Use Of Hip Arthroscopy Research Articles

Limited Retinacular Vessel Damage Does Not Compromise Femoral Head Perfusion During Hip Arthroscopy - Can the Vascular Safe Zone be Extended?

Objectives:The utilization of hip arthroscopy for FAI is on the rise. Hip arthroscopy has been shown to be safe to the blood supply of the femoral head when performing femoral osteochondroplasty. There are no reports of avascular necrosis of the femoral head after hip arthroscopy from cohort studies. Arthroscopic safe zones have been identified, based on femoral head vascularity studies, that extend from the lateral synovial fold anterior to 12 o clock to the medial synovial fold at 6 o clock. However, advances in technique have allowed for treatment of more extensile posterolateral cam deformities with both arthroscopic and open approaches, and may therefore place a portion of the retinacular vessels at risk for injury. The purpose of this study was to quantify the effect of an extended arthroscopic femoroplasty on femoral head vascularity. We hypothesized that limited retinacular vessel damage by extending a cam resection posterior to 12 o clock would not cause a significant reduction in femoral head perfusion.Methods:Ten fresh-frozen cadaveric specimens with an intact pelvis and bilateral femurs were used. The mean patient age was 66 years (range, 64-69). Each pelvis was randomized to either the Standard Resection (SR) or Wide Resection (WR) group. In the SR group, bone was resected with a motorized burr from the lateral synovial fold at 12 o clock to the medial synovial fold, at a depth of 10mm. In the WR group, bone was resected as in the SR group but was then extended posterolaterally to 11 o clock, damaging the intervening vessels. For each pelvis, one hip was the experimental side and the contralateral hip served as a matched control. Arteriotomy was performed and the medial femoral circumflex artery origin was cannulated. After unilateral arthroscopic resection, all specimens underwent a gadolinium-enhanced MRI with a validated, quantitative protocol. A CT scan was then performed to confirm the zones of osseous resection. Contrast enhancement on MRI was quantified in four quadrants of the femoral head using custom analysis software. Statistical analysis was performed using a two-sided unpaired t-test to assess differences in femoral head perfusion between the specimens in both groups.Results:MRI quantification revealed that the perfusion of the entire femoral head was reduced by a mean of 5.0 ± 3.9% compared to the matched control side in the SR group. In contrast, femoral head perfusion was reduced by a mean of 11.1 ± 16.1% compared to the matched control side in the WR group. The reduction in femoral head perfusion between the SR and WR groups was not statistically significant (p = 0.49). There were no significant differences between groups (p > 0.32). Postoperative CT scans confirmed that all osseous resections in the SR group were within the 12 to 6 o clock arc and all osseous resections in the WR group extended posteriorly beyond 12 o clock but not posterior to 11 o clock.Conclusion:Posterolateral retinacular vessel damage not extending past 11 o clock results in 11% reduction in femoral head perfusion when performing arthroscopic femoral osteochondroplasty. This drop in perfusion is not significantly different to the reduction in perfusion observed when performing osseous resection within previously recognized vascular safe zones. These findings lend support to the use of hip arthroscopy to address extensile cam deformities, but must also be interpreted with caution as further encroachment on the retinacular vessels may result in a dangerous drop in perfusion.

Hip arthroscopy for the management of trauma: a literature review.

The first descriptions of the use of hip arthroscopy for traumatic injuries were presented in 1980. One paper described arthroscopy for the removal of a bullet fragment while others reported using hip arthroscopy to remove fragments following total hip arthroplasty. With the application of traction and modification of arthroscopic instruments, hip arthroscopy has become a useful tool in treating trauma to the hip. Most of the literature describes traumatic hip dislocation. Several studies have documented the successful use of arthroscopy for removal of loose bodies, but it has also been used to treat labral tears, chondral defects and acetabular rim fractures. Complications reported include fluid extravasation, the lowering of the patient's body temperature using cool saline irrigation and further injury due to unrecognized concomitant pathology.

