慢性後方股関節脱臼に対する外科的治療：手術手技と臨床的転帰

Chronic posterior hip dislocations are rare and diffcult to treat. Open reduction is exceptionally challenging given the significant amount of scar tissue and muscle contractures, and need to preserve the blood supply to the femoral head while obtaining a stable, concentric reduction. The goal of this article was to describe the outcomes of two different novel surgical techniques for open reduction of chronic posterior hip dislocations.

This was a retrospective review of two different surgical techniques for the reduction of chronic posterior hip dislocations that were completed at a single tertiary referal center. All patients with chronic (>6 weeks) posterior hip dislocations treated with either a keyhole approach or a Ganz trochanteric flip osteotomy. Clinical outcomes included ability to ambulate without an assistive device and rates of complications. Patient-reported outcomes included the modified Harris-Hip Score (mHHS). Radiographic outcomes included rate of avascular necrosis.

Twelve patients with chronic posterior, native hip dislocations were included with an average age of 27.3 years (range 8-38) and average follow-up of 0.9 months (range 0.25-3.5). The average time of dislocation before surgical reduction was 5.5 months (range 3-11). Four patients were reduced with a keyhole approach and 8 patients with a Ganz osteotomy. Two femoral shortening osteotomies were required for initial reduction, both in the keyhole group. All patients ambulated independently and had satisfactory mHHS at final follow-up (mean 92.5 months, range 83-100).

In the treatment of chronic (>6 weeks) posterior hip dislocations, both the keyhole and the Ganz trochanteric flip osteotomy approaches have acceptable outcomes in regard to functional and patient-reported outcome measures. The Ganz osteotomy offers improved access to the acetabulum and mitigated the need for a femoral shortening osteotomy. Longer-term follow-up will provide information on the viability of hip preservation in patients suffering chronic posterior hip dislocations.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.