Hip Luxation
Image courtesy of Hill`s
Hip luxation is when the femoral head luxate or dislocate from the pelvis (acetabulum).
The most common cause of luxation is road traffic accidents; however, concomitant pathology, such as hip dysplasia, can predispose to luxation or cause hip luxation without any history of trauma (spontaneous luxation) due to poor coverage of the femoral head by the acetabulum. To read more about hip dysplasia please follow the link.
The luxation results in dorsal or ventral dislocation of the femoral head and tearing soft tissue structures such as the round ligament, the joint capsule, and muscles. In some cases, damages of the articular cartilages or fractures of the rim of the acetabulum or femoral head may be concurrent to luxation.
Diagnosis
This is based on clinical and XR exams. In some cases, CT may be required to diagnose microfractures of the acetabulum or femoral head.
Treatment
Closed reduction (without surgery) can be successfully performed in the first few days after luxation; however, this has a success rate of 50%.
Surgical treatment is often the treatment of choice.
The surgical technique depends on the type of luxation and on surgeon preferences.
Different techniques can be used: Capsulorrhaphy, Prosthetic Capsule Technique, Transposition of the Great Trochanter, Trans-articular Pinning, Extra-Articular Iliofemoral Suture, Fascia Lata Loop stabilization, and Toggle Stabilization. In most cases, a Toggle is the treatment of choice because allows early use of the limb after surgery.
In dysplastic hip joints or in case of fracture or cartilages damage, restoration of normal joint function may not be possible, and alternatives should be considered.
Total Hip Replacement is the gold standard; however, Femoral Head and Neck Ostectomy can be performed as a salvage procedure.
Toggle
The aim of the Toggle surgery is to restore the normal joint anatomy and function by reconstructing the round ligament. The round ligament is replaced with a synthetic ligament (eg. Nylon or LigaFiba). The synthetic ligament is passed within a predrilled hole on the femoral head, and it is anchored into the acetabulum through a toggle rod.
Complications
Rupture of the synthetic ligament or infections is major complications. The rupture of the synthetic ligament may result in re-luxation. In this case, a review surgery is required.
Infections are often treated with antibiotics; however, if the antibiotic treatment is not successful, a review surgery may be required.
Pre-op XR: Cranio-dorsal Hip luxation
Post-op XR: hip reduction using toggle