Complications and Reoperations During and After Hip Arthroscopy: A Systematic Review of 92 Studies and More Than 6,000 Patients

Pincer femoroacetabular impingement occurs in focal or global forms, the latter having more generalized and typically more extreme acetabular overcoverage. Severe global deformities are often treated with open surgical dislocation of the hip. Arthroscopic technical challenges relate to difficulties with hip distraction; central-compartment access; and instrument navigation, acetabuloplasty, and chondrolabral surgery of the posterior acetabulum. Techniques addressing these challenges are introduced permitting dual-portal hip arthroscopy with central-compartment access, subtotal acetabuloplasty, and circumferential chondrolabral surgery. The modified midanterior portal in combination with a zonespecific sequence of acetabular rim reduction monitored with fluoroscopic templating enables precision subtotal acetabuloplasty. Guidelines for acetabular rim reduction include the following suggested radiographic endpoints: postoperative center-edge angle of 35 , a neutral posterior wall sign, and an anterior margin ratio of 0.5. Arthroscopic zone-specific chondrophobic rim preparation and circumferential labral reparative and reconstructive techniques and tools permit the arthroscopic treatment of these challenging deformities.

Section: Global Pincer Femoroacetabular Impingement E201mentioning

confidence: 99%

Hip Arthroscopy for Challenging Deformities: Global Pincer Femoroacetabular Impingement

Matsuda

Gupta

Hanami

2014

“…With increased time performing the procedure, there is increased risk regarding sciatic nerve neurapraxia and perineal skin damage. 4 The technique also decreases the complication of fluid extravasation caused by increasing the pump pressure to increase the arthroscopic working space to improve visualization. 7 Arthroscopic surgery involving any joint can benefit from the use of a portal bridge retractor as we have described in this report.…”

Section: Discussionmentioning

confidence: 99%

“…Iatrogenic chondral or labral injury is seen in up to 6% of hip arthroscopy cases and can be due to inadequate visualization. 4 Adequate visualization of cam lesions can be a challenge to inexperienced surgeons in the peripheral compartment, and without visualization, those that are missed on preoperative imaging also can be missed intraoperatively. 5,6 We describe a simple but effective technique to improve visualization for arthroscopic hip procedures in the peripheral compartment.…”

mentioning

confidence: 99%

Hip Arthroscopic Portal Bridge Retraction Technique for Improved Peripheral Compartment Visualization

McGrath

Kuechle

2014

Hip arthroscopy has been shown to be an effective technique in managing an increasingly widening set of indications for hip pathology. In any arthroscopic procedure, obtaining good visualization is one of the most critical components to performing a successful operation. Whereas other authors have described various techniques for improving visualization, we describe an additional simple but effective technique in this report. We describe the use of a retracting suture bridge between portal sites that allows for improved visualization of the peripheral compartment in hip arthroscopy, as well as other arthroscopic procedures.

“…If left unrepaired, the capsular defect can become symptomatic and lead to instability, anterior hip pain, and in rare cases, subluxation or dislocation. 11 The magnitude of iatrogenic instability may be underestimated, because surgeons may fail to diagnose this relatively new entity. A previous study reported that 35% of patients who underwent revision hip arthroscopy were found to have undiagnosed direct observational instability.…”

Section: Discussionmentioning

confidence: 99%

The Quebec City Slider: A Technique for Capsular Closure and Plication in Hip Arthroscopy

Menge

Chahla

Soares

et al. 2016

Biomechanical and clinical studies have shown that the hip joint capsule plays an important role in maintaining stability and hip mechanics, including rotation and translation. The recent literature has shown that capsule closure after hip arthroscopy helps to restore stability. Without restoration of the native anatomy, the hip joint may translate when patients engage in activities that place force across the hip, leading to either microinstability or frank dislocation. The purpose of this note is to describe our preferred technique of capsular closure or plication during hip arthroscopy.