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