Total Hip Arthroplasty in Chronic Unreduced Hip Fracture-Dislocation

Diagnosis, Preoperative Evaluation, Classification and Total Hip Arthroplasty in Patients with Long-Term Unreduced Hip Joint Dislocation, Secondary Osteoarthritis and Pseudoarthrosis

“…In this situation, the "standard" acetabular component could be placed on the original acetabular bone socket with structural bone grafting or augmented to fill the bone deficiency area [23]. Similarly to our study, Ilyas [17] has reported that the femoral head might be an optimum selection in this situation. In that study, 13/15 patients with old, short-term hip dislocations (time from injury to surgery equaling less than 1 year) received total hip arthroplasty with the femoral head as a structural bone graft.…”

“…The time when the pseudoacetabulum was formed remained unknown consequent to the deficiency of the patients' preoperative longitudinal data. In reports from Nagi [14] and Ilyas [17], which characterized the time period from initial injury to surgery as less than one year, no pseudoacetabulum was mentioned. In contrast, according to the report from Pai [6], in four patients with unreduced hip dislocation more than one year, a pseudoacetabulum was formed.…”

“…This causes the gluteus medius and gluteus minimus to "bypass" the osteophytes, prolonging the distance from the attachment point of the muscle (posterior-superior border of the ilium) to the tip of the trochanter, increasing the muscle tension and causing a failure of reduction. In Ilyas's study [17], rather than the limited soft-tissue release in our study, they had performed extensive softtissue release including the capsule, iliopsoas, iliotibial band, rectus femoris and even hamstrings with another incision. In contrast, in our study, we found that after removing the osteophytes of the pseudoacetabulum, the muscle tension of the gluteus medius and gluteus minimus would be expected to decrease dramatically, making it easy to reduce the joint without over-release of soft-tissue or proximal femoral osteotomy (seen in the video).…”

“…Total hip arthroplasty using artificial joint prosthesis replacement might be considered the optimal treatment option because patients could be expected to be pain-free and have a satisfactory functional outcome postoperatively [8,16]. However, the unique characteristics of surgical procedures in these patients are also rarely reported [7,15,17]. In particular, long-term dislocation and pseudoacetabulum formation may have an effect on the surgical approach and acetabular component implantation.…”

External fixation-assisted reduction for the treatment of neglected hip dislocations with limb discrepancy: a retrospective study of 13 cases.

“…The common treatments reported in previous studies for neglected hip dislocation included skeletal traction and open reduction, but usually ended with unsatisfactory outcome and are associated with high incidence of post-operative complications such as nerve injury, AVN, and osteoarthritis [8,9]. Garrett et al recommended total hip replacement (THR) for hip dislocations with a duration of >3 months [10], but others have reported that limited correction of limb discrepancy that could be accomplished by THR [11,12]. Considering that the best treatment for neglected hip dislocation remains controversial and to improve clinical outcome, we propose a new surgical strategy to treat neglected acetabular dislocations using external fixators in preoperative traction.…”