Bilateral varus osteotomies in hip deformities: are early interventions superior? A long-term follow-up

Modern Surgical Treatment of Recurrent Posterior Dislocation of the Native Hip

BACKGROUND

Redislocation of the native hip is rare. An anterior fulcrum between the proximal part of the femur and the pelvis must be present for a posterior dislocation to occur. The purpose of this study is to describe the cases of 9 patients with posterior redislocation or recurrent subluxation of the native hip that was treated with hip preservation surgery.

METHODS

We retrospectively identified the cases of 9 patients, from 2 institutions, who had undergone hip preservation surgery for the management of posterior redislocation or recurrent subluxation of the native hip after a dislocation. The mean number of dislocations prior to surgery was 3.2 (range, 1 to 7). Pelvic radiographs were used to classify the acetabular morphology, sufficiency of acetabular containment, and structural anatomy of the proximal part of the femur. Radiographic identification of impinging structures was used to guide surgical treatment, which involved either femoral correction alone or the combination of femoral correction and an anteverting periacetabular osteotomy.

RESULTS

At a mean follow-up of 73.8 months (range, 10 to 192 months), there had been no subsequent episodes of dislocation or subluxation in any of the hips treated with correction of the anatomic pivot point. An algorithmic approach is presented.

CONCLUSIONS

In patients who have episodes of redislocation or recurrent subluxation of the native hip, the identification of anatomic abnormalities that create a fulcrum between the proximal part of the femur and the pelvis is critical for making appropriate treatment decisions.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Valgus hip with high antetorsion causes pain through posterior extraarticular FAI

BACKGROUND

Valgus hips with increased antetorsion present with lack of external rotation and posterior hip pain that is aggravated with hip extension and external rotation. This may be the result of posterior femoroacetabular impingement (FAI).

QUESTIONS/PURPOSES

We asked whether (1) the range of motion (ROM); (2) the location of anterior and posterior bony collision zones; and (3) the prevalence of extraarticular impingement differ between valgus hips with increased antetorsion compared with normal hips and hips with idiopathic FAI.

METHODS

Surface models based on CT scan reconstructions of 13 valgus hips with increased antetorsion, 22 hips with FAI, and 27 normal hips were included. Validated three-dimensional collision detection software was used to quantify the simulated hip ROM and the location of impingement on the acetabular and the femoral sides.

RESULTS

Hips with coxa valga and antetorsion showed decreased extension, external rotation, and adduction, whereas internal rotation in 90° of flexion was increased. Impingement zones were more anteroinferior on the femur and posteroinferior on the acetabular (pelvic) side; and the zones were more frequently extraarticular, posterior, or to a lesser degree anterior against the inferior iliac spine. We found a higher prevalence of extraarticular impingement for valgus hips with increased antetorsion.

CONCLUSIONS

Valgus hips with increased antetorsion predispose to posterior extraarticular FAI and to a lesser degree anteroinferior spine impingement.

[Joint-preserving surgery of the adult hip. Intertrochanteric femoral osteotomy]

Due to advances in total joint replacement, intertrochanteric osteotomy (ITO) is performed more infrequently in spite of good clinical results. Nevertheless, there are several good indications for this joint-preserving procedure in adults. Detailed biomechanical knowledge and precise clinical examination are prerequisites for correct indications and planning of ITO. The main target of this surgical procedure is improvement of joint congruency and normalization of load transfer to protect damaged cartilage. Very good results can be obtained in hip dysplasia, non-union of the femoral neck and proximal femoral deformities if the therapeutic principles are followed. Higher failure rates have to be expected in femoral head necrosis and osteoarthritis, depending on the degree of pre-existing cartilage damage.