Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced...

Area of Science:

• Orthopedic Surgery
• Hip Preservation Surgery
• Avascular Necrosis Treatment

Background:

• Avascular necrosis (AVN) of the femoral head often affects young patients, leading to pain and joint destruction.
• Surgical hip dislocation allows direct access for advanced reconstructive techniques.
• Current joint-preserving options for AVN aim to delay or avoid total hip arthroplasty.

Purpose of the Study:

• To evaluate the outcomes of surgical hip dislocation with bone grafting, cartilage repair, and femoral osteotomy in treating AVN.
• To assess the progression of osteonecrosis and osteoarthritis after the procedure.
• To determine changes in pain, function, and the need for subsequent surgeries.

Main Methods:

• Retrospective review of 12 patients (13 hips) with AVN treated with surgical hip dislocation.
• Procedures included curettage, bone grafting, cartilage repair (suturing, chondrogenesis, osteochondral grafting), and femoral osteotomy.
• Follow-up averaged 3 years, with assessment of AVN/osteoarthritis progression (ARCO/Tönnis staging) and pain/function (Merle d'Aubigné-Postel score).

Main Results:

• 9 out of 13 hips showed no progression of AVN or advanced osteoarthritis; 3 hips improved at least one ARCO stage.
• The Merle d'Aubigné-Postel score significantly improved from 14.1 to 16.6 (p=0.012), indicating better pain relief and function.
• One hip progressed to requiring total hip arthroplasty; 3 hips experienced complications, and 3 required subsequent surgery.

Conclusions:

• Surgical hip dislocation with bone grafting and cartilage repair demonstrates potential for joint preservation in AVN.
• Early results suggest favorable outcomes regarding pain, function, and halting disease progression.
• Longer follow-up and larger patient cohorts are necessary to definitively establish the long-term efficacy and joint-preserving capacity of this approach.