Open hip debridement

What is it? This is a procedure carried out in patients who are not suitable for hip arthroscopy. If a patient has had childhood hip disease such as Perthes, Slipped Upper Femoral Epiphysis or Avascular necrosis, their hip can often be left deformed and this can lead to the femoral head "impinging" against the rim of the acetabular socket. If the deformity is severe, then it is difficult to ensure that a full correction/reshaping has been carried out arthroscopically. In this cases an open procedure is advised.

Investigations Prior to surgery, all patients undergo a detailed physical examination. They will require plain x-rays and 3 D CT scans to give an accurate image of the deformity and allow pre-operative planning.


Picture 1: X-ray showing a healed SUFE with malunion and impingement

Procedure Each patient undergoes a general anaesthetic and the procedure takes approximately 2 hours minutes to carry out. All patients are given intra-venous antibiotics and blood thinning drugs to prevent a blood clot.

 

Pictures 2 and 3: Photographs of a hip showing a moderate Cam deformity before and after resection.

An incision is made on the side of the hip and a careful dissection is carried out. A portion of bone is removed from the side of the femur, preserving the muscle attachments and the dissection is continued until the hip joint is accessible. The hip is dislocated and a thorough inspection is made of both the femoral head and pelvic socket. Any abnormalities on the socket or cartilaginous labrum are treated at the stage and the head is reshaped using special instruments. Once that is completed, the hip is reduced and the bony fragment is reattached using screws.

Picture 4: Post-operative x-ray following labral repair (note anchors), femoral reshaping and trochanteric reattachment.

Following the surgery, the patient undergoes an active rehabilitation program. This works on restoring range of movement and muscle strength. The patient is usually partially weight-bearing for at least six weeks while the bony repair heals. Patients are usually in hospital for between 2-4 days and are followed up by a dedicated therapist. They are reviewed in out-patients at six weeks and their progress is carefully monitored.

The speed of patient recovery can vary following the operation and most return to normal activities 6 to 12 weeks following surgery.

Open hip debridement is a significant procedure and the risks are greater than with hip arthroscopy. There is a small risk of infection, blood clots, temporary nerve injury and non-union of the bony fragment. Some patients will get discomfort from the screws and these may need to be removed as a day-case procedure.