Basic Hip Arthroscopy: Diagnostic Hip Arthroscopy

Stone, Austin V.; Howse, Elizabeth A.; Mannava, Sandeep; Miller, Brooke A.; Botros, Daniel; Stubbs, Allston J.

doi:10.1016/j.eats.2017.01.013

Cited by 13 publications

(5 citation statements)

References 8 publications

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“…Hip arthroscopy was performed following standard approaches [30,31], and macroscopic intra-articular pathology was graded using the Outerbridge score for chondral lesions [32], the Lage classification for labral lesion [33], and the Ilizaliturri mapping system for topographic localization [34]. Surgeons were very careful in preserving tissues and avoiding labral debridement when repair of these structures is the goal.…”

Section: Macroscopic Findings and Tissue Sample Collectionmentioning

confidence: 99%

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

et al. 2020

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Background: Hip osteoarthritis (HOA) is the most common hip disorder and a major cause of disability in the adult population, with an estimated prevalence of end-stage disease and total hip replacement. Thus, the diagnosis, prevention, and treatment of the early stages of the disease in young adults are crucial to reduce the incidence of end-stage HOA. The purpose of this study was to determine whether (1) a relationship among the inflammatory status of labrum and synovium collected from patients with femoroacetabular impingement (FAI) would exist; and (2) to investigate the associations among the histopathological features of joint tissues, the pre-operative symptoms and the postoperative outcomes after arthroscopic surgery. Methods: Joint tissues from 21 patients undergoing hip arthroscopy for FAI were collected and their histological and immunohistochemical features were correlated with clinical parameters. Results: Synovial mononuclear cell infiltration was observed in 25% of FAI patients, inversely correlated with the hip disability and osteoarthritis outcome score (HOOS) pain and function subscales and with the absolute and relative change in total HOOS. All the labral samples showed some pattern of degeneration and 67% of the samples showed calcium deposits. The total labral score was associated with increased CD68 positive cells in the synovium. The presence of labral calcifications, along with the chondral damage worsened the HOOS post-op symptoms (adjusted R-square = 0.76 p = 0.0001). Conclusions: Our study reveals a relationship between the histologic labral features, the synovial inflammation, and the cartilage condition at the time of FAI. The presence of labral calcifications, along with the cartilage damage and the synovitis negatively affects the postoperative outcomes in patients with FAI.

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Section: Macroscopic Findings and Tissue Sample Collectionmentioning

confidence: 99%

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

et al. 2020

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“…All arthroscopic procedures were performed by a single surgeon. Patient positioning, surgical approach, and diagnostic arthroscopic examination were performed as described previously [27,28]. Arthroscopic assessment allowed for confirmation of impingement type and further characterization of chondral lesions including grade, size, and location.…”

Section: Methodsmentioning

confidence: 99%

Clinical presentation, imaging findings, and arthroscopic features in skeletally immature and mature adolescent hip patients: a comparative double-cohort retrospective study

Schallmo

Marquez-Lara

Luo

et al. 2021

Journal of Pediatric Orthopaedics B

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The purpose of this study was to evaluate differences in clinical presentation and extent of surgery required based on skeletal maturity between two cohorts of adolescent hip arthroscopy patients. We hypothesized that skeletal immaturity would be associated with a lower frequency of pincer impingement and a decreased need for surgical acetabuloplasty. A database of 1481 hip arthroscopies performed by a single orthopaedic surgeon between 2008 and 2016 was queried. Patients ≤18 years of age with femoroacetabular impingement were divided into two groups based on Risser score: Risser 1-4 (skeletally immature) or Risser 5 (skeletally mature). Groups were compared with respect to presentation, diagnosis, and arthroscopic procedures performed. Eighty-eight skeletally immature and 49 skeletally mature patients were included. Mixed impingement was more common in skeletally mature patients than immature (67.3% vs. 48.9%, P = 0.037). Skeletal maturity was associated with a significantly increased probability of undergoing acetabuloplasty (odds ratio = 4.6, 95% confidence interval 1.4-15.5; P = 0.014). Extent of chondral degeneration was similar between groups. Our findings support the hypothesis that skeletally immature hips undergo acetabuloplasty less frequently and demonstrate similar chondromalacia compared with a skeletally mature cohort. These results suggest that arthroscopic treatment for impingement-associated hip pain may be a reasonable option to consider for symptomatic skeletally immature patients who have completed a structured course of nonoperative treatment. Additional longitudinal outcomes data are needed to clarify the natural history of impingement-associated hip pain in younger populations and whether hip arthroscopy delays progression of osteoarthritis in these patients.

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“…Identification of the medial femoral circumflex artery and retinacular vessels through internal rotation and extension of the hip is important in the step to determine the safe zone for osteochondroplasty (typically between the 12- and 6-o'clock positions). 10 , 12 Once the capsule is visualized, a T-capsulotomy can be created with a radiofrequency probe (DYONICS RF SYSTEM; Smith & Nephew Endoscopy) or arthroscopic blade using the “fifty-yard line” or mid-point of the interportal capsulotomy as a starting point ( Video 1 , Fig 8 C). Capsular tagging stitches can then be placed within each limb of the T capsulotomy to provide enhanced retraction and visualization during cam lesion resection ( Fig 8 D).…”

Section: Surgical Technique (With Video Illustration)mentioning

confidence: 99%

Top Ten Pearls for Successful Hip Arthroscopy for Femoroacetabular Impingement

Perry

DeFroda

Gürsoy

et al. 2021

Arthroscopy Techniques

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Hip arthroscopy is an increasingly popular procedure used to treat femoroacetabular impingement. However, the procedure is technically challenging with a steep learning curve. To prevent complications and to optimize patient outcomes, proper patient positioning, correct portal placement, and adequate capsular closure are necessary. For central compartment procedures, creation of a minimal interportal capsulotomy, placement of traction stitches, adequate rim trimming, and balanced labral repair are recommended. For peripheral compartment procedures, adequate osteochondroplasty should be performed and assessed intraoperatively. The purpose of this technical note is to describe the senior author's top 10 pearls for a successful hip arthroscopy procedure to treat femoroacetabular impingement.

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Basic Hip Arthroscopy: Diagnostic Hip Arthroscopy

Cited by 13 publications

References 8 publications

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

Labral calcification plays a key role in hip pain and symptoms in femoroacetabular impingement

Clinical presentation, imaging findings, and arthroscopic features in skeletally immature and mature adolescent hip patients: a comparative double-cohort retrospective study

Top Ten Pearls for Successful Hip Arthroscopy for Femoroacetabular Impingement

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