We investigated the preliminary results of femoral head necrosis treated by modified femoral neck osteotomy through surgical hip dislocation in young adults. 33 patients with femoral head osteonecrosis received modified femoral neck osteotomy through surgical hip dislocation from March 2015. 14 patients who had minimal 12 months of follow-up were reviewed radiographically and clinically (mean follow-up:16 months, 12–36 months). The mean age of the patients 32 years at the time of surgery (ranged from 16 to 42years). There were 6 women and 8 men. The cause of the osteonecrosis was steroid administration in 6, alcohol abuse in 4, trauma in 3, and no apparent risk factor in 1. According to the Ficat staging system, 1 hips was stage II, 9 hips III, and 4 hips stage IV. The posterior or anterior rotational angle was 90–180° with a mean of 143°. Clinical evaluation was performed in terms of pain, walk and range of motion on the basis of Merle d'Aubigné hip scores: 17–18 points are excellent, 15–16 are good, 13–14 are fair, 12 or less are poor. Recollapse of the final follow-up anteroposterior radiograph was prevented in 13 hips. One patient got 1 mm recollapse 18 months after surgery. No patient got progressive joint space narrowing. The Merle d'Aubigné score was excellent in 7 hips, good in 5, fair in 2. The preliminary results suggest that modified femoral neck osteotomy through surgical hip dislocation is in favor of young patients. But longer term follow-up is necessary

Sequelae of Legg-Calve -Perthes disease (LCPD) and treatment of developmental dysplasia of the hip (DDH) can present a coxa breva or coxa magna deformity, sometimes associated with coxa vara. This unique deformity decreases the efficiency of the abductor mechanism, causing a Trendelenburg gait and hip pain, leg length discrepancy and leads to intra- and extra-articular impingement, and eventually osteoarthritis. Several surgical techniques have been advocated to treat this kind deformity, such as great trochanter transfer, relative femoral neck lengthening. We evaluated primary results of true femoral neck-lengthening osteotomy (TFNLO) in combination with periacetabular osteotomy (PAO) for treatment of Coxa Breva through surgical hip dislocation (SHD). Fourteen patients with Coxa Breva received true femoral neck lengthening osteotomy in combination of PAO through SHD between March 2020 and October 2023. Ten patients with minimum 1 year followed-up were retrospectively reviewed clinically and radiographically. Eight patients had Perthes disease, 2 had DDH received closed reduction and fixation during childhood. The mean age at surgery was 16 years (range, 12 to 31 years). Clinical findings, radiographic analyses including the change in horizontal femoral offset and the leg length discrepancy as well as complications were assessed. Horizontal femoral offset improved 19.5mm(6–28mm). Limb length increase 16.8mm(11–30mm). Mean HHS increased from 80.6(66–91) to 91.8(88–96). Complication: screw broken in 1(no need operation). Asymptomatic fibrous union of the great trochanter was found in 1. No infection and joint space narrow as well as nerve palsy happened. TFNLO combined with PAO can be effective for the treatment of patients with Coxa breva. But long term follow up is warranted

Introduction & Objective. Labral refixation has established as a standard in open or arthroscopic treatment for femoroacetabular impingement (FAI). The rationale for this refixation is to maintain the important suction seal in the hip. To date, only few short-term results are available which indicate a superior result in FAI hips with labral refixation compared to labral resection. Scientific evidence of a beneficial effect of labral refixation in the long-term follow-up is lacking. Aim of this study was to evaluate if labral refixation can improve the cumulative 10-year survivorship in hips undergoing surgical hip dislocation for FAI compared to labral resection. Methods. We performed a retrospective comparative study of 59 patients treated with surgical hip dislocation for symptomatic FAI between December 1998 and January 2003. We analyzed two matched groups: The ‘resection’ group consisted of 25 hips that were treated consistently by excision of the damaged labrum. The ‘refixation’ group consisted of 34 hips that were treated with labral reattachment. Correction of the osseous deformity (rim trimming/femoral osteochondroplasty) did not differ between the two groups. We then evaluated the clinical (Merle d'Aubigné score) and radiographical results (according to Tönnis) at a follow-up of ten years. We calculated a cumulative Kaplan-Meier survivorship curve with the following factors as endpoints: conversion to total hip arthroplasty (THA), radiographic evidence of osteoarthritis progression, or a poor clinical result (defined as Merle d'Aubigné score of less than 15). The two curves were compared using the Log-rank test. Results. Hips with labral refixation had a significantly higher survivorship (78%, 95% confidence interval [CI] 64–92%) at ten years compared to labral resection (46%, 95% CI 26–66, p=0.008). 7 (20.6%) patients in the refixation group reached an endpoint: 2 with THA; 5 with a poor clinical result, and 5 with progression of OA. 15 (60.0%) patients in the resection group reached an endpoint: 3 with THA; 12 with a poor clinical result, and 4 with progression of OA. Conclusion. This is the first study proving that labral refixation leads to significantly better results in patients 10 years after open surgical hip dislocation for FAI. It seems advisable to preserve the labrum in this patient population whenever possible

