Ernie Sink, Surgical Dislocation of the Hip and Femoroacetabular Impingement (FAI)

This week, I speak with Ernie Sink from the Hospital for Special Surgery (HSS) in New York. Dr Sink is a world-renowned expert in hip preservation surgery, and today, we discuss surgical hip dislocation as an approach to treating hip pathology. We talk about femoroacetabular impingement or FAI and its description by the group led by Prof. Reinhold Ganz in Bern, Switzerland, and the evolution towards arthroscopic approaches to treating it. We discuss objective measures to quantify FAI, the importance of making an accurate diagnosis, and the difficulties in distinguishing subtle abnormalities.  We talk about a recent paper he published that analyzed the outcomes of the surgical dislocation approach for treating complex FAI and how he distinguishes complex FAI from milder conditions, considering it a spectrum of pathology. We then consider two papers comparing surgical hip dislocation and arthroscopy to treat this condition. The first, a comparison in an adult population, showed that both treatments were equally effective. We discussed surgeon preference for one or another, leading to its being offered. A more recent study in an adolescent population found that females with subtle Cam deformities on the femoral neck who did not participate in sports were at higher risk of having a sub-optimal outcome, and we discussed this. We conclude on the current state and future of open hip surgery in the era of arthroscopy.