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Tips for the surgical repair of hip dislocations

  • Identify the greater trochanter and the deep gluteal tendon

  • Approach the dislocated head of femur by tracking along the ventral border of the deep gluteal tendon and muscle.

  • Rotate the head outwards and trim off any torn ligament.

  • Drill a short hole [1.5mm diameter for Size 1 Han-de ligature] at the dorsal edge of the fovea.

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  • In some animals the fovea is very low [ventral] on the femoral head. A ligature placed in this position runs the risk of cutting through the head into the femoral neck. In these cases, the drill hole may have to encroach on the articular surface to ensure an adequate grip.

  • Expose the proximal, lateral femoral surface and drill a shallow hole through the lateral cortex, mid shaft and level with the third trochanter.

  • Place a C-drill guide across the two drilled holes.

  • Drill a bone tunnel up the femoral neck to emerge on the femoral head.

  • Place the loop passer up the tunnel and withdraw a loop of strong suture material down the tunnel

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  • Expose the acetabulum and trim off torn ligament.

  • Drill a hole [2mm diameter for a Size 1 Han-de toggle] in the dorsal, cranial quadrant of the acetabulum. Take care not to penetrate deep into the pelvic cavity.

  • Now change surgical gloves, open the Han-de ligature, and move the toggle up the ligature to lock the ligature against the toggle.

  • Place the toggle into the acetabular hole. With the end of the loop passer, push the toggle into the pelvic cavity.

  • Pull on both ligature strands to lock the toggle in place. Then pull each individual strand to eliminate any loops of ligature around the toggle.

  • Thread the ligature through the preplaced loop in the femoral neck and pull the ligature through to the lateral femur.

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  • Wash out the acetabulum and replace the head of the femur into its normal position.

  • Thread the second toggle onto the ligature and tie a surgeon’s knot with a couple of throws.

  • Check the full range of motion of the joint and the degree of laxity in the joint. The ligature should hold the head in the acetabulum firmly but not too tight.

  • Readjust the tension if required. If satisfactory, complete the knot with multiple [4] throws.

  • Suture the joint capsule, if possible, and follow with a routine closure.

Alternative

Another technique is to place a toggle with ligature through the ventral border of the ilium, cranial to the acetabulum. Then pass the ligature through a bone tunnel in the greater trochanter and anchor the ligature over a toggle on the caudal surface of the greater trochanter.

This technique can be used by itself or to supplement the toggle /acetabular technique. Patients with dysplastic hips, or very active patients, may be candidates for this combined technique.

 



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