Introduction:. A surgical hip dislocation provides circumferential access to the femoral head and is essential in the treatment pediatric and adult hip disease. Iatrogenic injury to the femoral head blood supply during a surgical may result in the osteonecrosis of the femoral head. In order to reduce vessel injury and incidence of AVN, the Greater Trochanteric Osteotomy (GTO) was developed and popularized by Ganz. The downside of this approach is the increased morbidity associated with the GTO including non-union in 8% and painful hardware requiring removal in 20% of patients. (reference) Recent studies performed at our institution have mapped the extra-osseous course of the medial femoral circumflex artery and provide surgical guidelines for a vessel preserving posterolateral approach. In this cadaveric model using Gadolinium enhanced MRI, we investigate whether standardized alterations in the postero-lateral surgical approach may reliably preserve femoral head vascularity during a posterior surgical hip dislocation. Methods:. In 8 cadaveric specimens the senior author (ES) performed a surgical hip dislocation through the posterolateral approach with surgical modifications designed to protect the superior and inferior retinacular arteries. In every specimen the same surgical alterations were made using a ruler: the Quadratus Femoris myotomy occurred 2.5 cm off its trochanteric insertion, the piriformis tenotomy occurred at its insertion and extended obliquely leaving a 2 cm cuff of conjoin tendon (inferior gemellus), and the Obturator Externus (OE) was myotomized 2 cm off its trochanteric insertion. (Figure 1) For the capsulotomy, the incision started on the posterior femoral neck directly beneath the cut obturator externus tendon and extending posteriorly to the acetabulum. Superior and inferior extensions of the capsulotomy ran parallel to the acetabular rim creating a T-shaped capsulotomy. After the surgical dislocation was complete, the medial femoral circumflex artery (MFCA) was cannulated and Gadolinium-enhanced MRI performed in order to assess intra-osseous femoral head perfusion and compared to the gadolinium femoral head perfusion of the contra-lateral hip as a non-operative control. Gross-dissection after polyurethane latex injection in the cannulated MFCA was performed to validate MRI findings and to assess for vessel integrity after the surgical dislocation. Results:. In 8 cadaveric specimens MRI quantification of femoral head perfusion was 94.3% and femoral head-neck junction perfusion was 93.5% compared to the non-operative control. (Figure 2) Gross dissection after latex injection into the MFCA demonstrated intact superior and inferior retinacular arteries in all 8 specimens. (Figure 3). Discussion and Conclusions:. In this study, perfusion to the femoral head and head-neck junction is preserved following posterior surgical dislocation through the postero-lateral approach. These preliminary findings suggest that specific surgical modifications can protect and reliably maintain vascularity to the femoral head after surgical hip dislocation. This approach may benefit hip resurfacing and potentially decease risk of femoral neck fracture secondary to osteonecrosis. In addition this may allow a vascular preserving surgical hip dislocation to be performed without the need for a GTO

