Arthroscopic Synovectomy of the Hip Joint: The Regional Surgical Technique

Tian, Kui; Gao, Guanying; Dong, Hanmei; Zhang, Weiguo; Wang, Jianquan; Xu, Yan

doi:10.1016/j.eats.2022.02.029

Cited by 2 publications

(4 citation statements)

References 19 publications

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“…8 Therefore, we have developed a standardized protocol to maximize the removal of loose bodies and synovium. 25 Applying this technique in the current study, we found that 14 of 23 patients (60.8%) had residual loose bodies, which was lower than 7 of 9 (77.8%) patients reported by Lee et al 12 Most of the residual loose bodies presented at the posterior capsule and posterior acetabular fossa on CT, areas that pose challenges for arthroscopic access. Extended incision of the lateroposterior joint capsule could also cause migration of loose bodies to outside of the joint, such as to the obturator externus and subcutaneous area.…”

Section: Discussioncontrasting

confidence: 43%

“…We divided the hip synovia of both the peripheral and the central compartments into 7 regions as described by Tian et al 25 As shown in Figure 1, hip synovia were separated into region 1, medial capsular recess; region 2, anterior capsular recess; region 3, lateral capsular recess; region 4, posteroinferior recess; region 5, posterosuperior recess; region 6, perilabrum; and region 7, acetabular fossa.…”

Section: Surgical Techniquementioning

confidence: 99%

“…and J.W.) with .10 years of experience in hip arthroscopy performed all operations using a standard supine approach 25 with the patient on a traction table (Smith & Nephew). Arthroscopic inspection, loose body removal, and synovectomy were performed in order from the peripheral compartment to the central compartment.…”

Section: Surgical Techniquementioning

confidence: 99%

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Longitudinal Assessment of Clinical Outcomes After Arthroscopic Treatment for Hip Synovial Chondromatosis and the Effect of Residual Loose Bodies: Minimum 4-Year and 8-Year Follow-up

Zhu,

Gao,

Luan

et al. 2024

Am J Sports Med

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Background: Arthroscopic treatment is recommended for hip synovial chondromatosis. However, evidence regarding long-term clinical outcomes is limited. Purpose: To evaluate long-term patient-reported outcomes (PROs) and survival, and to determine the potential effect of residual loose bodies, as evaluated by immediate postoperative computed tomography (CT), on clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between March 2010 and May 2015 were included in the study. Preoperative radiography, CT, and magnetic resonance imaging were performed. Preoperative, midterm (minimum of 4 years), and long-term (minimum of 8 years) PROs were collected for visual analog scale for pain, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and 12-item international Hip Outcome Tool (iHOT-12). The percentages achieving minimal clinically important difference (MCID) were calculated. PROs and survival were compared between patients with and without residual loose bodies evident on immediate postoperative CT scan. Results: A total of 28 patients (20% of patients were lost to follow-up) were included in the study with a mean follow-up period of 104.9 months (range, 96-139 months). PROs including visual analog scale for pain (preoperative, 3.8 ± 1.2; midterm, 0.9 ± 1.7; long-term, 0.8 ± 1.4), mHHS (preoperative, 66.4 ± 14.4; midterm, 92.8 ± 12.3; long-term, 93.5 ± 10.5), NAHS (preoperative, 45.2 ± 16.2; midterm, 81.8 ± 15.3; long-term, 83.1 ± 12.9), and iHOT-12 (preoperative, 48.4 ± 15.6; midterm, 69.3 ± 11.7; long-term, 72.7 ± 11.4) were improved at both midterm and long-term follow-up (all with P < .001). In total, 27 (96.4%), 28 (100%), and 26 (92.9%) patients achieved MCID for mHHS, NAHS and iHOT-12, respectively, at the long-term follow-up. No significant difference was found in any of the PROs and the rate of achieving MCID between midterm and long-term follow-up (all with P > .05). One patient (3.6%) underwent revision surgery. Among the 23 patients who had loose bodies on preoperative CT or radiographs, 14 patients (60.9%) with residual loose bodies evident on immediate postoperative CT demonstrated lower NAHS ( P = .045) and iHOT-12 ( P = .037) scores but a comparable survival ( P > .05) at long-term follow-up compared with those who did not have loose bodies. Conclusion: Arthroscopic treatment for hip synovial chondromatosis achieved satisfactory long-term clinical outcomes with strong survival. Most patients maintained or improved their overall functional status between midterm and long-term follow-up. Furthermore, patients with residual loose bodies had less favorable clinical outcomes, although the survival rate was comparable.

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Section: Discussioncontrasting

confidence: 43%

Section: Surgical Techniquementioning

confidence: 99%

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Longitudinal Assessment of Clinical Outcomes After Arthroscopic Treatment for Hip Synovial Chondromatosis and the Effect of Residual Loose Bodies: Minimum 4-Year and 8-Year Follow-up

Zhu,

Gao,

Luan

et al. 2024

Am J Sports Med

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“…Normally, we use 4 portals during the surgical procedure, as described in our previous study. 18 The AL portal is established first. The MAP is made from the AL portal with inspection using a 30° arthroscope.…”

Section: Surgical Techniquementioning

confidence: 99%