questions
4

Hip Arthroscopy

Author:
Topic updated on 05/04/14 8:41pm
Introduction
  • hip arthrscopy.jpg (300×258)Technically difficult because of deep location of hip joint
  • Lower morbidity than open arthrotomy with easier post-operative course
  • Indications
    • FAI
    • labral tears
    • AVN (diagnosis and staging)
    • loose bodies
    • synovial disease
    • chondral injuries
    • ligamentum teres injuries
    • snapping hip
    • mechanical symptoms
    • impinging osteophytes
  • Contraindications
    • advanced DJD
    • hip ankylosis
    • joint contracture
    • severe osteoporotic bone
    • significant protrusio acetabuli
Positioning and Scope insertion
  • Position
    • may be done supine or in lateral decubitus position
  • Joint distension
    • can load joint with saline to distend joint
      • typically done under flouroscopic guidance
    • requires traction in line with the femoral neck
      • well padded perineal post
      • ~50 pounds of traction
  • Scope insertion
    • anterolateral scope placed first
      • arthroscope insertion over guidewire
    • anterior portal placed second
      • then placed under fluoroscopic guidance with the hip flexed and in internal rotation
    • posterior portal placed last
Portals
  • Anterolateral portal 
    • function
      • primary viewing portal
      • anterolateral hip joint access
    • location and technique
      • located 2 cm anterior and 2 cm superior to anterosuperior border of greater trochanter
      • typically established first under fluoroscopic guidance
  • Posterolateral portal
    • function
      • posterior hip joint access
    • location and technique
      • located 2 cm posterior to the tip of the greater trochanter
  • Anterior portal
    • function
      • anterior hip joint access
    • location and technique
      • located at intersection between
        • superior ridge of greater trochanter
        • ASIS
      • flexion and internal rotation of hip loosens capsule and assists scope insertion
  • Distal anterolateral portal
    • function
      • provides access to the peripheral compartment in the region of the femoral neck
    • location and technique
      • used in conjunction with the anterolateral portal to visualize the peripheral compartment
      • traction is removed and the hip is placed in either neutral flexion and extension or in 45 degrees of flexion to relax the anterior capsule
      • fluoroscopy and direct arthroscopic visualization is used to guide portal placement
      • portal is established 3 to 5 cm distal to the anterolateral portal, just anterior to the lateral aspect of the proximal femoral shaft and neck
    • structures visualized within the peripheral compartment
      • femoral head
      • labrum
      • zona orbicularis   
        • provides a landmark for the iliopsoas tendon 
      • medial synovial fold
      • femoral neck
      • peripheral capsular attachments
Rehabilitation
  • Immediate post-operative period
    • NWB or PWB for ~ one week
    • with gradual progression to full weight bearing
  • Rehabilitation
    • strengthening is started after full ROM is achieved
  • Return to full activity
    • at ~ 3 months
Complications
  • Direct injuries
    • can occur from scope or cannula placement
    • most commonly reported complication
      • chondral injuries
  • Neurovascular injury
    • traction related
      • pudendal nerve injury
        • most common neurovascular complication
        • due to traction post in groin for traction
        • neuropraxia or compression injury
      • peroneal nerve injury
        • traction neuropraxia
      • may prevent traction injuries with
        • intermittent release of traction
        • adequate anesthesia
    • anterolateral portal
      • risks superior gluteal nerve
    • posterolateral portal
      • risks sciatic nerve
        • increased risk with external rotation of hip
    • anterior portal
      • risks lateral femoral cutaneous nerve injury
      • risks femoral neurovascular bundle
      • risks ascending branch of lateral femoral circumflex artery

 

Please Rate Educational Value!
4.0
Average 4.0 of 11 Ratings

Qbank (4 Questions)

TAG
(OBQ11.262) The zona orbicularis is the arthroscopic landmark for access to which of the following structures? Topic Review Topic

1. Iliopsoas
2. Pectineus
3. Sartorius
4. Adductor brevis
5. Rectus femoris

PREFERRED RESPONSE ▶
TAG
(OBQ07.136) Complications from hip arthroscopy are most commonly related to which of the following? Topic Review Topic

1. Use of traction
2. Lateral positioning
3. Supine positioning
4. Deep venous thrombosis
5. Heterotopic ossification

PREFERRED RESPONSE ▶
TAG
(OBQ06.209) During hip arthroscopy, the sciatic nerve is most at risk with which of the following portal techniques? Topic Review Topic

1. Anterior peritrochanteric portal with limb in internal rotation
2. Anterior peritrochanteric portal with limb in flexion
3. Posterior peritrochanteric portal with limb in internal rotation
4. Posterior peritrochanteric portal with limb in external rotation
5. Distal lateral portal with limb in neutral rotation

PREFERRED RESPONSE ▶
TAG
(OBQ06.223) A 29-year-old male undergeoes hip arthroscopy using the three portals shown in Figure A. Postoperatively he develops numbness in the distribution shown in yellow. This complication was most likely caused by which of the following? Topic Review Topic
FIGURES: A          

1. Injury to the Pudendal nerve from Portal A
2. Injury to the Femoral nerve from Portal B
3. Injury to the Lateral Femoral Cutaneous Nerve from Portal A
4. Injury to the Common Peroneal nerve from Portal C
5. Injury to the a sensory branches of the sciatic nerve from Portal B

PREFERRED RESPONSE ▶



Cases

http://upload.orthobullets.com/cases/2050/image_2.jpg http://upload.orthobullets.com/cases/2050/image_6.jpg http://upload.orthobullets.com/cases/2050/image_7.jpg
HPI - 52 yo female anethesiologist complains of worsening R hip pain for several month...
poll How would you treat this patient?
10/21/2014
137 responses
3
http://upload.orthobullets.com/cases/1461/xr pelvis 1.jpg http://upload.orthobullets.com/cases/1461/ct 3d hip 1.jpg http://upload.orthobullets.com/cases/1461/ct 3d hip 2.jpg
HPI - 36 yr old with hx of pelvic trauma as a child. No previous hip surgery.
poll What are next steps?
3/27/2013
107 responses
4
http://upload.orthobullets.com/cases/1315/pelvis.jpg http://upload.orthobullets.com/cases/1315/hip ap.jpg http://upload.orthobullets.com/cases/1315/dunn.jpg
HPI - 29 yr of female with hip pain for many years. Right worse than left
poll How would you obtain access to joint?
11/6/2012
1326 responses
4
http://upload.orthobullets.com/cases/1429/xray1.jpg http://upload.orthobullets.com/cases/1429/xray2.jpg http://upload.orthobullets.com/cases/1429/xray3.jpg
HPI - 17 yr female. Pulled "muscle" she was told when she was younger running track. P...
poll Next step?
2/26/2013
94 responses
4
See More Cases

Videos

video
Video shows basic setup and hip arthroscopy portal placement
12/16/2012
1274 views
4
video
Left hip arthroscopy shows release of the iliopsoas tendon for treatment of inte...
2/12/2012
1228 views
2
video
Hip Arthroscopy: Chondroplasty and Osteoplasty for Cam Lesion in Femoroacetabula...
12/29/2011
759 views
4
See More Videos

Posts

Groups


Evidence & References Show References




Topic Comments