Purpose. Surgical dislocation is useful for assessing and treating proximal femoral hip deformities. Legg-Calv Perthes disease (LCPD) causes proximal femoral growth deformity, resulting in reduced femoral head-neck offset and femoracetabular incongruity. The purpose of this study was to demonstrate the efficacy and report the short-term results of surgical hip dislocation for the treatment of adolescents with healed LCPD. Method. This retrospective review included 29 adolescents [19 males and 10 females, age 17 (range nine-35)] with LCPD, who underwent surgical hip dislocation between January 2001 and December 2009. All subjects had a clear diagnosis of LCPD, pre and postoperative WOMAC scores and at least one year of clinical and radiographic follow up. In addition to surgical dislocation, all patients underwent femoral head-neck osteoplasty, 21 underwent relative femoral neck lengthening and trochanteric transfer, 12 underwent intertrochanteric osteotomy and seven had labral debridement. The average follow-up was three years from the time of surgical intervention. Results. Postoperative WOMAC scores improved globally for pain, stiffness and function (p<0.0001, p<0.0004 and p<0.0009 respectively). Eight patients required additional surgical procedures after surgical dislocation (one periacetabular osteotomy, one flexion intertrochanteric osteotomy, one arthrotomy, five arthroscopies with labral/cartilage debridement. Three patients underwent total hip arthroplasties during the follow-up period and were considered failures. Two of the 29 patients experienced superficial wound complications. Conclusion. Surgical dislocation is an effective technique for the treatment of proximal femur deformity associated with LCPD. In the short-term, patients experience improved symptoms and function from this procedure

Introduction. Magnetic resonance imaging with intraarticular contrast (arthro-MRI) and radial cuts is the gold standard to quantify labral and chondral lesions in the setting of femoroacetabular impingement. To date, no study exists that has evaluated these findings as potential predictors of outcome for the long term follow-up after surgical treatment of FAI. Objectives. The purpose of this study was to detect potential predictors for failure after surgical hip dislocation for FAI based on specific preoperative arthro-MRI of the hip at a minimum follow-up of 10 years. Methods. Retrospective case series of 97 hips (75 patients) undergoing surgical hip dislocation for FAI between July 2001 and March 2003. Minimum follow-up was 10 years. Twelve radiographic factors were preoperatively evaluated on specific arthro-MRIs with radial cuts of the hips. Patients were then evaluated clinically and radiographically at latest follow-up (mean followup of 11 years, range 10–13 years). The following endpoints were chosen: conversion to total hip arthroplasty (THA), radiographic evidence of progression of osteoarthritis (OA), and/or a Merle d'Aubigné-Postel score of less than 15 indicating a poor clinical result. Univariate and multivariate Cox-regression analysis were performed with these endpoints as failures. Results. Hips with failure at 10-year follow up after surgical hip dislocation where more likely to show typical signs like decentration of the femoral head (52.9% compared to 17% in hips with good long term outcome; p = 0.007) in preoperative arthro-MRI evaluation. The strongest arthro-MRI based predictors of failure at the 10 year follow-up were a ‘double fond’ (hazard ratio with 95% confidence interval, 3.4 [3.2–3.7], p = 0.001), decentration of the femoral head (3.0 [2.8–3.3], p = 0.004) and posterior-inferior femoral osteophytes (3.3 [3.1–3.6], p = 0.002). Conclusions. Factors like double fond, decentration of the femoral head and postero-inferior femoral osteophytes in preoperative arthro-MRI predict inferior long term outcome after surgical hip dislocation for FAI. Therefore we recommend preoperative evaluation with arthro-MRI in addition to conventional radiography

Heterotopic ossification is a recognised complication of surgery on the hip joint that can adversely affect the outcome. The aim of this study was to determine the incidence of heterotopic ossification following surgical hip dislocation and debridement for femoro-acetabular impingement using Ganz trochanteric flip osteotomy approach. We also compared the incidence of heterotopic ossification between two subgroups of patients; in the first group, a shaver burr was used to reshape the femoral head and in the second group, an osteotome was used. Methods: We reviewed postoperative radiographs of all patients who underwent surgical hip dislocation and debridement during the period between March 2003 and July 2007. We excluded patients with radiographic follow-up of less than one year. Brooker classification was used to grade heterotopic ossifications. Results: Ninety eight patients (mean age 35 years, range 12–65 years) were included with a mean radiological follow-up of 23 months (range 12–61 months). The overall incidence of heterotopic ossification was 31%. None of the patients developed Brooker grade III or IV heterotopic ossifications. The incidence of heterotopic ossifications in the shaver burr group (n=57) and in the osteotome group (n=41) was 30% and 32%, respectively. Conclusions: Heterotopic ossification of minor grade is a common complication of surgical hip dislocation using trochanteric flip osteotomy approach. The use of a shaver burr did not result in higher rates of heterotopic ossifications despite the formation of large amounts bone debris

