Ganz et al. describe a technique for complete surgical dislocation of the adult hip using a trochanteric flip osteotomy and anterior dislocation through a posterior approach. The external rotators are preserved throughout, protecting the medial femoral circumflex artery and eliminating the risk of avascular necrosis. The study reports outcomes in 213 hips followed over seven years at the University of Bern.
Surgical dislocation of the hip was essentially abandoned before this paper because no one had established how to do it without destroying the femoral head's blood supply. The vascular anatomy was understood well enough to fear the procedure — Ganz's 2000 anatomical study of the MFCA (Gautier et al., JBJS Br) provided the missing foundation. But no technique had translated that anatomy into reproducible intraoperative safety.
This paper is why hip preservation surgery exists as a field. When you see a young patient with anterior groin pain, a cam or pincer deformity on imaging, and limited flexion-internal rotation, the surgical option on the table. Osteochondroplasty with full joint visualization. Traces directly back to this technique.
The critical intraoperative rule this paper establishes: repair the capsule, but do not tighten it. Tensioning the capsule compresses retinacular vessels and experimentally drops femoral head perfusion. This is a step residents routinely miss.
The 37% heterotopic ossification rate is worth knowing for boards, but clinically it is mostly noise. 86% of cases were Brooker grade I, and the incidence fell as the team gained experience. The real number to remember is zero: zero cases of avascular necrosis in 213 hips.
Ganz et al. describe a technique for complete surgical dislocation of the adult hip using a trochanteric flip osteotomy and anterior dislocation through a posterior approach. The external rotators are preserved throughout, protecting the medial femoral circumflex artery and eliminating the risk of avascular necrosis. The study reports outcomes in 213 hips followed over seven years at the University of Bern.
Surgical dislocation of the hip was essentially abandoned before this paper because no one had established how to do it without destroying the femoral head's blood supply. The vascular anatomy was understood well enough to fear the procedure — Ganz's 2000 anatomical study of the MFCA (Gautier et al., JBJS Br) provided the missing foundation. But no technique had translated that anatomy into reproducible intraoperative safety.
This paper is why hip preservation surgery exists as a field. When you see a young patient with anterior groin pain, a cam or pincer deformity on imaging, and limited flexion-internal rotation, the surgical option on the table. Osteochondroplasty with full joint visualization. Traces directly back to this technique.
The critical intraoperative rule this paper establishes: repair the capsule, but do not tighten it. Tensioning the capsule compresses retinacular vessels and experimentally drops femoral head perfusion. This is a step residents routinely miss.
The 37% heterotopic ossification rate is worth knowing for boards, but clinically it is mostly noise. 86% of cases were Brooker grade I, and the incidence fell as the team gained experience. The real number to remember is zero: zero cases of avascular necrosis in 213 hips.