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Scientific Articles   |    
Multicenter Study of Complications Following Surgical Dislocation of the Hip
Ernest L. Sink, MD1; Paul E. Beaulé, MD, FRCSC2; Daniel Sucato, MD3; Young-Jo Kim, MD, PhD4; Michael B. Millis, MD4; Michael Dayton, MD5; Robert T. Trousdale, MD6; Rafael J. Sierra, MD6; Ira Zaltz, MD7; Perry Schoenecker, MD8; Amy Monreal, BA1; John Clohisy, MD8
1 The Children's Hospital, 13123 East 16th Avenue, Aurora, CO 80045. E-mail address for E.L. Sink: sinke@hss.edu
2 Ottawa Hospital, 501 Smyth Road, CCW 1646, Ottawa, ON K1H 8L6, Canada
3 Texas Scottish Rite Hospital, 2222 Welborn Street, Dallas, TX 75219
4 Children's Hospital Boston, 300 Longwood Avenue, Hunnewell 225, Boston, MA 02115
5 University of Colorado Hospital, 13001 East 17th Place, Aurora, CO 80045
6 Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
7 Oakland Orthopaedic Surgeons, 30575 Woodward Avenue, #100, Royal Oak, MI 48073
8 Washington University in St. Louis, 4921 Parkview Place, Suite A, St. Louis, MO 63110
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jun 15;93(12):1132-1136. doi: 10.2106/JBJS.J.00794
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Abstract

Background: 

Surgical hip dislocation enables complete exposure of the hip joint for treatment of various hip disorders. There is limited information regarding the complications associated with this procedure. Our purpose is to report the incidence of complications associated with surgical dislocation of the hip in a large, multicenter patient cohort.

Methods: 

A retrospective, multicenter analysis of patients who had undergone surgical hip dislocation was performed. Patients who had undergone a simultaneous osteotomy were excluded. Complications were recorded, with specific assessment for osteonecrosis, trochanteric nonunion, femoral neck fracture, nerve injury, heterotopic ossification, and thromboembolic disease. We graded complications with a validated classification scheme that includes five grades based on the treatment required to manage the complication and any long-term morbidity. With this classification, a Grade-I complication is one that requires no change in the routine postoperative course, Grade II requires a change in outpatient management, Grade III requires invasive surgical or radiologic management, Grade IV is associated with long-term morbidity or is life-threatening, and Grade V results in death.

Results: 

The study included 334 hips in 302 patients seen at eight different North American centers. There were eighteen complications (5.4%) that were classified as Grade I (not clinically relevant and required no deviation from routine postoperative care). There were six complications (1.8%) classified as Grade II (treated on an outpatient basis or with close observation and resolved). There were nine complications (2.7%) classified as Grade III (treatable and resolved with surgery or inpatient management). There was one complication (0.3%) classified as Grade IV (resulting in a long-term deficit). A total of thirty hips had one or more complications, for an overall incidence of 9%. Excluding heterotopic ossification, the complication rate was sixteen (4.8%) of 334.

Conclusions: 

Surgical hip dislocation is a safe procedure with a low complication rate. Many of the complications were clinically unimportant heterotopic ossification. There were no cases of femoral head osteonecrosis or femoral neck fracture, and, with the exception of one sciatic neurapraxia that partially resolved, no other complication resulted in long-term morbidity.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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