Pros and cons of surgical hip dislocation for the treatment of femoroacetabular impingement

Abstract

A more detailed understanding of the anatomy of the medial femoral circumflex artery enabled the development of the modern technique for surgical hip dislocation. Although the surgical hip dislocation is best known as an open method for treating femoroacetabular impingement, it allows the surgeon to address a variety of different hip pathologies, including femoral head and posterior wall acetabular fractures, chondral defects requiring cartilage restoration techniques, and excision of benign tumors. When the technique of an extended retinacular flap is added, surgeons are able to perform intra-articular osteotomies and open reduction of slipped capital femoral epiphysis while preserving the blood supply to the femoral head. The surgical hip dislocation allows direct observation of both intra-articular and extra-articular impingement and a means of correcting both during 1 procedure. The downsides of the surgical hip dislocation are largely related to the trochanteric flip osteotomy, with up to half of patients reporting mild residual lateral hip pain 1 year postoperatively. Trochanteric nonunion and residual abductor weakness are also potential complications of the surgical hip dislocation technique. Several studies have shown improved pain and functional outcomes in short-term and mid-term follow-up after treatment of femoroacetabular impingement. It has a low complication rate in the hands of experienced surgeons and is an important technique for addressing complex intra-articular hip pathology that would be technically challenging arthroscopically.