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Hip Dislocation

- Discussion:
    - dislocate the hip posteriorly by flexing, adducting, and gently  internally rotating the hip;
         - this may drive the femur against posterior edge of acetabulum;
    - place bone hook beneath femoral neck at level of lesser troch. to  gently lift the head out of the acetabulum;
         - a hip skid may be placed to break the suction;
    - lig. teres usually is avulsed from femoral head during dislocation;
    - in younger pts, it may require division before femoral head can be delivered into the wound;
    - in protrusio, the femoral neck might have to be transected in situ;
    - if hip does not dislocate, do not force it;
         - excise approx. 2 cm of posterior superior portion of femoral head;
         - divide psoas tendon at its insertion on lesser trochanter
         - w/ hip internally rotated as much as possible, expose tendon  beneath inf. part of quadratus, & place tip of long
                handled hemostat under it so it can be scetioned transversely;
                - stay close to bone to avoid laceration of MFCA
         - incise transversely several cm of insertion of maximus  tendon on the femur to increase internal rotation;
                - section only amount of tendon necessary to allows sufficient internal rotation to dislocate the hip;
                - often encounter bleeding from cruciate vessels.