1: J Bone Joint Surg Br  2001 Nov;83(8):1119-24 

Surgical dislocation of the adult hip a technique with full access to the
femoral head and acetabulum without the risk of avascular necrosis.

Ganz R, Gill TJ, Gautier E, Ganz K, Krugel N, Berlemann U.

Department of Orthopaedic Surgery, University of Bern, Inselspital, Switzerland.

Surgical dislocation of the hip is rarely undertaken. The potential danger to
the vascularity of the femoral head has been emphasised, but there is little
information as to how this danger can be avoided. We describe a technique for
operative dislocation of the hip, based on detailed anatomical studies of the
blood supply. It combines aspects of approaches which have been reported
previously and consists of an anterior dislocation through a posterior approach
with a 'trochanteric flip' osteotomy. The external rotator muscles are not
divided and the medial femoral circumflex artery is protected by the intact
obturator externus. We report our experience using this approach in 213 hips
over a period of seven years and include 19 patients who underwent simultaneous
intertrochanteric osteotomy. The perfusion of the femoral head was verified
intraoperatively and, to date, none has subsequently developed avascular
necrosis. There is little morbidity associated with the technique and it allows
the treatment of a variety of conditions, which may not respond well to other
methods including arthroscopy. Surgical dislocation gives new insight into the
pathogenesis of some hip disorders and the possibility of preserving the hip
with techniques such as transplantation of cartilage.

PMID: 11764423 [PubMed - indexed for MEDLINE]