had one or more complications, for an overall incidence of 9%. Excluding heterotopic ossification, the complication rate was sixteen (4.8%) of 334.
Surgical hip dislocation is a safe procedure with a low complication rate. Many of the complications were clinically unimportant heterotopic ossification. There were no cases of femoral head osteonecrosis or femoral neck fracture, and, with the exception of one sciatic neurapraxia that partially resolved, no other complication resulted in long-term morbidity.

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    • "The technique of surgical dislocation of the hip as described by Ganz et al.63 enables 360° exposure of the hip that has been reported in several studies for the treatment of various hip disorders.64 We have successfully used this technique in cases with end-stage OA of the hip in adolescent patients. "
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    ABSTRACT: Hip deformity secondary to Legg-Calvé Perthes disease (LCPD) may result in femoroacetabular impingement (FAI) and ultimately osteoarthritis. Observations made with the surgical hip dislocation approach have improved our understanding of the pathologic mechanics of FAI. However, owing to concerns about complications related to the vascularity, the role of surgical hip dislocation in the treatment of healed LCPD remains controversial. We present an algorithm to treat deformities associated with healed LCPD and asked (1) whether femoral head-neck osteochondroplasty and other procedures performed with the surgical hip dislocation approach provide short-term clinical improvement; and (2) is the complication rate low enough to be acceptable. We retrospectively reviewed 29 patients (19 males, 10 females; mean age, 17 years; range, 9-35 years) with symptomatic LCPD between 2001 and 2009. All patients underwent a surgical hip dislocation approach and femoral head-neck osteochondroplasty and 26 patients had 37 additional procedures performed. Clinical improvement was assessed using the WOMAC index. The minimum followup was 12 months (mean, 3 years; range, 12-70 months). WOMAC scores improved at final followup (8 to 4 for pain, 21 to 13 for function, and 4 to 2 for the stiffness subscales). No patients had osteonecrosis, implant failure, deep infection, or nonunion. Three patients underwent THA at 1, 3, and 6 years after their index procedure. Using the surgical hip dislocation approach as a tool to dynamically inspect the hip for causes of FAI, we were able to perform a variety of procedures to treat the complex deformities of healed LCPD. In the short term, we found improvement in WOMAC scores with a low complication rate.
    Clinical Orthopaedics and Related Research 11/2011; 470(9):2441-9. DOI:10.1007/s11999-011-2187-1 · 2.77 Impact Factor
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    Recent Advances in Hip and Knee Arthroplasty, 01/2012; , ISBN: 978-953-307-841-0
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