Frank R. Ebert, M.D. Union Memorial Hospital Baltimore, Maryland Hip Arthroscopy.
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Transcript of Frank R. Ebert, M.D. Union Memorial Hospital Baltimore, Maryland Hip Arthroscopy.
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Frank R. Ebert, M.D.Frank R. Ebert, M.D.
Union Memorial HospitalUnion Memorial Hospital
Baltimore, MarylandBaltimore, Maryland
Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
Burman JBJS 1931Burman JBJS 1931• First published reportFirst published report
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Level of Acceptance began in Level of Acceptance began in 1980’s 1980’s
Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip ArthroscopyPre-Op EvaluationPre-Op Evaluation
Mechanical SymptomsMechanical Symptoms• Catching / LockingCatching / Locking• Pain with hip flexion and internal rotationPain with hip flexion and internal rotation
History of some torsional event about hipHistory of some torsional event about hip
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Hip ArthroscopyHip ArthroscopyIndicationsIndications
Avascular NecrosisAvascular NecrosisOsteo ArthritisOsteo ArthritisSeptic ArthritisSeptic ArthritisLabral InjuriesLabral InjuriesLoose BodiesLoose BodiesForeign Body Foreign Body
RetrievalRetrievalPediatric DisordersPediatric Disorders
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip ArthroscopyIndicationsIndications
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Hip ArthroscopyHip ArthroscopyIndicationsIndications
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Hip ArthroscopyHip ArthroscopyPre-Op EvaluationPre-Op Evaluation
Plain radiographs – AP pelvis / LateralPlain radiographs – AP pelvis / Lateral
MRI – gadolinium enhancement plus MRI – gadolinium enhancement plus marcainemarcaine
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
Fracture Table / Hip DistractorFracture Table / Hip Distractor
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PositionPosition• Supine – Byrd-Supine – Byrd-Arthroscopy 94Arthroscopy 94
• Lateral – Glick-Lateral – Glick-Arthroscopy 87 Arthroscopy 87
Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
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PortalsPortals1)1) LateralLateral
2)2) Antero LateralAntero Lateral
3)3) Postero Lateral – not routinely usedPostero Lateral – not routinely used
Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
Technique Supine Technique Supine PositionPosition• Foot tractionFoot traction• Well padded perineal Well padded perineal
postpost• Lateral distraction - Lateral distraction -
KeyKey
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
Lateral Portal – 6” 18 gauge spinal needle Lateral Portal – 6” 18 gauge spinal needle under fluroscopic guidanceunder fluroscopic guidance
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
Seldinger Technique – cannulated obturator and Seldinger Technique – cannulated obturator and sleeves passed over a wiresleeves passed over a wire
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
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Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique
Seldinger Technique Seldinger Technique – antero lateral portal– antero lateral portal• Line drawn at Line drawn at
intersection of ASIS intersection of ASIS and trochanteric lineand trochanteric line
• 4545o o cephalad and 30cephalad and 30o o
toward the midlinetoward the midline
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Hip ArthroscopyHip ArthroscopyResultsResults
Most common reason Most common reason for arthroscopyfor arthroscopy• Labral Tear – 70 to 80 Labral Tear – 70 to 80
percent success ratepercent success rate
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip ArthroscopyComplicationsComplications
Pudendal nerve neurapraxiaPudendal nerve neurapraxia
Lateral femoral cutaneous neurapraxiaLateral femoral cutaneous neurapraxia
Chondral scuffs from inadequate distrationChondral scuffs from inadequate distration
Sciatic neurapraxia – avoid postero lateral Sciatic neurapraxia – avoid postero lateral portalportal
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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Hip ArthroscopyHip Arthroscopy
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