frank r. ebert, m.d. union memorial hospital baltimore, maryland hip arthroscopy

Frank R. Ebert, M.D.Frank R. Ebert, M.D.

Union Memorial HospitalUnion Memorial Hospital

Baltimore, MarylandBaltimore, Maryland

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Burman JBJS 1931Burman JBJS 1931• First published reportFirst published report

Level of Acceptance began in Level of Acceptance began in 1980’s 1980’s

Hip ArthroscopyHip Arthroscopy

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

Hip ArthroscopyHip ArthroscopyIndicationsIndications

Avascular NecrosisAvascular NecrosisOsteo ArthritisOsteo ArthritisSeptic ArthritisSeptic ArthritisLabral InjuriesLabral InjuriesLoose BodiesLoose BodiesForeign Body Foreign Body

RetrievalRetrievalPediatric DisordersPediatric Disorders

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip ArthroscopyIndicationsIndications

Hip ArthroscopyHip ArthroscopyIndicationsIndications

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

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

Fracture Table / Hip DistractorFracture Table / Hip Distractor

PositionPosition• Supine – Byrd-Supine – Byrd-Arthroscopy 94Arthroscopy 94

• Lateral – Glick-Lateral – Glick-Arthroscopy 87 Arthroscopy 87

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

PortalsPortals1)1) LateralLateral

2)2) Antero LateralAntero Lateral

3)3) Postero Lateral – not routinely usedPostero Lateral – not routinely used

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

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

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

Lateral Portal – 6” 18 gauge spinal needle Lateral Portal – 6” 18 gauge spinal needle under fluroscopic guidanceunder fluroscopic guidance

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

Seldinger Technique – cannulated obturator and Seldinger Technique – cannulated obturator and sleeves passed over a wiresleeves passed over a wire

Hip ArthroscopyHip ArthroscopyOperative TechniqueOperative Technique

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

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

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

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

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Hip ArthroscopyHip Arthroscopy

Thank youThank you