Femoroacetabular impingement surgery: are we moving too fast and too far beyond the evidence?

Femoroacetabuler impingement (FAI) is becoming increasingly recognised as a potential pathological entity for individuals with hip pain. Surgery described to correct FAI has risen exponentially in the past 10 years...

Hip arthroscopy and osteoarthritis: Where are the limits and indications?

The use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years. The procedure has shown good and excellent results in symptom relief and function improvement for patients with femoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI. However, surgical results are less successful among patients with advanced articular damage and secondary hip osteoarthritis. The aim of this article is to present some clinical and imagenological tools to discriminate the good candidates for arthroscopic FAI treatment from those who are not, due to extensive articular damage.

Hip arthroscopy in the setting of hip arthroplasty.

Hip arthroscopy has traditionally been viewed as a hip preservation procedure performed in patients with native joint pathology. However, as the list of indications for arthroscopic hip intervention grows, further advances are expanding its use. The purpose of this systematic review was to examine existing evidence supporting the use of hip arthroscopy in the setting of hip arthroplasty. Using predetermined inclusion criteria, EMBASE, MEDLINE and PubMed were searched for articles addressing arthroscopic hip surgery performed in hips containing joint replacement arthroplasties. Inclusion criteria limited our search to human and English language studies addressing articles where clear surgical indications are described. Article screening was conducted in duplicate. Seven-hundred and forty-three studies were retrieved before duplicate screening, and 18 satisfied inclusion criteria. Eleven case series, six case reports and one prospective cohort study are included. In total, 171 patients underwent hip arthroscopy following previous arthroplasty. Indications for arthroscopy included iliopsoas tendinopathy (35.8%), symptomatic hips with no clear diagnosis despite extensive investigation (24.6%), periprosthetic infection (6.4%) and intra-articular loose bodies (3.5%). Almost all patients who underwent hip arthroscopy experienced positive outcomes from the procedure. Hip arthroscopy after hip arthroplasty is supported by our systematic review for a variety of indications. Hip arthroscopy can be a safe and effective method of treating hip arthroplasty patients with iliopsoas tendinopathy. Hip arthroscopy also has utility in patients with symptomatic hip arthroplasty despite exhaustion of other diagnostic avenues. A systematic review of level IV studies.

Arthroscopic Technique for Treatment of Combined Pathology Associated With Femoroacetabular Impingement Syndrome Using Traction Sutures and a Minimal Capsulotomy

The use of hip arthroscopy is gaining popularity for diagnostic and therapeutic purposes. With our increasing understanding of hip biomechanics and pathophysiology, our techniques for treatment are evolving as well. The main aim is to preserve the joint and prolong the degenerative process associated with femoroacetabular impingement (FAI). In general, combined pathology is encountered when a diagnosis of FAI is established. In our experience, we have seen large number of patients with a combination of cam and pincer lesions with or without associated labral tears. It is optimal to address all symptomatic pathology with one surgical intervention. The described technique shows the feasibility of dealing with the hip FAI pathology by using traction sutures on the capsule through a 2-portal technique.

Hip arthroscopy for femoroacetabular impingement: a health economic analysis.

There has been a significant increase in use of hip arthroscopy for femoroacetabular impingement over the last 10 years. However, some care providers in the United Kingdom are not commissioning such an intervention due to cost constraints and lack of published cost effectiveness studies. A cost analysis for a prospective cohort of 58 patients undergoing hip arthroscopy for femoroacetabular impingement was performed. The short form 12 six dimension health utility score (SF12-6D) was used. This was recorded preoperatively and one year after surgery. Three time points (one, two, and 10 years) from operation were used to calculate the quality-adjusted-life-years (QALYs) gained. Predicted need for conversion to total hip replacement and diminishing gain with time (5% per year) was incorporated into the two- and 10-year models. The Scottish Tariff was used to assign the cost of surgery. The number of QALYs gained one year after surgery was 0.159, which equated to a cost per QALY of £19,335. This cost decreased to £10,118 per QALY gained at two years, and further still to £2,677 per QALY gained at 10 years. Multivariable regression analysis found that a worse preoperative SF12-6D was an independent predictor of greater QALYs gained one year after surgery (R² = 0.51, p<0.001). At no point in time, from one year onwards, does hip arthroscopy for femoroacetabular impingement cost more than £20,000 per QALY, making it a cost-effective intervention according to the National Institute for Health and Clinical Excellence.

