|
https://upload.orthobullets.com/topic/3100/images/hip arthrscopy.jpg
https://upload.orthobullets.com/topic/3100/images/portals.jpg
https://upload.orthobullets.com/topic/3100/images/zona_orbicularis.jpg
https://upload.orthobullets.com/topic/3100/images/peripheral_compartment_medial_view.jpg
https://upload.orthobullets.com/topic/3100/images/zona_orbicularis_arthroscopic_image.jpg
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
 

Please rate topic.

Average 4.2 of 30 Ratings

Questions (6)
EVIDENCE & REFERENCES (13)
VIDEOS (10)
CASES (3)
GROUPS (2)
Topic COMMENTS (2)
Private Note