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Open Surgical Hip Dislocation with Labral Reconstruction using Ligamentum Teres Autograft

March 01, 2017

Contributors: Amos Dai, BS; Daniel James Kaplan, BA; Michael Ryan, MD; Jonathan M Vigdorchik, MD, FAAOS; Jonathan M Vigdorchik, MD, FAAOS

Purpose: The acetabular labrum is an important structure for hip stability, helping deepen the hip socket and extend coverage of the femoral head. The acetabular labrum also is important in synovial fluid dynamics, preventing the efflux of synovial fluid from joint compartments and sealing the fluid inside the hip. Morphologic and functional changes and degeneration of the acetabular labrum may result in femoroacetabular impingement and hip dysplasia, inducing acetabular labral tears. Indications for labral reconstruction include hip pain and dysfunction and irreparable labral tears caused by a degenerative labrum or labral deficiency. Labral reconstruction is contraindicated in patients with early stages of arthritis and patients with a femoral head cyst. This video demonstrates the use of ligamentum teres autograft during open surgical hip dislocation and labral reconstruction. Methods: This video discusses the case presentation of a 25-year-old man with a 3-year history of left hip pain localized to the groin area after activity. Nonsurgical treatment, including physical therapy and the use of anti-inflammatory medications, and an intra-articular anesthetic injection failed. On physical examination, the patient had a positive impingement sign and decreased strength with resisted hip flexion. Imaging studies confirmed a large cam deformity extending to the lateral and posterior area and a large degenerative labral tear with no good labral tissue for repair. This video demonstrates open labral reconstruction with the use of ligamentum teres autograft, femoroplasty, and acetabuloplasty for the management of femoroacetabular impingement. Results: Postoperative radiographs confirmed proper alignment of the screws. The patient was instructed to limit hip extension to 0°, limit hip flexion to 90°, and follow strict trochanteric precautions. Weight-bearing limitations were discussed, and the patient was instructed to perform continuous passive motion exercises for 8 hours per day for 4 weeks and use a stationary bike (with no resistance) after 2 weeks postoperatively. Radiographs obtained 3 months postoperatively demonstrated healing of the trochanteric osteotomy, restoration of the head-neck junction, and elimination of the cam deformity. Conclusion: Open surgical hip dislocation and labral reconstruction with the use of ligamentum teres autograft results in hip stability and improved function. Related studies on labral reconstruction report good short- and long-term outcomes with regard to pain and function and overall improvement in patient-reported outcome measures. Potential complications include progression of osteoarthritis, heterotopic ossification, and trochanteric nonunion.

Results for "Hip Preservation"

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