The ligamentum teres-its increasing importance.

The ligamentum teres (LT) has attracted much greater interest over recent years due to the increased use of hip arthroscopy. There have been advancements in our understanding of the LT’s biomechanical function and its role in hip and groin pain. Our ability to suspect LT tears by clinical examination and imaging has improved. Publications by many authors concerning LT tear treatment and outcomes continue to increase. This manuscript is a review of the function, mechanism of injury, clinical assessment, imaging, arthroscopic assessment, treatment, outcomes, reconstruction, and unusual conditions of the LT.

Complications following hip arthroscopy: a retrospective review of the McMaster experience (2009–2012)

The use of hip arthroscopy has been steadily rising as technology, experience and surgical education continue to advance. Previous reports of the complication rate associated with hip arthroscopy have varied. The purpose of this study was to report our experience with hip arthroscopy complications at a single Canadian institution (McMaster University). We performed a retrospective chart review of 2 hip arthroscopists at the same institution to identify patients who had undergone the index surgery and had been followed for a minimum of 6 months postoperatively. We used a standard data entry form to collect information on patient demographic and clinical characteristics, including age, sex, surgical indication and type of complication if any. A total of 211 patients underwent 236 hip arthroscopies. The mean age at time of surgery was 37 ± 13 years and mean follow-up was 394 ± 216.5 days. The overall complication rate associated with hip arthroscopy was 4.2% (95% confidence interval 2.3%-7.6%). We identified 4 major and 6 minor complications. Overall, hip arthroscopy appears to be safe, with minor complications occurring more frequently than major ones. However, surgeons should recognize the possibility of serious complications associated with this procedure. Future research should focus on prospective designs looking for potential prognostic factors associated with hip arthroscopy complications.

Hip Arthroscopy for Labral Tears in Workers’ Compensation

Background: Workers’ compensation (WC) status has been related to clinical outcomes; however, no comparative studies have been performed to assess 2-year outcomes between hip arthroscopy patients based on WC status. Purpose: To evaluate 2-year outcomes of patients receiving WC who underwent hip arthroscopy for labral tears and to compare outcomes with those of a matched control group not receiving WC. Study Design: Cohort study; Level of evidence, 3. Methods: During the study period between June 2008 and August 2010, data were collected on all patients treated with hip arthroscopy. Inclusion criteria for the study group were diagnosis of labral tear and WC status. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sport-Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. A matched-pair group of patients not associated with WC was selected in a 1:1 ratio according to age within 3 years, sex, surgical procedures, and radiographic findings. Results: Twenty-one hips were included in each group. Patients with WC status had significantly lower preoperative PRO scores for all measures (P < .001). However, there was no significant difference between VAS pain scores between the groups. Of the WC patients, 86% returned to work at a median 82 days postoperatively. For the WC group, the score improvement from preoperative to 2-year follow-up was 46 to 67.7 for mHHS, 39.3 to 66 for NAHS, 39.7 to 69.5 for HOS-ADL, and 15.3 to 49.8 for HOS-SSS. For the control group, the score improvement from preoperative to 2-year follow-up was 67.9 to 85.8 for mHHS, 62.6 to 84.4 for NAHS, 69.8 to 86.9 for HOS-ADL, and 41.9 to 73.8 for HOS-SSS. Both groups demonstrated statistically significant postoperative improvement in all scores, and the average amount of change of preoperative to postoperative scores between the 2 groups was only significantly different for the HOS-ADL in the control group (P = .043). However, the WC group demonstrated greater improvement in aggregate scores in the HOS-ADL. Pain scores decreased from 7 to 3.9 in the WC group and 5.8 to 3.2 in the control group and were not significantly different between the groups. Patient satisfaction was 6.8 for the WC group and 7.7 for the control group, with no significant difference between groups. Conclusion: Our study demonstrated that WC patients had significantly lower baseline PRO scores when compared with a matched-pair control group. However, both groups demonstrated statistically significant postoperative improvement in all scores. Patients with WC status started and ended with lower absolute scores but benefited from arthroscopic intervention for hip injuries. While patient and physician expectations may be adjusted accordingly, these results may reflect favorably on the use of hip arthroscopy for labral tears in the WC population.

