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Modern Surgical Treatment of Recurrent Posterior Dislocation of the Native Hip
Bayard C Carlson1, Nicholas M Desy1, Joshua D Johnson1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Hip preservation surgery effectively prevents posterior redislocation and subluxation by correcting the anatomic pivot point. This approach is crucial for patients experiencing recurrent hip instability, leading to successful outcomes.
Area of Science:
- Orthopedic Surgery
- Hip Preservation
- Biomechanical Analysis
Background:
- Posterior hip redislocation is a rare complication following initial dislocation.
- An anterior fulcrum between the proximal femur and pelvis is necessary for posterior dislocation.
- Recurrent hip instability poses significant challenges in native hip management.
Purpose of the Study:
- To describe outcomes of hip preservation surgery in patients with recurrent posterior hip redislocation or subluxation.
- To evaluate the efficacy of surgical correction in preventing further instability.
- To identify critical anatomical factors influencing hip stability.
Main Methods:
- Retrospective review of 9 patients undergoing hip preservation surgery for native hip instability.
- Radiographic assessment of acetabular morphology, femoral anatomy, and containment.
- Surgical intervention involved femoral correction alone or combined with periacetabular osteotomy based on radiographic findings.
Main Results:
- No episodes of dislocation or subluxation occurred post-surgery in any treated hips.
- Mean follow-up was 73.8 months, demonstrating long-term stability.
- Correction of the anatomic pivot point proved effective in all cases.
Conclusions:
- Identifying anatomical abnormalities creating a fulcrum is critical for managing native hip redislocation.
- Hip preservation surgery targeting the anatomic pivot point offers a successful treatment strategy.
- An algorithmic approach aids in decision-making for recurrent hip instability.
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.
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