To treat extra-articular impingement, a careful intraoperative examination is used to identify the specific sites of impingement—both intra-articular and extra-articular—and the specific bony anatomy causing the impingement. Intra-articular cam and rim impingement is generally addressed first followed by reexamination. Extra-articular impingent is treated by addressing the specific site(s) of impingement identified on the intraoperative examination, with osteoplasty for an impinging anterior trochanteric facet, inside-out removal of a prominent posterior trochanteric ridge, or relative femoral neck lengthening. After treating the sites of extra-articular impingement, there should be a substantial improvement in range of motion.
Although the ability to directly observe impingement at the time of surgery is an advantage of the surgical dislocation, correct management of impingement requires that the surgeon is able to recognize the pathoanatomy causing impingement and knows how to address it safely. A surgical dislocation is more invasive than arthroscopy, so careful soft-tissue handling and hemostasis have a significant impact on the postoperative result. Similarly, postoperative physical therapy that includes appropriate progression of range of motion, strength, and incorporates soft-tissue release work is critical for good results and return to activity. Unlike arthroscopy, surgical dislocation generally involves a short inpatient stay. In addition there is some potential for painful postoperative adhesions that can be related to the intraoperative soft-tissue management or postoperative rehabilitation.51,52
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