SAFE SURGICAL HIP DISLOCATION

Abstract

Safe surgical dislocation of the hip is based on detailed studies of the vascular anatomy of the hip. The blood supply of femoral head is mainly based on medial circumflex femoral artery (MFCA). Obturatorexternus tendon is crossed posteriorly by the deep branch of MFCA which is surgically important because the tendon protects this branch from being disrupted or stretched during dislocation of hip. In its intra-articular course, it divides into posterior superior nutrient arteries of the femoral head which are the most important source of blood supply; they can completely perfuse the femoral head without any other vascular input. The hip joint can be surgically dislocated using other approaches. However, the Ganz method of surgical hip dislocation has many advantages. Ganz surgical dislocation produces an anterior dislocation using low-grade controlled trauma. The time of dislocation is much shorter than the six-hour limit which is thought to be critical after traumatic dislocations. All external rotator muscles are left intact and, therefore, protect the MFCA. Intraoperative monitoring of perfusion of the femoral head is possible. The abductor muscles are detached by trochanter flip osteotomy and rigid fixation of the fragment restores immediate stability and allows for early mobilization of the patient.