The Use of Double-Loaded Suture Anchors for Labral Repair and Capsular Repair During Hip Arthroscopy

With the development of hip joint preservation procedures, the use of hip arthroscopy has grown dramatically over the past decade. However, recent articles have reported cases of hip instability after hip arthroscopy. Little is known about the role of static and dynamic stabilizers on hip joint stability, but there are concerns that an extensile capsulotomy or capsulectomy, osteoplasty of the acetabulum and proximal femur, and labral detachment or debridement during hip arthroscopy could potentially compromise hip stability. The safety parameters for arthroscopic hip surgery have not yet been fully established, and techniques are being developed for labral refixation and capsular repair after arthroscopic treatment of femoroacetabular impingement in an attempt to decrease the chance of iatrogenic hip instability or microinstability. The surgical technique presented in this article may provide anatomic repair of both the labrum and capsule using a double-loaded suture anchor technique. We believe that this technique increases both operative efficiency and the strength of the overall repair, which may minimize the risk of iatrogenic hip instability after hip arthroscopy.

Complications following hip arthroscopy: a systematic review and meta-analysis

The use of hip arthroscopy to address injuries and conditions about the hip is becoming more widespread. There are several narrative reviews regarding complications of hip arthroscopy but a systematic review is currently lacking. The primary goal of this study is to determine the complication rate associated with hip arthroscopy in the literature. A search of the EMBASE and Ovid Medline databases was performed to identify articles published between 1 January 2000 and 25 November 2011 that reported a complication rate after hip arthroscopy. Appropriate inclusion and exclusion criteria were applied to identify articles, and a meta-analysis was performed to determine an overall complication rate. Complications were divided into major and minor. A total of 66 papers (n = 6,962 hip arthroscopies) were identified and deemed appropriate for analysis. The overall complication rate was found to be 4.0 % (95 % CI 2.9-5.2 %). Of the 287 complications identified in the literature, 20 were deemed major constituting a rate of 0.3 %. Hip arthroscopy appears to be safe. The vast majority of complications are minor in nature. Prospective trials looking at the complications of hip arthroscopy would aid in identifying prognostic factors. Systematic review and meta-analysis, Level III.

Emergent Hip Arthroscopy: Life-saving Intervention for Septic Hip and Secondary Multiorgan Failure

This article describes the case of a 27-year-old female athletic trainer who presented to the emergency department in acute renal failure with rhabdomyolysis and disseminated intravascular coagulation following a brief onset of right hip pain and staphylococcal facial infection. Despite the absence of fever, peripheral leukocytosis, or organisms on gram stain from emergent joint aspiration, magnetic resonance imaging revealed a large hip effusion; a presumptive diagnosis of septic hip was made. Emergent hip arthroscopy was performed in the middle of the night within 3 hours of presentation. Minimally invasive, high-volume irrigation and debridement was rapidly performed using dual-portal arthroscopy. Although this approach required prolonged critical respiratory and hemodynamic support, the patient recovered from a life-threatening situation not often seen by arthroscopic or sports medicine surgeons. The unusual diagnosis of staphylococcal hip sepsis with multifocal dissemination was established, as was an atypical but important indication for emergent hip arthroscopy. Although generally implemented to improve quality of life, this case represents the use of hip arthroscopy to increase its quantity as well. Hip arthroscopy may have an emergent indication with life-saving potential.

