Many, if not most, hip injuries in young active patients including hip impingement, labral tears, labral insufficiency, loose bodies, hip instability, and snapping hip can be adequately treated with hip arthroscopy when non-surgical treatments fail to improve symptoms and function. But when the bony deformity or deformities (cam, pincer, or both) causing the labrum to tear is excessive or highly complex (Perthes disease, OCD lesion), hip arthroscopy may not be able to address the entire problem adequately, potentially resulting in residual deformity and higher risk for needing a revision surgery. In these circumstances, an open surgical procedure, called a surgical hip dislocation, is an option. To safely access the hip joint, the surgery carefully dissects between muscles around hip, avoiding having to cut any muscles. A small part of the thigh bone (greater trochanter) is cut (osteotomy) to provide access to the front of the hip joint. This open surgery allows for safe dislocation of the hip joint, while preserving the blood supply to the femoral head (ball), and simultaneously providing complete access the entire acetabulum (socket) and femoral head (ball). Difficult to reach areas using an arthroscope are easily accessible with the surgical hip dislocation when needed. Resection of excessive bone on the socket (pincer resection), abnormal, aspherical bone on the ball (cam deformity, and labral repairs are all performed easily with a surgical dislocation. Additionally, more complex procedures, including cartilage grafting (OATS), Perthes deformity correction, femoral osteotomies, and labral reconstructions can all be performed with a surgical hip dislocation. The osteotomy is repaired at the end of the surgery with metal screws.
While hip arthrosocpy is an outpatient surgery, allowing patients to go home the same day, the surgical hip dislocation, as an open surgery, is more invasive and an overnight stay is generally recommended. Most patients are able to go home 1-2 days after surgery. Most patients require a brace after surgery for six to eight weeks. The brace is needed to prevent the leg from certain motions and to protect the repair and osteotomy. Weight-bearing (the amount of weight one is able to put on the operative leg) will be modified, and crutches will be provided and required after surgery for six weeks while the repair heals. Therapy will begin immediately to facilitate decreased swelling and pain, muscle activation and motion, and eventually improve strength to maximize function after surgery. While the initial recovery in the first six weeks is slower than after most hip arthroscopy surgeries, therapy progress becomes essentially the same as hip arthroscopy starting at 7-8 weeks. Both surgeries generally allow progression to higher-demand strengthening and running starting at three months. Full return-to-sport ranges from five to nine months depending on the sport, which is consistent with hip arthroscopy.