Hip Arthroscopy: Applications and Technique

McCarthy, JC

doi:10.5435/00124635-199505000-00001

Cited by 134 publications

(47 citation statements)

References 17 publications

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“…Although many of the earliest applications of the technique were designed to address soft tissue lesions in the joint such as labral tears, cartilage lesions, and loose bodies [21,23,27,37,39,41], a growing body of literature has suggested specific patterns of underlying bony morphologic features of the hip may be responsible for the chondrolabral disorders historically treated by arthroscopy [4,14,34,42]. As a result, there has been a relative shift in the focus of hip arthroscopists toward these bony abnormalities, chief among them the cam and pincer lesions that comprise femoroacetabular impingement (FAI).…”

Section: Introductionmentioning

confidence: 99%

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Heyworth

Dolan²,

Nguyen

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Currently, plain radiographs and MRI are the standard imaging modalities used for diagnosing femoroacetabular impingement (FAI) and preoperative planning for arthroscopic treatment of FAI. The value of three-dimensional (3D) CT for these purposes is unclear. Questions/purposes We therefore determined the reliability of CT assessment of FAI and whether CT findings of hip disease predict arthroscopic findings. Methods We retrospectively assessed the preoperative CT scans of 118 patients who underwent primary hip arthroscopy. Intraoperative findings, including size of the cam lesion, presence of an acetabular labral articular disruption lesion, and one of four types of labral tear were recorded and compared with the retrospectively read CT findings. Results Agreement analysis between CT and intraoperative detection of FAI yielded kappa values of 0.48 for cam lesions and 0.16 for pincer lesions. Increasing values for the CT-based alpha angle correlated with increasing severity of arthroscopically assessed acetabular labral articular disruption grade. Each pattern of FAI predicted a specific labral tear type. Conclusions Our data suggest CT has moderate value in predicting mechanically based labral tear patterns, although better parameters for assessment of pincer lesions are needed. Diagnostic assessment of patients with suspected FAI may be improved with use of 3D CT. Level of Evidence Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Introductionmentioning

confidence: 99%

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Heyworth

Dolan²,

Nguyen

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…3 of all labral tears seen during hip arthroscopy have associated articular cartilage damage, and it is the extent of this associated injury that is often the limiting determinant on the outcome of arthroscopic labral débridement [5,6,28,30,31,42]. MRI arthrograms are accurate for preoperatively detecting labral lesions, but they have limitations in detecting associated acetabular cartilage delamination [5,7,15,23,43].…”

Section: Discussionmentioning

confidence: 99%

“…Hip arthroscopy is useful in the treatment of labral tears, but labral excision alone does not completely resolve hip pain in patients with concomitant cartilage injury, with success rates of only 21% reported [5,17,35,42]. Microfracture of the acetabulum or acetabular rim resection can be performed in conjunction with the arthroscopy, but in either case the chondral delamination will alter the prognosis and postoperative rehabilitation protocol [6,8,11,28,32,39,40,42]. An open femoroacetabular osteoplasty with resection of as much as 1 cm of the rim of the acetabulum to remove the site of chondral delamination can be planned if preoperatively it is recognized the labral tear is associated with acetabular cartilage delamination [35].…”

Section: Discussionmentioning

confidence: 99%

Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

Gdalevitch

Smith

Tänzer

2008

Clin Orthop Relat Res

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The treatment and prognosis of labral tears of the hip depend primarily on whether there is concomitant injury of the adjacent acetabular articular cartilage. We asked whether a delamination cyst on the preoperative plain radiographs correlated with delamination of the acetabular articular cartilage at the time of hip arthroscopy. We reviewed the preoperative radiographs of 125 consecutive hips that had a labral tear at hip arthroscopy for the presence of a delamination cyst. A delamination cyst was defined as an acetabular subchondral cyst either directly adjacent to a lateral acetabular cyst or in relation to a subchondral crack in the anterosuperior portion of the acetabulum. All patients with acetabular cartilage delamination at arthroscopy were identified. There were 16 patients with delamination cysts on radiographs and 15 patients with cartilage delamination at arthroscopy.

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“…16,17 Venting the joint or injecting normal saline solution with joint distention can aid in breaking the suction seal and facilitate distraction across the hip joint; in some instances these forces are reduced to 50 lb (23 kg). 18,19 The complications related to excessive traction force or the duration of the applied traction are well documented and include, but are not limited to, pudendal neurapraxia, sciatic nerve injury, lower-extremity skin compromise, and genital injury. 9,10,[20][21][22][23] Optimal surgical outcomes after hip arthroscopy hinge on many factors, including safe, reproducible positioning of the patient on the operating table for optimal surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation

Mannava

Howse

Stone

et al. 2015

Arthroscopy Techniques

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Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases.

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Hip Arthroscopy: Applications and Technique

Cited by 134 publications

References 17 publications

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation

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