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Indications for Hip Arthroscopy
J. Bohannon Mason, MD
Ortho Team Course
Dallas, TX November 11, 2016
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Consultant DePuy-Synthes, OrthoSensor
Royalties DePuy-Synthes
Associate Editor, Journal of Arthroplasty
Board/Committee AAHKS Publications
Institutional Research Funding Depuy-Synthes, Smith Nephew Richards, Stryker, Smith Arthritis Fund
Disclosures
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Introduction
• Surgical treatment of symptomatic hip disease has changed over the last decade
– Arthroscopy– Osteotomy (PAO)– Surgical hip
dislocation
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Goals
• Review Established Indications for hip arthroscopy
• Discuss evolving indications for hip arthroscopy
• Review contra-indications for hip arthroscopy
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Development of Arthroscopic Techniques
• Improved instrumentation• Co-adaptation of shoulder techniques• Clear evolution of hip specific techniques
– T capsulotomy– Labral fixation– Flexible/angled instrumentation
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Explosive Growth of Hip Arthroscopy
• 3.6 16.7 per 100,000• 460% increase in utilization• Expanding Recognition of pathology• Mainstream education of residents• Fellowship programs dedicated
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Hip Arthroscopy
• Setup
– Supine or Lateral decubitus position
– Requires Traction• 50lbs, 10mm• Goal <90min
– C-Arm
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Hip Arthroscopy
• Approach/Technique
– 2 or 3 portals• 3rd- Distal anterior
lateral (DALa) -improved placement of anchors
• Do not go past midline to avoid injury to LFCN
ASISMid-anterior Portal
DALa
Anterolateral Peritroch
Posterolateral peritroch
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Established Indications
• FAI• Labral tears• Loose bodies• PVNS, synovial
based pathologies• Ligamentum tears
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Labral Repair
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Femoroacetabular Impingement
• Process by which a misshapen hip joint secondarily leads to breakdown of the intra-articular structures causing pain and dysfunction
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FAI – Structural Impingement
• Acetabular rim impingement
• Associated labrallesions
• Femoral impingement
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28 yo CAM/FAI
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Isolated Intra-articular Abnormalities
• Labral tears -traumatic
• Ligamentum tear• Loose bodies
– Synovial osteochondromatosis
– trauma• Synovitis
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Isolated Peri-articular Abnormalities
• Excision of OsAcetabuli– Associated
labral tear/repair
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Extra-articular Femoro-Pelvic Impingement
Trochanteric Pelvic Impingement
Subspine Impingement IschiofemoralImpingement
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Evolving Indications
• Psoas impingement• Peri-articular soft
tissue procedures– IT band release– Abductior repair
• Ischiofemoralimpingement
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Evolving Indications
• Psoas impingement• Peri-articular soft
tissue procedures– IT band release– Abductior repair
• Ischiofemoralimpingement
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37 yo with painful grinding sensation/sound with walking
Ischiofemoral impingement
Quadratus femorus
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Contra-Indications for Hip Arthroscopy
• Advanced intra-articular disease– Acetabular cyst
formation– Vacuum sign– Posterior/inferior
osteophyte formation
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Contra-Indications for Hip Arthroscopy
• FAI with Tonnis 2 or higher– Severity of lesions
dependent on • Degree of structural
conflict• Duration symptoms
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Contra-Indications for Hip Arthroscopy
• Complex/extensive pathomorphology– Posteriolateral
extension of CAM– Global rim trim– Pediatric disease
sequelae• SCFE• Perthes
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Contra-Indications for Hip Arthroscopy
• Severe Acetabularretroversion– Antero-superior over
coverage– Posterior wall sign– Ischial spine sign
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Contra-Indications for Hip Arthroscopy
• Posterior femoral neck pathology
• CAM lesion that extends posterior to retinacular vessels
Osteochondromaon femoral neck
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Contra-Indications for Hip Arthroscopy
• Inaccessible hip
– Obesity– Heterotopic
ossification– Severe scaring
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Contra-Indications for Hip Arthroscopy
• Dysplasia
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Conclusions• Excellent clinical outcomes can be
expected with established indications– FAI– Isolated intra-articular hip abnormalities
• Can be effective adjunct to open procedures
• Major contra-indications are established OA and major structural deformities
• Future study is needed to delineate evolving indications
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Thank You