Trends in Hip Arthroscopy

Recent advances in diagnosis and instrumentation have facilitated the arthroscopic treatment of hip pathology. However, little has been reported on trends in the utilization of hip arthroscopy. The purpose of this study was to examine changes in the use of hip arthroscopy as reflected in the American Board of Orthopaedic Surgery (ABOS) database. We also surveyed directors of both sports and joint reconstruction fellowships to determine attitudes toward hip arthroscopy training. The number of hip arthroscopy cases in the ABOS database during 1999 through 2009 was determined. A survey was devised to determine the type of hip arthroscopy training that was currently being offered at the fellowship level. The number of hip arthroscopy procedures performed by ABOS candidates increased significantly from 0.02 cases per candidate in 1999 to 0.36 cases per candidate in 2009 (p &lt; 0.0001). From 2003 through 2009, a significantly greater percentage of ABOS candidates with sports fellowship training (10.4%) than candidates without such training (2.9%) performed hip arthroscopy (p &lt; 0.0001). During this same time period, candidates in the Northeast and Northwest performed the most hip arthroscopy procedures as a percentage of total procedures (p &lt; 0.0001). Nearly half of the sports and joint reconstruction fellowships that included hip arthroscopy as a component of the training in 2010 had added it within the past three years. Fellows performed fewer than twenty hip arthroscopy cases per year in the majority of training programs. The number of hip arthroscopy procedures performed by candidates taking Part II of the ABOS examination increased eighteenfold between 1999 and 2009. This increase is likely the result of several factors, including an increase in the number of programs offering training in hip arthroscopy.

Hip arthroscopy in patients with painful hip following resurfacing arthroplasty

Determining the etiology of persistent groin pain after hip resurfacing arthroplasty (HRA) can be very challenging, even for the experienced surgeon. The purpose of the present study was to evaluate the use of hip arthroscopy as a diagnostic and therapeutic tool for the painful hip following resurfacing arthroplasty. In the present paper, the indications for arthroscopy and the arthroscopic findings in 15 patients with persistent and incapacitating groin pain following HRA are described. In all patients, nonsurgical diagnostic investigations such as ultrasound and radiography, blood sample analysis, and technetium and leukocyte-labeled scanning were inconclusive so that a definite diagnosis could not be established. In seven patients, synovial biopsies were taken arthroscopically to rule out metal sensitivity, low-grade infection, or excessive metal wear. A definite diagnosis from histological evaluation could be made in 5 out of the 7 patients. Five patients were clinical suspicious of iliopsoas tendinitis. Diagnostic arthroscopy and histological analysis of the synovial samples provided an alternative diagnosis in 2 out of the 5 patients. Three patients underwent femoral osteoplasty for impingement due to reduced anterior femoral offset with subsequent symptom relief. Hip arthroscopy after HRA is a valuable diagnostic alternative to open procedures in case of persistent groin pain, when noninvasive investigations fail to explain the symptoms. Multiple tissue samples should always be taken for histological examination and culture, as they are crucial in the final identification of the origin of the complaints.

Percutaneous Screw Fixation of Acetabular Fractures: Applicability of Hip Arthroscopy

Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy and a risk of intra-articular penetration. Evidence is lacking for any tools to provide visual scrutiny of fracture reduction and intra-articular screw penetration. We report 2 cases of fracture of the acetabulum that developed in young female athletes, in which the anterior column was fixed with a percutaneous screw by use of hip arthroscopy as an assisting tool for intra-articular observation. In our experience this method was found to be promising in terms of anatomic reduction of the fracture site, avoiding articular penetration during screw insertion, with additional advantages of joint debridement, lavage, and reduction in radiation exposure.