Management of the young adult hip pathologies is a special entity in orthopaedic surgical practice that needs special emphasis and consideration. A wide range of pathological and traumatic conditions occur in the young adult hip that lead to functional disability and the development of premature osteoarthritis. Proper surgical interference when the hip is still in the pre-arthritic stage restores function to the young hip and protects it from early degenerative changes, and hence the anticipated need for future joint replacement surgery is prevented. Accurate estimation of the biomechanical error combined with careful understanding of the hip joint biology is the cornerstone of success of any hip preservation surgery ever performed to save the young adult hip. Safe surgical hip dislocation approach was adopted as one of the tools in the hands of the hip preservation surgeon to treat a broad spectrum of intra-articular hip pathologies like Perthes disease and severe forms of slipped capital femoral epiphysis (SCFE). Osteo-chondroplasty at the head-neck junction with relative femoral neck lengthening for Perthes disease, and Subcapital re-orientation of severe SCFE based on its retinacular vascular pedicle are often performed via the surgical hip dislocation approach. The approach is also useful with certain types of acetabular fractures that enables fixation of dual-column fractures via single approach with intra-articular visualization for the accuracy of reduction and hardware placement. The 4 cm mini-open direct anterior approach is ideal for the surgical treatment of cases with cam and/or pincer types of femoro-acetabular impingement. Peri-articular osteotomies performed either on the acetabular or the femoral sides of the hip joint are extremely useful in the correction of the biomechanical error that led to an existing hip pathology. Periacetabular osteotomies are commonly performed to treat dysplasia of the young hip. Proximal femoral osteotomies are commonly performed to treat a wide range of hip pathologies including non-unions of femoral neck fractures in the young adult. Correction of the biomechanical error at the proper timing ensures normalization of the hip joint loading conditions and range of motion that leads to reversal of the pathologic process and prevention of osteoarthritis. A hip joint replacement would have an unknown but certainly a finite life, whereas a young hip that has healed after hip preservation surgery would definitely last for a lifetime

Purpose: The purpose of this study was to examine the arthroscopy findings in the hips of patient with persistent pain after surgical hip dislocation for femoroacetabular impingement syndrome. Type of study: Retrospective, consecutive series of patients. Patients and Methods: Sixteen consecutive patients (6 male/10 female; average age 33,5 years 19–60y) with persistent pain after surgical hip dislocation for the treatment of femoroacetabular impingement were included. At the index surgery, all patients had an osteo-chondroplasty of the head neck junction and a resection of the acetabular rim with reattachment of the labrum in 9 cases. All patients had a preoperative arthro-MRI and were treated with arthroscopy of the hip. Results: At arthroscopy all reattached labra were stable. In the cases without preservation of the labrum, the joint capsule was attached level with the acetabular rim and had important synovitis. All patients had adhesions between the neck of the femur and joint capsule or between labrum and capsule. In 3 patients the arthroscopic procedure was technically limited by massive thickening of the capsule. Overall 75% (12 of 16) patients showed less pain or were pain free. MDA improved from preoperatively 13 to 16 points at last follow up. Conclusions: Persistent pain after surgical dislocation of the hip could result from intraarticular adhesions that can be shown in the MRI. Hip arthroscopy after previous surgery can be demanding due to scarring. If the adhesions can be released good results can be achieved. Hip arthroscopy is a save therapeutical tool to treat patients with intraarticulary adhesions after surgical dislocation of the hip for femoroacetabular impingement

