1 / 17

SURGICAL HIP DISLOCATION

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. Patient age is highly variable Younger patients more common

quanda
Download Presentation

SURGICAL HIP DISLOCATION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SURGICAL HIP DISLOCATION By Sabrina Cerciello

  2. SURGICAL HIP DISLOCATION is a demanding surgical procedure that permits unlimited access to the entire hip joint to address lesions and labral pathology

  3. Age Consideration • Patient age is highly variable • Younger patients • more common • better results • less irreversible tissue damage • Older patients • caution with patient selection d/t co-morbidities and poor bone quality • at this point in life, may be more beneficial or necessary for a Total Hip Replacement (THR)

  4. FAI • 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 over-activity of hip joint

  5. TYPES • Two Types • Cam • femoral head/neck deformity • cartilage delamination • acetabular cartilage lifted from underlying bone • Pincer • “over-coverage” of acetabulum • labral tear • labrum = ring of elastic tissue on rim of socket of hip joint

  6. FAI TYPES

  7. 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

  8. OTHER INDICATIONS • Slipped Capital Femoral Epiphysis • separation of the femoral head from the femur at the growth plate • Perthes Disease • osteonecrosis at the femoral head • Developmental Dysplasia of the Hip (DDH) • Abnormal development of hip joint • Exostoses • extra bone growth • Hip Abnormalities

  9. GANZ TECHNIQUE • Trochanteric Flip Osteotomy • 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

  10. COMPLICATIONS • Necrosis • Nerve palsies • Infections • Adhesions • Nonunions • Hardware failures • Blood loss • RARE

  11. POST-OP TREATMENT • 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

  12. POST-OP PHASES • Phase I • Day 1 – Week 6 • Protect surgical site, minimize pain and inflammation, patient compliance w/ activity modification • Phase II • Weeks 6 – 12 • same emphasis as Phase I • Phase III • Weeks 12 – 16 • Independent HEP, optimized ROM, 5/5 strength, pain free ADLs • Phase IV • Weeks 16 – 20 • Independent HEP, minimize post-exercise soreness

  13. STRENGTHENING • Isometric Therex IMMEDIATELY after surgery • Ankle pumps x10 • Gluteal sets x10 • Quadriceps sets x10 • 3 sets/day • Aquatic walking at chest height~2 weeks • More intensive strengthening may begin after ~3 months • closed chain, eccentric loading, treadmill

  14. STRETCHING • BE VERY CAUTIOUS! • starts ~3 mos. post-op • Independent ROM 1-2 years post-op • Dependent on stable pelvis • pelvis motion creates “false movement” of hip joint & no stretching is achieved • Paired with proprioception or balance work • Bosu, Biodex, single limb stance, swiss balls

  15. HOME EXERCISE PROGRAM • Isometric Quad sets • Towel roll under knee • Ankle pumps • Abdominal sets • Abdominal control with arm motion • 2-5lbs in hand • AAROM • Knee Extension

  16. WHY NOT A THR? • 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

  17. REFERENCES • 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/S0749806307006688>. • 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-surgery.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/PMC2635463/?tool=pubmed>. • Sink, E. “Surgical Hip Dislocation.” Orthopedics. May 2009. Retrieved 11 Oct. 2012. <http://www.healio.com/orthopedics/journals/ortho/%7Bd7a2e1ac-d7d5-4d3c-8e52-8a713f0e4218%7D/surgical-hip-dislocation>.

More Related