Is combined surgical dislocation and proximal femoral osteotomy a safe procedure for correction of complex hip
Frank W Parilla1, Jeffrey J Nepple1, Gail E Pashos1
1Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave., Saint Louis, MO 63110, USA.
Insights
Complex hip deformities treated with surgical dislocation and proximal femoral osteotomy (SD/PFO) show acceptable major complication rates (4.2%). This combined approach offers good surgical access and outcomes for hip preservation surgery.
Area of Science:
- Orthopedic Surgery
- Hip Preservation Surgery
- Surgical Techniques
Background:
- Complex hip deformities present surgical challenges for access and complication risks.
- Combined surgical dislocation and proximal femoral osteotomy (SD/PFO) offers improved joint access and proximal femoral correction.
- Limited data exists on the safety and complication profile of SD/PFO procedures.
Purpose of the Study:
- To define the early complication profile of combined SD/PFO surgery for complex hip deformities.
- To assess the safety and outcomes of SD/PFO in a large cohort.
- To evaluate complication rates using a standardized grading scheme.
Main Methods:
- Retrospective analysis of 48 hips undergoing combined SD/PFO for complex deformities.
- Standardized, validated complication grading scheme for hip preservation surgery was used.
- Mean patient age was 19.1 years, with 60% having prior surgery.
Main Results:
- Mean follow-up was 2.9 years, with significant improvements in outcome scores.
- Major complications (Grade III or higher) occurred in 4.2% of cases (2/48).
- Both major complications were osteotomy non-unions, successfully treated with revision surgery.
Conclusions:
- Combined SD/PFO is a viable surgical strategy for complex hip deformities, with an acceptable major complication rate of 4.2%.
- The complication profile is comparable to isolated SD or PFO procedures.
- Results suggest generalizability among experienced surgeons, despite patient and deformity complexity.
Abstract:
Complex deformities of the hip requiring intra-articular and proximal femoral correction are challenging with regard to surgical access and complication risk. Combined surgical dislocation and proximal femoral osteotomy (SD/PFO) is a surgical strategy that provides unrestricted access to the joint with the capability for adjunctive PFO. Although providing excellent surgical access, concerns over a potentially high risk of postoperative complications remain, and published information on the safety of this technique remain scarce. In this study, we defined the early complication profile of combined surgery across 48 hips with a variety of complex deformities using a standardized, validated complication grading scheme for hip preservation surgery. Patients were mean age 19.1 years 13-33 years and 60% had previous surgery. At the early mean follow-up of 2.9 years, considerable improvement was seen across all outcome scores. Major complications (Grade III or higher) occurred at a rate of 4.2% (n = 2). Both were osteotomy non-unions, and both were treated successfully with revision PFO and bone grafting at mean 1.1 years. To our knowledge, the current series of combined SD-PFO surgeries represents the largest to date for which detailed complication data have been reported. Given the complexity of these disorders, a major complication rate of 4.2% is acceptable. Our complication rates were comparable to those reported for isolated SD and PFO procedures. These rates did not vary significantly across morphologic variants or patient-specific characteristics. Additionally, our complication risk profile is consistent with previous, smaller reports, which supports the generalizability of these results among appropriately experienced surgeons.