Introduction: The open treatment of hip impingement is now a well-recognised technique with numerous publications about pathogenesis and surgical technique. There are very few publications of very small series discussing surgical results. We present the results of 148 hips at a mean follow-up of 20 months (range 4 – 55). Methods: This is a two surgeon series of sequential patients including the early learning curve. Patients were treated for impingement through a Ganz trochanteric osteotomy and open surgical hip dislocation. Patient data, operative findings and methods, complication and clinical follow up were recorded as a prospective audit and include Oxford and McCarthy Non Arthritic Hip scores. Results: The patient demographics are as follows:. 141 patients, 148 hips. Average age 35, range 10–65 years. Ratio Male to Female 73:75. All patients underwent femoral osteochondroplasty. 60% of cases had the labrum detached, acetabular rim recession and labral repair with bone anchors. 3 patients had the labrum reconstructed with the ligamentum teres autograft. We have had 9 failures (6%) as defined by revision to arthroplasty. 2 hips underwent successful revision open surgery for inadequately treated posterior impingement. 3 patients required arthroscopy after open surgery (2 of whom are now pain free). 7 further patients have persistent groin pain but not required further intervention. We have had the following complications: 4 trochanteric non unions requiring revision fixation, 2 deep vein thrombosis, 2 haematomas, 1 superficial infection, no deep Infections. Life table survival curve with revision to arthroplasty defined as failure. Discussion: The early to midterm results of this innovative procedure are encouraging even when including the decision making and surgical technique learning curves. We will present the hip scores and discuss the failures in detail to warn others embarking on this surgery which cases are more likely to lead to unsatisfactory outcomes

In 2000, Reinhold Ganz developed a surgical technique for treating slipped capital femoral epiphysis using his surgical hip dislocation approach to facilitate anatomical reconstruction of the slipped epiphysis—reportedly, without risk of avascular necrosis. This technique is now being adopted cautiously in paediatric orthopaedic centres internationally. The technique will be described and early results presented. Complications and their treatments will also be discussed. Early experience suggests morbidity following the procedure is not insignificant and until more corroborating safety data is available, the author suggests this technically demanding surgery should only be offered to children whose significant deformity would otherwise result in childhood disability

Anatomic reduction (subcapital re-alignment osteotomy) via surgical hip dislocation – increasingly popular. While the reported AVN rates are very low, experiences seem to differ greatly between centres. We present our early experience with the first 29 primary cases and a modified fixation technique. We modified the fixation from threaded Steinman pins to cannulated 6.5mm fully-threaded screws: retrograde guidewire placement before reduction of the head ensured an even spread in the femoral neck and head. The mean PSA (posterior slip angle) at presentation (between 12/2008 and 01/2011) was overall 68° (45–90°). 59% (17/29) were stable slips (mean PSA 68°), and 41% (12/29) were unstable slips unable to mobilise (mean PSA 67°). The vascularity of the femoral head was assessed postoperatively with a bone scan including tomography. The slip angle was corrected to a mean PSA of 5.8° (7° anteversion to 25° PSA). We encountered no complications related to our modified fixation technique. All cases with a well vascularised femoral head on the post-operative bone scan (15/17 stable slips and 8/12 unstable slips) healed with excellent short term results. Both stable slips with decreased vascularity on bone scan (2/17, 12%) had been longstanding severe slips with retrospectively suspected partial closure of the physis, which has been described as a factor for increased risk of avascular necrosis (AVN). One of these cases was complicated by a posterior redislocation due to acetabular deficiency. In the unstable group, 4/12 cases (33%) had avascular heads intra-operatively and cold postoperative bone scans, 3 have progressed to AVN and collapse. Anatomic reduction while sparing the blood supply of the femoral head is a promising concept with excellent short term results in most stable and many unstable SCFE cases. Extra vigilance for closed/closing physes in longstanding severe cases seems advisable. Regardless of treatment, some unstable cases inevitably go on to AVN

