SURGICAL HIP SURGICAL HIP DISLOCATIONDISLOCATION

By Sabrina By Sabrina CercielloCerciello

SURGICAL HIP DISLOCATION SURGICAL HIP DISLOCATION

is a demanding surgical procedure that is a demanding surgical procedure that permits unlimited access to the permits unlimited access to the

entire hip joint to address lesions and entire hip joint to address lesions and labral pathologylabral pathology

Age ConsiderationAge Consideration Patient age is highly variablePatient age is highly variable Younger patientsYounger patients

more commonmore common better resultsbetter results less irreversible tissue damageless irreversible tissue damage

Older patients Older patients caution with patient selection d/t co-caution with patient selection d/t co-

morbidities and poor bone qualitymorbidities and poor bone quality at this point in life, may be more beneficial or at this point in life, may be more beneficial or

necessary for a Total Hip Replacement (THR) necessary for a Total Hip Replacement (THR)

FAIFAI Femoro-Acetabular Impingement Femoro-Acetabular Impingement

Abnormal and wearing contact Abnormal and wearing contact between the ball and socket of the between the ball and socket of the hip joint, resulting in increased hip joint, resulting in increased friction during movement that may friction during movement that may damage joint (ref)damage joint (ref)

Most common indicationMost common indication

Typically young athletic men d/t Typically young athletic men d/t over-activity of hip joint over-activity of hip joint

TYPESTYPES Two TypesTwo Types

CamCam femoral head/neck deformityfemoral head/neck deformity

cartilage delaminationcartilage delamination acetabular cartilage lifted from underlying acetabular cartilage lifted from underlying

bonebone

PincerPincer ““over-coverage” of acetabulumover-coverage” of acetabulum

labral tearlabral tear labrum = ring of elastic tissue on rim of socket labrum = ring of elastic tissue on rim of socket

of hip jointof hip joint

FAI TYPESFAI TYPES

Pre-OperativeCam Lesion

Labral Tear d/t Cam Lesion

Post-Operativeimproved sphericity of femoral head

Radiograph of 10 y.o. girl diagnosed with Perthes disease

OTHER INDICATIONSOTHER INDICATIONS Slipped Capital Femoral EpiphysisSlipped Capital Femoral Epiphysis

separation of the femoral head from the separation of the femoral head from the femur at the growth plate femur at the growth plate

Perthes DiseasePerthes Disease osteonecrosis at the femoral headosteonecrosis at the femoral head

Developmental Dysplasia of the Hip Developmental Dysplasia of the Hip (DDH) (DDH) Abnormal development of hip jointAbnormal development of hip joint

Exostoses Exostoses extra bone growthextra bone growth

Hip Abnormalities Hip Abnormalities

GANZ TECHNIQUEGANZ TECHNIQUE Trochanteric Flip Trochanteric Flip

OsteotomyOsteotomy Anterior dislocation Anterior dislocation

through a posterior through a posterior approachapproach

~1.5 cm removed ~1.5 cm removed and reattached with and reattached with screwsscrews

Keeps external Keeps external rotator muscles intactrotator muscles intact

Preserves MFCA and Preserves MFCA and femoral blood supplyfemoral blood supply

2-3 hours2-3 hours

COMPLICATIONSCOMPLICATIONS Necrosis Necrosis Nerve palsiesNerve palsies InfectionsInfections AdhesionsAdhesions NonunionsNonunions Hardware Hardware

failures failures Blood lossBlood loss RARERARE

POST-OP TREATMENTPOST-OP TREATMENT TTWB or flat foot PWBTTWB or flat foot PWB 6-8 weeks on crutches6-8 weeks on crutches Anti-inflammatory Anti-inflammatory NO!NO! active abduction, passive adduction, active abduction, passive adduction,

flexion >80 degrees, external rotationflexion >80 degrees, external rotation Pillow under femurPillow under femur CPM 0CPM 0°°-30-30°° Seated AAROM for knee flexion/extension Seated AAROM for knee flexion/extension May return to work in 4-6 weeks and May return to work in 4-6 weeks and

sports in 16-24 weeks as permittedsports in 16-24 weeks as permitted

POST-OP PHASESPOST-OP PHASES Phase IPhase I

Day 1 – Week 6Day 1 – Week 6 Protect surgical site, minimize pain and Protect surgical site, minimize pain and

inflammation, patient compliance w/ activity inflammation, patient compliance w/ activity modificationmodification

Phase IIPhase II Weeks 6 – 12 Weeks 6 – 12 same emphasis as Phase Isame emphasis as Phase I

Phase IIIPhase III Weeks 12 – 16Weeks 12 – 16 Independent HEP, optimized ROM, 5/5 strength, Independent HEP, optimized ROM, 5/5 strength,

pain free ADLspain free ADLs Phase IVPhase IV

Weeks 16 – 20Weeks 16 – 20 Independent HEP, minimize post-exercise Independent HEP, minimize post-exercise

sorenesssoreness

STRENGTHENINGSTRENGTHENING Isometric Therex Isometric Therex IMMEDIATELYIMMEDIATELY

after surgeryafter surgery Ankle pumps x10Ankle pumps x10 Gluteal sets x10Gluteal sets x10 Quadriceps sets x10Quadriceps sets x10 3 sets/day3 sets/day

Aquatic walking at chest height~2 Aquatic walking at chest height~2 weeksweeks

More intensive strengthening may More intensive strengthening may begin after ~3 monthsbegin after ~3 months closed chain, eccentric loading, treadmillclosed chain, eccentric loading, treadmill

