Safe Surgical Dislocation of the Hip

Traditionally, surgical dislocation of the native hip has been discouraged because of the possible risk to the femoral head blood supply. Reinhold Ganz has clarified the proximal femoral vascular anatomy and has used this knowledge to develop a safe surgical dislocation technique for the hip. This new surgical technique has made possible safe and effective treatment of many intra-articular and periarticular conditions of the hip, many of which cause pain and arthrosis. In the hip, osteoarthritis very commonly is associated with well-recognized developmental deformities, classically from dysplasia, slipped epiphysis, or Perthes disease. Recent work has demonstrated that other much less well-recognized anatomic hip abnormalities, such as acetabular retroversion, acetabular overcoverage, and decreased femoral head-neck offset, are equally important generators of pathologic mechanics that frequently lead to arthrosis. Currently, the surgical dislocation technique plays a central role in treating hips with femoroacetabular impingement. Additionally, the surgical dislocation technique facilitates other femoral procedures such as flexion intertrochanteric osteotomy and femoral neck osteotomies. The surgical technique will be described in detail and the most recent surgical results will be discussed.