Outcomes following different types of surgical intervention for femoroacetabular impingement (FAI) are well reported individually but comparative data are deficient. The purpose of this study was to conduct a systematic review (SR) and meta-analysis to analyze the outcomes following surgical management of FAI by hip arthroscopy (HA), anterior mini open approach (AMO), and surgical hip dislocation (SHD). This SR was registered with PROSPERO. An electronic database search of PubMed, Medline, and EMBASE for English and German language articles over the last 20 years was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We specifically analyzed and compared changes in patient-reported outcome measures (PROMs), α-angle, rate of complications, rate of revision, and conversion to total hip arthroplasty (THA). A total of 48 articles were included for final analysis with a total of 4,384 hips in 4,094 patients. All subgroups showed a significant correction in mean α angle postoperatively with a mean change of 28.8° (95% confidence interval (CI) 21 to 36.5; p < 0.01) after AMO, 21.1° (95% CI 15.1 to 27; p < 0.01) after SHD, and 20.5° (95% CI 16.1 to 24.8; p < 0.01) after HA. The AMO group showed a significantly higher increase in PROMs (3.7; 95% CI 3.2 to 4.2; p < 0.01) versus arthroscopy (2.5; 95% CI 2.3 to 2.8; p < 0.01) and SHD (2.4; 95% CI 1.5 to 3.3; p < 0.01). However, the rate of complications following AMO was significantly higher than HA and SHD. All three surgical approaches offered significant improvements in PROMs and radiological correction of cam deformities. All three groups showed similar rates of revision procedures but SHD had the highest rate of conversion to a THA. Revision rates were similar for all three revision procedures

Objectives. The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). Methods. The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies. Results. Fifteen eligible level IV studies were included in this review comprising 261 patients (266 hips). Treatment groups included arthroscopic osteochondroplasty, surgical hip dislocation, and traditional open osteotomy. The mean alpha angle corrections were 32.14° (standard deviation (. sd). 7.02°), 41.45° (. sd. 10.5°) and 6.0° (. sd. 5.21°), for arthroscopy, surgical hip dislocation, and open osteotomy groups, respectively (p < 0.05). Each group demonstrated satisfactory clinical outcomes across their respective scoring systems. Major complication rates were 1.6%, 10.7%, and 6.7%, for arthroscopy, surgical dislocation and osteotomy treatments, respectively. Conclusion. In the context of SCFE-related FAI, surgical hip dislocation demonstrated improved correction of the alpha angle, albeit at higher complication and revision rates than both arthroscopic and open osteotomy treatments. Further investigation, including high-quality trials with standardised radiological and clinical outcome measures for young patients, is warranted to clarify treatment approaches and safety. Cite this article: K. O. Oduwole, D. de Sa, J. Kay, F. Findakli, A. Duong, N. Simunovic, Y. Yi-Meng, O. R. Ayeni. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017;6:472–480. DOI: 10.1302/2046-3758.68.BJR-2017-0018.R1

Femoroacetabular impingement is a prearthritic deformity frequently associated with early chondral damage. Several techniques exist for restoring larger cartilage defects. While AMIC proved to be an effective treatment in knee and ankle, there are only short-term data available in hip. This study aimed to investigate the mid-term clinical outcome of patients with chondral lesions treated by AMIC and evaluate the quality of repair tissue via MRI. This retrospective, single center study includes 18 patients undergoing surgical hip dislocation for FAI between 2013 and 2016. Inclusion criteria were: cam or pincer-type FAI, femoral or acetabular chondral lesions > 1 cm. 2. , (IRCS III-IV). Due to exclusion criteria and loss-to-follow-up 9 patients (10 hips) could be included. Patient reported outcome measures included Oxford Hip Score (OHS) & Core Outcome Measure Index (COMI)). MRIs were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. None of the patients underwent revision surgery except screw removals from the greater trochanter. Followup data indicate a satisfactory to good hip function at 5 years: PROMS improved from pre- to postop at 5 years: OHS from 38.1 to 43.4, COMI from to 1.8 and UCLA from 4 to 8.1 respectively. MOCART score was 67.5 postoperatively. Subgrouping showed slightly better results for acetabular defects (Ø 69.4) compared femoral defects (Ø 60). Based on the reported mid-term results, we consider AMIC as a valuable treatment option for larger chondral defects of the hip

