SURGICAL DISLOCATION OF THE HIP
Mohamed R .Abdallah
The Department of Orthopedic, Faculty of Medicine, Cairo University
Background: Surgical dislocation of the hip is rarely undertaken. Surgical procedures with use of traditional techniques to reposition the proximal femoral epiphysis in the treatment of slipped capital femoral epiphysis are associated with a high rate of femoral head osteonecrosis.1 Therefore, most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal part of the femur.2 This residual deformity can lead to secondary osteoarthritis resulting from femoroacetabular cam impingement.3
Objective: The aim of this study was to report the results of the technique of capital realignment with surgical hip dislocation and its reproducibility to restore hip anatomy and function.
Patients and Methods: This prospective study included 50 patients (50 hips, 29 Lt hip and 21 Rt hip). This study included 31 males and 19 females. The mean age of our patients was 21 years (11-39 years). The mean duration of symptoms before the operation was 8.42 month (1 -26 months). Mean follow up period was 16.11 month (7- 40 month).
Results: 39 patients, (39 hips) had excellent clinical and radiographic outcomes with respect to hip function and radiographic parameters. Postoperative flexion was ranged from 30 to 130 with mean of 104.34. Post operative IR in 900 flexion was ranged from 10 to 50 with mean of 40.Post operative ER in 90 0 flexion was ranged from 15 to 60 with mean of 45. As regarding postoperative HHS, in our series its mean was 96.3 (ranged from 65 to 100) mean correction was 28.5 (p 0.000). Mean WOMAC score was 97 (ranged from 72 to 100) with mean correction of 33 (p 0.000). Mean Merle d'Aubigne score was 16.8 (ranged from 10 to 18) with mean correction of 4.8 (p 0.000).
Conclusions: This study showed that the treatment of slipped capital femoral epiphysis with the modified Dunn procedure allows the restoration of normal proximal femoral anatomy by complete correction of the slip angle, such that probability of secondary osteoarthritis and femoroacetabular cam impingement may be minimized. It also allowed direct inspection, preservation of physical blood supply and inspection of intra-articular pathology, which can be evaluated and treated at the time of operation.