Hip arthroscopy: state of the art

The unique anatomy of the hip is challenging, and has slowed the progress of hip arthroscopy. The aim of this review is to provide an updated synthesis of existing clinical evidence on hip arthroscopy. A systematic computerized literature search was conducted by two independent reviewers using an iterative manipulation process of the keywords used singularly or in combination. The following databases were accessed on 30th November, 2009: PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez/); Ovid (http://www.ovid.com); and Cochrane Reviews (http://www.cochrane.org/reviews/). Case reports, literature reviews, letters to editors and articles not including outcome measures were excluded. Twenty-three publications met the inclusion criteria and were included. Hip arthroscopy can provide an alternative to traditional arthrotomy with great therapeutic potential. However, the available data do not allow definitive conclusion on its routine use. It is still unclear whether arthroscopy is superior to open surgery in the management of femoroacetabular impingement and labral lesions. Rather than providing strong evidence for or against the use of hip arthroscopy, this study generates potential areas for additional prospective investigations to evaluate the role of hip arthroscopy in clinical practice. There is a need to perform appropriately planned and powered studies to clarify the role of arthroscopy in hip pathology.

High resolution noncontrast MRI of the hip

The relatively thin cartilage of the hip joint, as well as its complex geometry, poses challenges for standardized, reproducible assessment of cartilage and the acetabular labrum. With appropriate pulse sequence parameters, however, accurate, reproducible assessment of cartilage and the labrum is feasible. More detailed evaluation of cartilage biochemistry may be obtained with techniques aimed at noninvasively evaluating the integrity of collagen and/or proteoglycan components in the articular cartilage. One of the benefits of noncontrast techniques lie in the ability to visualize the native synovium, and thereby detect the presence of synovial proliferative disorders, the clinical symptoms of which may mimic a labral tear or traumatic cartilage injury. Standard cartilage evaluation allows for the detection of surface delamination and osteoarthritis in the setting of femoroacetabular impingement, as well as subtle areas of subchondral collapse and secondary delamination of cartilage in the setting of osteonecrosis. This preserves the use of hip arthroscopy as a therapeutic rather than a diagnostic tool.

Arthroscopic management of an intraarticular osteochondroma of the hip

The role of hip arthroscopy in the management of femoroacetabular impingement (FAI) has been advancing rapidly. In this case report, we describe the use of hip arthroscopy to successfully treat a femoral neck osteochondroma that caused a symptomatic labral tear in a 37 year old woman. Hip arthroscopy offers several advantages to surgical dislocation of the hip in the management of intraarticular pathology and FAI. Hip arthroscopy is minimally invasive without the significant trauma to hip musculature, is useful in treatment of labral tears generated by FAI, and can be used to resect small lesions on the femoral head.

The Role of Arthroscopy in Evaluation of Painful Hip Arthroplasty

Unexplained pain after hip arthroplasty is frustrating for patients and surgeons. We describe the use of hip arthroscopy in management of the painful hip arthroplasty, critically evaluate the outcomes of these patients, and refine indications for hip arthroscopy in this setting. We retrospectively reviewed 14 patients (16 hips) who underwent hip arthroscopy after joint replacement. One patient had suspected septic arthritis despite negative aspiration and one had known septic arthritis but was not a candidate for open arthrotomy; two had intraarticular migration of hardware. The remaining 10 patients (11 hips) had persistent pain despite negative diagnostic studies. The two patients (two hips) with infection were successfully treated with arthroscopic lavage and débridement plus intravenous antibiotics. Intraarticular metal fragments and a loose acetabular screw were successfully removed in two patients (three hips). Findings in the remaining 11 hips included a loose acetabular component (one); corrosion at the head-neck junction of a metal-on-metal articulation (one); soft tissue-scar impingement at the head/cup interface (four); synovitis with associated scar tissue (four); and capsular scarring with adhesions (one). Arthroscopy represented a successful treatment or directly led to a successful treatment in 12 of 16 hips. We observed no complications as a result of the arthroscopy. Arthroscopy may be of value in selected patients undergoing hip arthroplasty with unexplained pain after an inconclusive standard workup. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.