STRETCHINGSTRETCHING BE VERY CAUTIOUS!BE VERY CAUTIOUS!

starts ~3 mos. post-opstarts ~3 mos. post-op

Independent ROM 1-2 years post-opIndependent ROM 1-2 years post-op

Dependent on Dependent on stablestable pelvis pelvis pelvis motion creates “false movement” of pelvis motion creates “false movement” of

hip joint & no stretching is achievedhip joint & no stretching is achieved

Paired with proprioception or balance Paired with proprioception or balance workwork Bosu, Biodex, single limb stance, swiss ballsBosu, Biodex, single limb stance, swiss balls

HOME EXERCISE PROGRAMHOME EXERCISE PROGRAM Isometric Quad setsIsometric Quad sets

Towel roll under knee Towel roll under knee Ankle pumpsAnkle pumps Abdominal setsAbdominal sets Abdominal control Abdominal control

with arm motionwith arm motion 2-5lbs in hand2-5lbs in hand

AAROM AAROM Knee ExtensionKnee Extension

WHY NOT A THR?WHY NOT A THR? Limited access to the various specific Limited access to the various specific

sections of the hip jointsections of the hip joint

Inability to reshape the acetabulumInability to reshape the acetabulum

Decreased ability to meticulously Decreased ability to meticulously reshape the femoral headreshape the femoral head

Higher risk of cartilage damage Higher risk of cartilage damage

REFERENCESREFERENCES1.1. Beck, M. "Groin Pain after Open FAI Surgery: the Role of Intraarticular Adhesions.” National Beck, M. "Groin Pain after Open FAI Surgery: the Role of Intraarticular Adhesions.” National

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2.2. ““Femoro-Acetabular Impingement (FAI).” The Hospital for Special Surgery. Retrieved 20 Oct. Femoro-Acetabular Impingement (FAI).” The Hospital for Special Surgery. Retrieved 20 Oct. 2012. <http://www.hss.edu/condition-list_hip-impingement-femoroacetabular-2012. <http://www.hss.edu/condition-list_hip-impingement-femoroacetabular-impingement.asp>.impingement.asp>.

3.3. Ganz, R., T. J. Gill, E. Gautier, K. Ganz, N. Krugel, and U. Berlemann. "Surgical Dislocation of Ganz, R., T. J. Gill, E. Gautier, K. Ganz, N. Krugel, and U. Berlemann. "Surgical Dislocation of the Adult Hip." the Adult Hip." Jbjs.orgJbjs.org. The Journal of Bone and Joint Surgery, Nov. 2001. Web. 13 Retrieved . The Journal of Bone and Joint Surgery, Nov. 2001. Web. 13 Retrieved Oct. 2012. Oct. 2012.

4.4. Jamali, Amir. (2010) Surgical Hip Dislocation. Retrieved 11 Oct. 2012. Joint Preservation Jamali, Amir. (2010) Surgical Hip Dislocation. Retrieved 11 Oct. 2012. Joint Preservation Institute web site. <http://www.jointpreservationinstitute.com/faq-surgical-hip-Institute web site. <http://www.jointpreservationinstitute.com/faq-surgical-hip-dislocation.html>dislocation.html>

5.5. Krueger, Andreas, Michael Leunig, Klaus A. Siebenrock, and Martin Beck. "Hip Arthroscopy Krueger, Andreas, Michael Leunig, Klaus A. Siebenrock, and Martin Beck. "Hip Arthroscopy After Previous Surgical Hip Dislocation for Femoroacetabular Impingement.” Science Direct, After Previous Surgical Hip Dislocation for Femoroacetabular Impingement.” Science Direct, Dec. 2007. Web. Retrieved 10 Oct. 2012. Dec. 2007. Web. Retrieved 10 Oct. 2012. <http://www.sciencedirect.com/science/article/pii/S0749806307006688>.<http://www.sciencedirect.com/science/article/pii/S0749806307006688>.

6.6. Munting, T.W. Open Hip Dislocation (Debridment) Surgery. Retrieved 13 Oct. 2012. Cape 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-hip-Town Sports and Orthopedic Clinic web site. <http://www.ctorth.com/dr-munting/open-hip-surgery.html>surgery.html>

7.7. Peters, Christopher L., and Jill A. Erickson. "Treatment of Femoro-Acetabular Impingement 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 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?Surgery, 2006. Web. Retrieved 11 Oct. 2012. <http://www.jbjs.org/article.aspx?Volume=88>.Volume=88>.

8.8. Ray, Linda. (2011) Hip Dislocation Surgery and Rehabilitation. Retrieved 11 Oct. 2012. Ray, Linda. (2011) Hip Dislocation Surgery and Rehabilitation. Retrieved 11 Oct. 2012. Livestrong. <http://www.livestrong.com/article/426593-hip-dislocation-surgery-Livestrong. <http://www.livestrong.com/article/426593-hip-dislocation-surgery-rehabilitation/>rehabilitation/>

9.9. Rebello, Gleeson, Samantha Spencer, Michael Millis, and Young-Jo Kim. "Surgical Dislocation Rebello, Gleeson, Samantha Spencer, Michael Millis, and Young-Jo Kim. "Surgical Dislocation in the Management of Pediatric and Adolescent Hip Deformity.” National Center for 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 Biotechnology Information, U.S. National Library of Medicine, 6 Oct. 2008. Web. Retrieved 12 Oct. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635463/?tool=pubmed>.12 Oct. 2012. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635463/?tool=pubmed>.

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