Dislocated Hip
Issue
Hip has been out for some time
- degree of acetabular dysplasia evident
- less time for remodelling
- increased instability if not addressed
Management
Open reduction + FDRO / Pelvic Osteotomy
- usually perform pelvic osteotomy to correct acetabular dysplasia
- reserve FDRO for > 3 years / or if difficult reducing hip
Post operative
Hip spica for 3/12
- change at 6/52
- CT to confirm enlocated
Acetabuloplasty
Redirectional / Salter
From G. Sciatic notch anteriorly to between ASIS and AIIS
- gigli saw posteriorly
- oscillating saw anteriorly to guide cut
- use apophysis as bone graft
- covers acetabular defect anterolaterally
- stabilised with K wires
Disadvantages
1. Provides anterolateral cover
- if combine with FDRO at same time can dislocate the head posteriorly
- i.e. is quite technically difficult to do both femur and acetabulum together
2. Cannot do bilaterally as hinge on pubic symphysis
Reshaping / Pemberton or Dega
Pemberton
- transiliac into tri-iradiate
Dega
- incomplete transiliac
- relay on plasticity of acetabular roof
Periacetabular osteotomy
- osteotomy follows acetabular curve
- use curved osteotomes
- insert iliac crest bone graft
- fix with pins
Advantage
- simple
- can do bilaterally
> 3 years dislocated hip
Management
Open reduction + Pelvic Osteotomy + DVRO with shortening
- need to add DVRO to obtain reduction
Exception
> 4 yrs and bilateral
- don't treat
- shown to have poor results
- head is aspherical
- transform painless hips to painful
2 - 3 years Acetabular Dysplasia
Management
Hip enlocated / Acetabular index > 300 and not improving
- pelvic osteotomy