SURGICAL HIP DISLOCATION By Sabrina Cerciello SURGICAL HIP
SURGICAL HIP DISLOCATION By Sabrina Cerciello
SURGICAL HIP DISLOCATION is a demanding surgical procedure that permits unlimited access to the entire hip joint to address lesions and labral pathology
Age Consideration n n Patient age is highly variable Younger patients more common n better results n less irreversible tissue damage n n Older patients caution with patient selection d/t co-morbidities and poor bone quality n at this point in life, may be more beneficial or necessary for a Total Hip Replacement (THR) n
FAI n n Femoro-Acetabular Impingement Abnormal and wearing contact between the ball and socket of the hip joint, resulting in increased friction during movement that may damage joint (ref) Most common indication Typically young athletic men d/t overactivity of hip joint
TYPES n Two Types n Cam n femoral head/neck deformity n n cartilage delamination n acetabular cartilage lifted from underlying bone Pincer n “over-coverage” of acetabulum n labral tear n labrum = ring of elastic tissue on rim of socket of hip joint
FAI TYPES
Pre-Operative Cam Lesion Labral Tear d/t Cam Lesion Post-Operative improved sphericity of femoral head Radiograph of 10 y. o. girl diagnosed with Perthes disease
OTHER INDICATIONS n Slipped Capital Femoral Epiphysis n n Perthes Disease n n Abnormal development of hip joint Exostoses n n osteonecrosis at the femoral head Developmental Dysplasia of the Hip (DDH) n n separation of the femoral head from the femur at the growth plate extra bone growth Hip Abnormalities
GANZ TECHNIQUE n Trochanteric Flip Osteotomy n n n Anterior dislocation through a posterior approach ~1. 5 cm removed and reattached with screws Keeps external rotator muscles intact Preserves MFCA and femoral blood supply 2 -3 hours
COMPLICATIONS n n n n Necrosis Nerve palsies Infections Adhesions Nonunions Hardware failures Blood loss RARE
POST-OP TREATMENT n n n n TTWB or flat foot PWB 6 -8 weeks on crutches Anti-inflammatory NO! active abduction, passive adduction, flexion >80 degrees, external rotation Pillow under femur CPM 0°-30° Seated AAROM for knee flexion/extension May return to work in 4 -6 weeks and sports in 16 -24 weeks as permitted
n Phase I n n Weeks 6 – 12 same emphasis as Phase III n n n Day 1 – Week 6 Protect surgical site, minimize pain and inflammation, patient compliance w/ activity modification Phase II n n POST-OP PHASES Weeks 12 – 16 Independent HEP, optimized ROM, 5/5 strength, pain free ADLs Phase IV n n Weeks 16 – 20 Independent HEP, minimize post-exercise soreness
STRENGTHENING n n n Isometric Therex IMMEDIATELY after surgery n Ankle pumps x 10 n Gluteal sets x 10 n Quadriceps sets x 10 n 3 sets/day Aquatic walking at chest height~2 weeks More intensive strengthening may begin after ~3 months n closed chain, eccentric loading, treadmill
STRETCHING n BE VERY CAUTIOUS! n starts ~3 mos. post-op n Independent ROM 1 -2 years post-op n Dependent on stable pelvis n n pelvis motion creates “false movement” of hip joint & no stretching is achieved Paired with proprioception or balance work n Bosu, Biodex, single limb stance, swiss balls
HOME EXERCISE PROGRAM n Isometric Quad sets n n Ankle pumps Abdominal sets Abdominal control with arm motion n Towel roll under knee 2 -5 lbs in hand AAROM Knee Extension
WHY NOT A THR? n n Limited access to the various specific sections of the hip joint Inability to reshape the acetabulum Decreased ability to meticulously reshape the femoral head Higher risk of cartilage damage
REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Beck, M. "Groin Pain after Open FAI Surgery: the Role of Intraarticular Adhesions. ” National Center for Biotechnology Information, 10 Dec. 2008. Web. Retrieved 10 Oct. 2012. <http: //www. ncbi. nlm. nih. gov/pubmed/19082679>. “Femoro-Acetabular Impingement (FAI). ” The Hospital for Special Surgery. Retrieved 20 Oct. 2012. <http: //www. hss. edu/condition-list_hip-impingement-femoroacetabular-impingement. asp >. Ganz, R. , T. J. Gill, E. Gautier, K. Ganz, N. Krugel, and U. Berlemann. "Surgical Dislocation of the Adult Hip. " Jbjs. org. The Journal of Bone and Joint Surgery, Nov. 2001. Web. 13 Retrieved Oct. 2012. Jamali, Amir. (2010) Surgical Hip Dislocation. Retrieved 11 Oct. 2012. Joint Preservation Institute web site. <http: //www. jointpreservationinstitute. com/faq-surgical-hip-dislocation. html > Krueger, Andreas, Michael Leunig, Klaus A. Siebenrock, and Martin Beck. "Hip Arthroscopy After Previous Surgical Hip Dislocation for Femoroacetabular Impingement. ” Science Direct, Dec. 2007. Web. Retrieved 10 Oct. 2012. <http: //www. sciencedirect. com/science/article/pii/S 0749806307006688>. Munting, T. W. Open Hip Dislocation (Debridment) Surgery. Retrieved 13 Oct. 2012. Cape Town Sports and Orthopedic Clinic web site. <http: //www. ctorth. com/dr-munting/open-hipsurgery. html> Peters, Christopher L. , and Jill A. Erickson. "Treatment of Femoro-Acetabular Impingement with Surgical Dislocation and Débridement in Young Adults. ” Journal of Bone and Joint Surgery, 2006. Web. Retrieved 11 Oct. 2012. <http: //www. jbjs. org/article. aspx? Volume=88>. Ray, Linda. (2011) Hip Dislocation Surgery and Rehabilitation. Retrieved 11 Oct. 2012. Livestrong. <http: //www. livestrong. com/article/426593 -hip-dislocation-surgery-rehabilitation/> Rebello, Gleeson, Samantha Spencer, Michael Millis, and Young-Jo Kim. "Surgical Dislocation in the Management of Pediatric and Adolescent Hip Deformity. ” National Center for Biotechnology Information, U. S. National Library of Medicine, 6 Oct. 2008. Web. Retrieved 12 Oct. 2012. <http: //www. ncbi. nlm. nih. gov/pmc/articles/PMC 2635463/? tool= pubmed>. Sink, E. “Surgical Hip Dislocation. ” Orthopedics. May 2009. Retrieved 11 Oct. 2012. <http: //www. healio. com/orthopedics/journals/ortho/%7 Bd 7 a 2 e 1 ac-d 7 d 5 -4 d 3 c-8 e 528 a 713 f 0 e 4218%7 D/surgical-hip-dislocation>.
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