Safety and efficacy of surgical hip dislocation in managing femoral head fractures: A systematic review and meta-analysis

BACKGROUND Femoral head fractures(FHFs)are considered relatively uncommon injuries;however,open reduction and internal fixation is preferred for most displaced fractures.Several surgical approaches had been utilized with controversial results;surgical hip dislocation(SHD)is among these approaches,with the reputation of being demanding and leading to higher complication rates.AIM To determine the efficacy and safety of SHD in managing FHFs by reviewing the results reported in the literature.METHODS Major databases including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials were searched to identify studies reporting on outcomes of SHD utilized as an approach in treating FHFs.We extracted basic studies data,surgery-related data,functional outcomes,radiological outcomes,and postoperative complications.We calculated the mean differences for continuous data with 95%confidence intervals for each outcome and the odds ratio with 95%confidence intervals for binary outcomes.P<0.05 was considered significant.RESULTS Our search retrieved nine studies meeting our inclusion criteria,with a total of 129 FHFs.The results of our analysis revealed that the average operation time was 123.74 min,while the average blood loss was 491.89 mL.After an average followup of 38.4 mo,a satisfactory clinical outcome was achieved in 85%of patients,ranged from 30%to 86%,with avascular necrosis,heterotopic ossification,and osteoarthritis being the most common complications occurring at an incidence of 12%,25%,and 16%,respectively.Trochanteric flip osteotomy nonunion and trochanteric bursitis as a unique complication of SHD occurred at an incidence of 3.4%and 3.8%,respectively.CONCLUSION The integration of SHD approach for dealing with FHFs offered acceptable functional and radiological outcomes with a wide range of safety in regards to the hip joint vascularity and the development of avascular necrosis,the formation of heterotopic ossification,and the development of posttraumatic osteoarthritis;however,it still carries its unique risk of trochanteric flip osteotomy nonunion and persistent lateral thigh pain.

Corrections in alpha angle following two different operative approaches for CAM-type femoral acetabular impingement-Ganz surgical hip dislocation vs anterior mini-open

BACKGROUND Femoroacetabular impingement(FAI)is a predisposing factor for secondary osteoarthritis of the hip joint.The two extensively described impingement mechanisms of FAI are CAM and Pincer-type.Initially managed conservatively,operative intervention should be offered to the persistently symptomatic patient.The measurement of the alpha angle is considered a standard method of assessing the severity of pathology in Cam-type FAI on pre-operative plain radiographs.The radiological correction of the alpha angle has not been previously compared between different surgical approaches.We hypothesize that there is no difference in alpha angle correction between Ganz surgical hip dislocation and the anterior mini-open approach.AIM To compare the magnitude of alpha angle correction achieved by using the Ganz surgical hip dislocation and the anterior mini-open approach.METHODS This is a retrospective study assessing seventy-nine patients identified in a 5-year period.These patients had preoperative radiographic evidence of FAI and underwent surgery by a single surgeon at our institution,a tertiary care center.Patients with missing radiographic documentation,radiographs with insufficient quality which then precluded accurate measurement of the angleα,a diagnosed congenital condition,isolated type II pathology(Pincer),and history of prior surgery were excluded from the study.Either the Ganz surgical hip dislocation or the anterior mini open approach was used.Postoperative radiographic evaluation of the alpha angle between the two surgical methods was done and corrected for age and gender using two-sample t-tests and Chi-square analyses.RESULTS A total of 79 patients met the inclusion and exclusion criteria.Forty-seven males(mean age of 35.3,range 16-53)and 32 females(mean age 36.7,range 16-60)were enrolled.Forty-seven patients underwent the anterior mini-open approach,and 32 underwent the Ganz surgical hip dislocation.There were no significant differences in age between the two surgical groups or in pre-and post-operative alpha angles based on patient gender.The mean pre-operative alpha angle for the Ganz surgical hip dislocation group was 88.0 degrees(SD 12.3)and 99.4 degrees(SD 7.2)for the anterior mini-open group.Mean post-operative angles were 49.9 degrees(SD 4.3)for the Ganz surgical hip dislocation and 43.8(SD 4.3)degrees for the anterior mini-open group.There was a statistically significant difference in patient’s pre-operative and post-operative angles(P=0.000)with both surgical approaches.CONCLUSION Statistically significant decreases in alpha angle were noted for both surgical techniques,with larger decreases seen in the anterior mini-open group.