OPEN HIP (DISLOCATION) DEBRIDEMENT SURGERY
This surgery was the original technique which allowed safe access to the hip with post operative full recovery. Using this surgery many of the causes of hip pain, which were not very well understood, were defined and clarified. In fact all of the indications for hip arthroscopic surgery were first defined by means of open hip dislocation surgery. Controlled dislocation of the hip is required in order to gain access to the joint. In fact, in many respects this surgery gives better visualization, and many surgeons in some of the bigger orthopaedic centers around the world still feel that open surgery is the gold standard for dealing with problems like Femoral Acetabular Impingement or FAI. There is some evidence to show comparable results but this is not yet conclusive.
Some cases that need surgery are of such a nature that arthroscopic surgery would not suffice because of access and the ability to perform enough surgery to ensure a good result. Also when attempting to perform some procedures arthroscopically, unless the surgeon is very experience , there is a higher risk of damage to the cartilage because of the tight constraints of the arthroscopic technique. Open surgery can in these cases be a lot safer.
Comparison with arthroscopic surgery
- The scar is a lot longer. However wounds do not heal from end to end,
but rather from side to side, and once healed there will only be a fine line
as all my sutures are under the skin and dissolve over time.
- Part of the procedure is cutting off a portion of the trochanter (knobbly
bit on the side of the hip), and reattaching it later with metal screws. The
beauty of this technique is that there is no cutting of muscle or tendon and once healed full and normal function is regained. Also, and this is most important, bone is the only organ in the body which heals to its original state. All other structures heal with the formation of some sort of scar which has a varying level of end stage function.
- Compared to arthroscopic techniques for the hip, most patients will spend 2 to 4 nights in hospital compared to one night.
Also the use of crutches will be required for a total of 6 weeks to prevent full weight bearing on the surgical side. Arthroscopic techniques demand crutches for between 2 to 4 weeks and sometimes also up to 6 weeks. For both techniques however, there is very little restriction for range of motion, in fact movement is encouraged vigorously and one can drive normally within 3 days.
- Post-operative pain is in many cases actually similar with the open surgery only a slight trend toward being more painful.
- Obviously with open surgery there is an increased level of blood loss, but this usually less than 500mls.
- At 3 months the levels of discomfort for both procedures are similar.
- Surgical times, in capable hands, for comparable complex procedures using the two techniques are also comparable. There are however some procedures that are better suited to each of the techniques, and your surgeon needs to be able to use either.
Important: Both arthroscopic and open hip surgery for the management of causes of hip pain in the younger patient, with the added aim of preserving the natural hip, is highly specialized surgery that is not the purvey of the ordinary orthopaedic or joint replacement surgeon. This is surgery that should rather be done by a surgeon who deals with more than just the worn-out hip and who has spent some time with other surgeons who are leaders in this field. With the mounting body of evidence in the literature, there is growing consensus that preservation of the natural hip is paramount especially for those under the age of 50years or the very active individual. The above techniques are some of the tools available to achieve this goal.