Evaluating the Outcomes of Surgical Hip Dislocation for Femoral Head Trauma: A Systematic Review.

Abstract

Femoral head fractures are complex injuries often associated with high-energy trauma and hip dislocation. Surgical hip dislocation (SHD), particularly the Ganz trochanteric flip osteotomy, was developed to provide extensive intra-articular access while preserving the femoral head's vascular supply. However, a consolidated synthesis of its outcomes is needed. This systematic review aims to evaluate the clinical and radiological outcomes, complication profiles, and key technical considerations of SHD for the management of femoral head trauma. A systematic literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines across five databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) on October 2, 2025. Studies reporting functional or radiological outcomes of SHD for femoral head trauma were included. The risk of bias was assessed using the ROBINS-I tool. Data on study characteristics, functional scores, and complications were extracted and synthesized narratively due to heterogeneity. Ten studies involving 267 patients were included. The majority of studies reported good to excellent functional outcomes, with mean modified Harris Hip Scores and Merle d'Aubigné scores indicating satisfactory recovery. The rate of avascular necrosis (AVN) was consistently low to moderate, ranging from 0% to 8.3% in most studies, a rate notably lower than historically reported for traditional posterior approaches. However, Pipkin type IV fractures were associated with a poor prognosis, with one study reporting an 87.5% rate of post-traumatic arthritis and a 57.1% conversion to total hip arthroplasty. Heterotopic ossification was a common but often asymptomatic finding. The comparative analysis underscored that early hip reduction (less than six hours) significantly improved outcomes. The overall risk of bias was low for all included prospective and retrospective cohort studies, while the two case series were appropriately judged to have a serious risk of bias inherent to their design. SHD is a safe and effective approach for femoral head trauma, facilitating anatomical reduction and yielding good functional outcomes with a low risk of AVN. The Ganz trochanteric flip osteotomy is the cornerstone technique. Prognosis is highly dependent on fracture type, with Pipkin IV injuries posing the greatest challenge, and the timing of surgical intervention is a critical modifiable factor for success.