- 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.