Modern Hip Preservation (PDF)

Reinhold Ganz is a retired professor of orthopaedics at the University Hospital in Berne, Switzerland. He graduated from medical school, University of Freiburg, Germany. After a postgraduate training in bone physiology and biomechanics at the Department of Pathology of the University of Basel and the AO Research Institute in Davos, he pursued his orthopaedic training under the guidance of Maurice E. Müller in Berne. Succeeding Müller as chief of the department in Berne, he started to give more attention to preservation of the native hip joint.
All research was started with detailed cadaver studies of the vascular supply beyond classic knowledge and was focusing on surgical utility of the findings. Teamwork was the key for success.
A first project was to optimize reorientation surgery of the dysplastic acetabulum. While the available procedures approached the acetabulum from the pelvic outside and as such were interfering with the main blood suppliers, a technique wasdeveloped to execute the majority of osteotomy steps from the inside of the pelvis, to spare the blood vessels and the abductor musculature. The technique allows large correction and provides sufficient fragment perfusion, even after extensive capsulotomy for additional intra-articular surgery. Meanwhile the Bernese Periacetabular Osteotomy (PAO) has gained worldwide acceptance.
Surgical dislocation of the hip joint was discredited at length for the risk of avascular head necrosis. Injection studies of the supplying vessels showed a way to perform a safe and reproducible dislocation without such risks. Rather unexpected, routine surgical dislocation allowed to observe the mechanism of impingement and to formulate the concept of one important initiation of osteoarthritis of the hip, hitherto viewed as primary.
Further studies allowed to extend the surgical dislocation approach with a retinacular flap containing the majority of the blood vessels of the head. The resultingcircumferential access to