Cadera/Hip/Hüfte/Hanche: un agujerito para ver el futuro

Can we predict femoral head vitality during surgical hip dislocation?

Alessandro Aprato, Andrea Bonani, Matteo Giachino, Marco Favuto, Francesco Atzori, Alessandro Masse

Journal of Hip Preservation Surgery Volume 1, Issue 2, Pp. 77-81.

Abstract

Purpose

Surgical hip dislocation is commonly performed in orthopaedic surgery for several pathologies that often present risk of avascular necrosis (AVN) of femoral head. Observation of blood spilling out from a drill hole, performed in the head after dislocation, has been proposed as a predictive test for AVN. No data have been published about test reliability. Study’s aim was to evaluate the correlation between ‘bleeding sign’ and AVN in surgical dislocation for elective disease and for acetabular fractures.

Methods

All patients meeting the indication for surgical dislocation were included in this prospective study. Patients with follow-up shorter than 8 months were excluded. Intra-operative assessment of head vascularity was performed in 44 patients through the ‘bleeding sign’: a 2.0-mm drill hole carried out on the head during surgery. A positive bleeding test was considered an immediate appearance of active bleeding. Development of AVN was considered the main outcome. Necrosis group criteria were detection of type II, III or IV X-ray according to Ficat classification.

Results

Forty-four patients with selected acetabular fractures, slipped capital femoral epiphysis and femoral head deformity were enrolled. Mean age was 25 years and mean follow-up was 36 months. Thirty-eight patients presented positive intra-operative bleeding sign and six demonstrated no bleeding. Sensitivity for the ‘bleeding sign’ was 97%, specificity was 83%, positive predictive value was 97%, negative predictive value was 83% and accuracy was 95% (P < 0.001).

Conclusions

Bleeding after head drilling is a reliable test for AVN in patients who undergo a surgical hip dislocation.

Cadera/Hip/Hüfte/Hanche: Tras la artroscopia de cadera, habría que cerrar bien la cápsula

Anterior hip dislocation 5 months after hip arthroscopy
Daniel C Austin, John G Horneff, John D Kelly
Arthroscopy: the Journal of Arthroscopic & related Surgery 2014, 30 (10): 1380-2

Hip dislocation subsequent to hip arthroscopy is a rare complication. We report on a case of low-energy anterior hip dislocation that occurred 5 months after hip arthroscopy, a period notably longer than any previously reported event. The patient was a track and field athlete who presented and received treatment for a labral tear and cam lesion. The athlete then dislocated her hip postoperatively during competitive jumping, a motion that requires significant hip flexion and extension. The most likely cause of the anterior dislocation was failure to close the capsule at the completion of surgery, lending credibility to recent trends in the literature suggesting routine capsular closure. We believe that a partial psoas release also contributed to dynamic hip instability because of increased femoral anteversion in this patient. This case suggests that hip capsule closure should be considered at the completion of every procedure and that a psoas release should be avoided in patients with significant anteversion. Furthermore, the biomechanics of competitive jumping may make these athletes more prone to dislocation and require more conservative return-to-sport recommendations.