Clin Orthop Surg.  2019 Sep;11(3):337-343. 10.4055/cios.2019.11.3.337.

Anterolateral Approach in the Treatment of Femoroacetabular Impingement of the Hip

• Kim HT
• Kim UJ
• Cho YJ

• KMID: 2462564
• DOI: http://doi.org/10.4055/cios.2019.11.3.337

Abstract

BACKGROUND
Ganz surgical hip dislocation via a posterior (Kocher-Langenbeck) approach is a popular procedure in the management of femoroacetabular impingement (FAI). We report the results of surgery performed through an anterolateral (Watson-Jones) approach in the management of anterolateral FAI.
METHODS
Twenty-one hips in 20 patients (mean age at the time of operation, 17.3 years) were treated surgically using an anterolateral approach: 12 hips with Legg-Calvé-Perthes disease, three septic hips, three hips with avascular necrosis (combined with slipped capital femoral epiphysis [SCFE], femoral neck fracture, and developmental dislocation of the hip), two hips with epiphyseal dysplasia, and one hip with SCFE. All patients had anterolateral FAI. Surgical hip dislocation was performed in four hips with trochanteric osteotomy. Combined osteotomies were for neck lengthening in 11 hips, varus or valgus osteotomy in the proximal femur in four hips, and pelvic osteotomy in four hips. Clinical results were evaluated using a modified Harris hip score (mHHS).
RESULTS
Range of hip flexion and abduction showed statistically significant improvement after surgery; however, the improvement in mean mHHS was not statistically significant.
CONCLUSIONS
An anterolateral approach can be used as an alternative to a posterior approach in the management of anterolateral FAI with or without hip dislocation while safely preserving the blood supply to the femoral head and allowing simultaneous procedures in the proximal femur.

Keyword

Femoroacetabular impingement; Hip dislocation

MeSH Terms

Dislocations
Femoracetabular Impingement*
Femoral Neck Fractures
Femur
Head
Hip Dislocation
Hip*
Humans
Legg-Calve-Perthes Disease
Neck
Necrosis
Osteotomy
Slipped Capital Femoral Epiphyses

Figure

• 

  Fig. 1 Arteries of the femoral head and neck viewed from a posterior aspect (surrounding muscles are removed). Subsynovial retinacular arteries enter the capsule from the medial femoral circumflex artery (MFCA). Subperiosteal stripping from the lateral aspect of the femur to the medial side (proximally from the level of the lesser trochanter) and a careful cut of the short external rotators along the bony cortex prevent vascular damage during hip dislocation and simultaneous proximal femoral osteotomy.

• 

  Fig. 2 Illustration of the hip joint and femur before dislocation of the femoral head and osteotomy in the proximal femur showing an osteotomized greater trochanter, opened capsule, longitudinally split vastus lateralis, and subperiosteal dissection to protect the medial femoral circumflex artery.

• 

  Fig. 3 Anteroposterior (A) and frog-leg lateral (B) views of a 14-year-old boy with Legg-Calvé-Perthes disease in the left hip show a short femoral neck, overgrown greater trochanter, and a 2-cm leg length discrepancy. At age 9 years, he underwent a valgus-flexion femoral osteotomy and then Chiari pelvic osteotomy due to the laterally uncovered femoral head. Clinically he showed limping and limited range of motion, especially in abduction.

• 

  Fig. 4 A patient underwent a neck lengthening osteotomy with lateral and distal transfer of the greater trochanter performed through an anterolateral approach. Simultaneous osteochondroplasty of the anterolateral aspect of the femoral head and neck was also performed through the same approach. Anteroposterior (A) and frog-leg lateral (B) views taken 3 years after surgery (at age 17) show improved biomechanical anatomy of the hip.

• 

  Fig. 5 Abduction (A) and lateral (B) arthrographs show improved sphericity of the femoral head. The hip range of motion improved by 10° in flexion and 15° in abduction.

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