Introduction 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
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.262) The zona orbicularis is the arthroscopic landmark for access to which of the following structures? Review Topic QID: 3685 Type & Select Correct Answer 1 Iliopsoas 83% (2794/3352) 2 Pectineus 5% (161/3352) 3 Sartorius 2% (71/3352) 4 Adductor brevis 2% (58/3352) 5 Rectus femoris 7% (250/3352) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 1 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ07.136) Complications from hip arthroscopy are most commonly related to which of the following? Review Topic QID: 797 Type & Select Correct Answer 1 Use of traction 93% (1985/2141) 2 Lateral positioning 3% (54/2141) 3 Supine positioning 1% (17/2141) 4 Deep venous thrombosis 1% (31/2141) 5 Heterotopic ossification 2% (46/2141) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 1 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ06.209) During hip arthroscopy, the sciatic nerve is most at risk with which of the following portal techniques? Review Topic QID: 220 Type & Select Correct Answer 1 Anterior peritrochanteric portal with limb in internal rotation 1% (17/2299) 2 Anterior peritrochanteric portal with limb in flexion 1% (19/2299) 3 Posterior peritrochanteric portal with limb in internal rotation 47% (1090/2299) 4 Posterior peritrochanteric portal with limb in external rotation 50% (1155/2299) 5 Distal lateral portal with limb in neutral rotation 0% (3/2299) L 4 Select Answer to see Preferred Response SUBMIT RESPONSE 4 You have 100% on this question. Just skip this one for now. Take This Question Anyway (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? Review Topic QID: 234 FIGURES: A Type & Select Correct Answer 1 Injury to the Pudendal nerve from Portal A 1% (37/4524) 2 Injury to the Femoral nerve from Portal B 1% (31/4524) 3 Injury to the Lateral Femoral Cutaneous Nerve from Portal A 96% (4350/4524) 4 Injury to the Common Peroneal nerve from Portal C 0% (9/4524) 5 Injury to the a sensory branches of the sciatic nerve from Portal B 2% (83/4524) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 3
All Videos (24) Podcasts (1) Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Endoscopic Gluteus Medius Repair - Richard C. Mather, MD (CSMS #97, 2018) Richard Mather Knee & Sports - Hip Arthroscopy 11/25/2018 103 views Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Hip Arthroscopy and Open Hip Procedure Rehabilitation - Melissa Strzelinski, PT, MPT (CSMS #95, 2018) Knee & Sports - Hip Arthroscopy 11/25/2018 88 views Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Open Hip Surgery for Borderline Dysplasia - Joel C. Williams, MD (CSMS #91, 2018) Joel Williams Knee & Sports - Hip Arthroscopy 11/25/2018 107 views Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Arthroscopic Treatment of Borderline Dysplasia - Shane J. Nho, MD, MS (CSMS #90, 2018) Knee & Sports - Hip Arthroscopy 11/25/2018 82 views Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery It’s All About the Labral Repair - John D. Kelly IV, MD (CSMS #86, 2018) Knee & Sports - Hip Arthroscopy 11/25/2018 190 views Login to View Community Videos Login to View Community Videos 2017 HSS Holiday Knee & Hip Course Hip Preservation Overview, Case Presentations: MRI and Arthroscopy Correlation - Danyal H. Nawabi, MD, FRCS and Douglas Mintz, MD Knee & Sports - Hip Arthroscopy 9/5/2018 195 views Login to View Community Videos Login to View Community Videos 2017 HSS Holiday Knee & Hip Course Hip Preservation or Total Hip Replacement? - Robert L. Buly, MD Knee & Sports - Hip Arthroscopy 8/30/2018 567 views Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2018 Incorporating Hip Arthroscopy into My Practice - Marc Safran, MD (COA 2018, 10.4) Knee & Sports - Hip Arthroscopy 8/30/2018 157 views Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2018 When to Refer for Hip Arthroscopy - Dean Matsuda, MD (COA 2018, 10.3) Knee & Sports - Hip Arthroscopy 8/30/2018 154 views Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2018 Evaluating the Painful Hip - Marc Safran, MD (COA 2018, 10.2) Knee & Sports - Hip Arthroscopy 8/30/2018 442 views Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2018 Arthroscopic Advances of the Hip and Pelvis - Dean Matsuda, MD (COA 2018, 10.1) Knee & Sports - Hip Arthroscopy 8/30/2018 87 views Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Hip Arthroscopy Complications: What Are we Seeing and Can we Prevent Them?? - Christopher Larson, MD (2.25, 2018 Winter SKS) Team Orthobullets (5) Knee & Sports - Hip Arthroscopy 7/16/2018 104 views Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Video Spotlight & Case Presentation: Hip Arthroscopy - Christopher Larson, MD ( 2.23, 2018 Winter SKS) Knee & Sports - Hip Arthroscopy 7/16/2018 124 views Login to View Community Videos Login to View Community Videos 2018 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine Hip Arthroscopy, Indications and Technique - Travis G. Maak, MD (2.22, 2018 Winter SKS) Knee & Sports - Hip Arthroscopy 7/16/2018 210 views Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2017 Hip Arthroscopy-Catherine Robertson ,M.D. (COA 2017, 9.2) Catherine Robertson Knee & Sports - Hip Arthroscopy 4/13/2018 274 views Login to View Community Videos Login to View Community Videos 2017 Chicago Sports Medicine Symposium: World Series of Surgery Approach to Failed Hip Arthroscopy - Richard C. Mather III, MD, MBA (CSMS #88, 2017) Richard Mather Knee & Sports - Hip Arthroscopy 11/17/2017 71 views Login to View Community Videos Login to View Community Videos 2017 Chicago Sports Medicine Symposium: World Series of Surgery Hip Arthroscopy Rehabilitation Principles - Phillip Malloy MS PT (CSMS #87, 2017) Knee & Sports - Hip Arthroscopy 11/17/2017 65 views Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Outcomes Assessment After Hip Arthroscopy - Richard C. Mather III, MD (CSMS #81, 2016) Richard Mather Knee & Sports - Hip Arthroscopy 10/26/2016 216 views Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Rehabilitation After Hip Arthroscopy - Caty Stegemann, PT (CSMS #82, 2016) Knee & Sports - Hip Arthroscopy 10/26/2016 178 views Upgrade to View Premium Videos Upgrade to View Premium Videos 2016 Chicago Sports Medicine Symposium When Arthroscopy is Not Indicated - Michael D. Stover, MD (CSMS #77, 2016) Michael Stover Knee & Sports - Hip Arthroscopy 10/26/2016 269 views Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Live Surgery Broadcast 12 PM - Saturday, August 6, 2016 - Shane Nho, MD, MS & Charles A. Bush-Joseph, MD (CSMS #92, 2016) Charles Bush-Joseph Knee & Sports - Hip Arthroscopy 10/26/2016 224 views Upgrade to View Premium Videos Upgrade to View Premium Videos Hip arthroscopy portal placement David Abbasi Knee & Sports - Hip Arthroscopy 12/16/2012 5072 views Upgrade to View Premium Videos Upgrade to View Premium Videos Arthroscopic Hip Iliopsoas release for Internal Snapping Hip Michael Hughes Knee & Sports - Hip Arthroscopy 2/12/2012 2023 views Upgrade to View Premium Videos Upgrade to View Premium Videos Hip Arthroscopy for Cam Lesion in Femoroacetabular Impingement David Abbasi Knee & Sports - Hip Arthroscopy 12/29/2011 2939 views Sports⎪Hip Arthroscopy Team Orthobullets 4 Knee & Sports Listen Now 11:32 min 15 hours ago 1 plays See More See Less
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