Acetabulum fractures caused by civilian firearms represent a unique challenge for orthopaedic surgeons. Treatment strategies should include the assessment of infection risk due to frequently associated abdominal injuries and maintenance of joint function. Still, internationally accepted treatment algorithms are not available. The aim of the study was to increase knowledge about civilian gunshot fractures of the acetabulum by describing their characteristics and management at a high-volume tertiary hospital. All adult patients admitted to our hospital between January 2009 and December 2022 with civilian gunshot fractures of the acetabulum were included in this descriptive retrospective study. In total our institution treated 301 patients with civilian gunshot fractures of the hip joint and pelvis during the observation period, of which 54 involved the acetabulum. Most patients were young males (88,9%) with a mean age of 29 years. Thirty patients (55,6%) had associated intraabdominal or urological injuries. Fracture patterns were mostly stable fractures with minor joint destruction amenable to conservative fracture treatment (n=48, 88,9%). Orthopaedic surgical interventions were performed in 21 patients (38,9%) with removal of bullets in contact with the hip joint via arthrotomy or surgical hip dislocation as most frequent procedures. Most patients received antibiotics on admission (n=49, 90,7%). Fracture related infections of the acetabulum were noted in six patients (11,1%) while the mortality in the study population was low with one demised patient (1,9%) due to the trauma burden. Most civilian acetabulum gunshot fractures are associated with intraabdominal or urological injuries. In comparison to the literature on extremity gunshot fractures, there is an increased risk of infection in our study population. The decision for surgical wash-out and bullet removal should be based on contamination and anticipated joint destruction, while osteosynthesis or primary arthroplasty are rarely necessary for these injuries

Removal of bullets retained within joints is indicated to prevent mechanical blockade, 3rd body wear and resultant arthritis, plus lead arthropathy and systemic lead poisoning. The literature is sparse on this subject, with mostly sporadic case reports utilizing hip arthroscopy. We report on the largest series of removal of bullets from the hip joints using open surgical. We reviewed prospectively collected data of patients who presented to a single institution with civilian gunshot injuries that breached the hip joint between 01 January 2009 and 31 December 2022. We included all cases where the bullet was retained within the hip joint area. Exclusion criteria: cases where the hip joint was not breached, bullets were not retained around the hip area or cases with isolated acetabulum involvement. One hundred and eighteen (118) patients were identified. One patient was excluded as the bullet embedded in the femur neck was sustained 10 years earlier. Of the remaining 117 patients, 70 had retained bullets around the hip joint. In 44 patients we undertook bullet removal using the followingsurgical hip dislocation (n = 18), hip arthrotomy (n = 18), removal at site of fracture fixation/replacement (n = 2), posterior wall osteotomy (n = 1), direct removal without capsulotomy (tractotomy) (n = 5). In 26 patients we did not remove bullets for the following reasons: final location was extra-capsular embedded in the soft tissues (n=17), clinical decision to not remove (n=4), patients’ clinical condition did not allow for further surgery (n= 4) and patient refusal (n=1). No patients underwent hip arthroscopy. With adequate pre-operative imaging and surgical planning, safe surgical removal of retained bullets in the hip joint can be achieved without the use of hip arthroscopy; using the traditional open surgical approaches of arthrotomy, tractotomy and surgical hip dislocation

Our understanding of pre-arthritic hip disease has evolved tremendously but challenges remain in categorizing diagnosis, which ultimately impacts choice of treatments and clinical outcomes. This study aims to report patient reported outcome measures (PROMs) comparing four different condition groups within hip preservation surgery by a group of fellowship-trained surgeons. From 2018 to 2021, 380 patients underwent hip preservation surgery at our center and were classified into five condition groups: dysplasia: 82 (21.6%), femoro-acetabular impingement (FAI): 173 (45.4%), isolated labral tear: 103 (27.1%), failed hip preservation: 20 (5.3%) and history of childhood disease/other: 2 (0.5%). International hip outcomes Tool 12 (IHOT-12), numeric pain score and patient-reported outcomes measurement information system (PROMIS) were collected pre-operatively and at 3 months and 1 year post-operatively, with 94% and 82% follow-up rate respectively. Arthroscopy (75.5%) was the most common procedure followed by peri-acetabular osteotomy (PAO) (22.4%) and surgical dislocation (2.1%). Re-operation rate were respectively 18.3% (15), 5.8% (10), 4.9% (5), 30% (6) and 0%. There were 36 re-operations in the cohort, 14 (39%) for unintended consequences of initial surgery, 10 (28%) for mal-correction leading to a repeat operation, 8 (22%) progression of arthritis, and 4 (11%) for incorrect initial diagnosis/intervention. Most common re-operations were hardware removal 31% (7 PAO, 3 surgical hip dislocation and 1 femoral de-rotational osteotomy), arthroscopy 31% (11) and arthroplasty 28% (10). All groups had significant improvements in their IHOT-12 as well as PROMIS physical and numerical pain scales, except those with failed hip preservation. Dysplasia group showed a slower recovery. Overall, this study demonstrated a clear relation between the condition groups, their respective intervention and the significant improvements in PROMs with isolated labral pathology being a valid diagnosis. Establishing tertiary referral centers for hip preservation and longer follow-up is needed to monitor the overall survivorship of these various procedures

