Surgical dislocation with trochanteric osteotomy: A surgical approach for femoroacetabular impingement

Purpose of review: The understanding of how abnormal hip morphology adversely affects the biomechanics of the hip, and how this may lead to the development of osteoarthritis, has been expanded in recent years. Professor Reinhold Ganz has described the concept of femoroacetabular impingement and has developed the technique of surgical dislocation, which allows the surgeon to treat a variety of intraarticular and extraarticular pathologic conditions, including femoroacetabular impingement. This review will focus on the technique of surgical dislocation of the hip, with an emphasis on the review of the pathophysiology of femoroacetabular impingement. The authors will discuss in detail the surgical technique, review the results of recent series, and suggest possible future applications. Recent findings: Articles from Bern have detailed the pathophysiology of femoroacetabular impingement and the technique of surgical dislocation of the hip. Midterm results (4-year follow-up) showed a 76% good or excellent rating, with no cases of avascular necrosis. Poor predictors of outcome were advanced degenerative changes or extensive articular cartilage damage. An independent report showed similar findings with pain relief and improvement in hip function. A basic science article investigated the maximum amount of bone that may be resected to decrease the risk of postoperative femoral neck fracture. Summary: Surgical dislocation of the hip is a safe, effective approach to gain full access to the hip, with a low risk of avascular necrosis. Using surgical dislocation to treat femoroacetabular impingement in patients without significant degenerative changes can yield good to excellent results, and pain relief and improvement in function can be expected.