Executing an extended retinacular flap containing the blood supply for the femoral head, reduction osteotomy (FHO) can be performed, increasing the potential of correction of complex hip morphologies. The aim of this study was to analyse the safety of the procedure and report the clinical and radiographic results in skeletally mature patients with a minimum follow up of two years. Twelve symptomatic patients (12 hips) with a mean age of 17 years underwent FHO using surgical hip dislocation and an extended soft tissue flap. Radiographs and magnetic resonance imaging producing radial cuts (MRI) were obtained before surgery and radiographs after surgery to evaluate articular congruency, cartilage damage and morphologic parameters. Clinical functional evaluation was done using the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score (HOS), and the modified Harris Hip Score (mHHS). After surgery, at the latest follow-up no symptomatic avascular necrosis was observed and all osteotomies healed without complications. Femoral head size index improved from 120 ± 10% to 100 ± 10% (p<0,05). Femoral head sphericity index improved from 71 ± 10% before surgery to 91 ± 7% after surgery (p<0,05). Femoral head extrusion index improved from 37 ± 17% to 5 ± 6% (p< 0,05). Twenty five percent of patients had an intact Shenton line before surgery. After surgery this percentage was 75% (p<0,05). The NAHS score improved from a mean of 41 ± 18 to 69 ± 9 points after surgery (p< 0,05). The HOS score improve from 56 ± 24 to 83 ± 17 points after surgery (p< 0,05) and the mHHS score improved from 46 ± 15 before surgery to 76 ± 13 points after surgery (p< 0,05). In this series, femoral head osteotomy could be considered as safe procedure with considerable potential to correct hip deformities and improve patients reported outcome measures (PROMS). Level of evidence - Level IV, therapeutic study. Keywords - Femoral head osteotomy, Perthes disease, acetabular dysplasia, coxa plana

Objective. To define the common pathology of the hips with irreducible posterior dislocation combined with femoral head fracture and the outcome of surgical treatment using surgical hip dislocation technique. Design: retrospective observational clinical study. Setting: Level III referral trauma center. Patients/Participants: from January 2011till February 2014 five patients with irreducible posterior hip dislocation and femoral head fracture who underwent operation were included and they followed for at least 18 months. Intervention. Open reduction and internal fixation of fractured femoral head and labral repair by suture anchors using surgical hip dislocation through trochanteric flip osteotomy approach. Main Outcome Measures: Clinical and radiographical findings of the irreducible posterior hip dislocation, intraoperative findings, clinical outcomes using Merle d'Aubigné & Postel and Thompson & Epstein scores, and radiological outcome. Results. All patients presented clinically with a shortened lower limb in neutral or external rotation of the hip (not in Internal rotation). All were Pipkin type II fracture of femoral head with the intact part of the head buttonholed on the posterior wall of the acetabulum through a capsule-labral flap. Postoperative computed tomography revealed perfect reduction except one case with severe comminution with good reduction. Only one patient with delayed operative management developed avascular necrosis and underwent total hip arthroplasty. Conclusion. Irreducible femoral head fracture-dislocation is rare injury with different clinical presentation that shows neutral or externally rotated limb and optimal surgical management is not clear. Surgical hip dislocation gives full access to the femoral head for reconstruction and opportunity to direct repair of the labral tears