Complications of arthroscopic surgery of the hip

Arthroscopic osteochondroplasty has become the most common treatment for cam-type femoroacetabular impingement. However, gauging the appropriate depth and location of the femoral osteochondroplasty remains challenging, given the parallax observed from using a 70 arthroscope across multiple viewing perspectives. Consequently, reliable techniques must use a combination of arthroscopic and fluoroscopic checks and balances to assess the femoral head-neck junction to help guide bony resection. We have developed a technique for osteochondroplasty that has made the process more efficient and reliable in our hands. It involves creating a trough at the apex of the osteochondroplasty and then contouring the proximal and distal regions to re-create normal proximal femoral geometry. This article details our technique for femoral osteochondroplasty, which can be performed alone for isolated cam impingement or in concert with other intra-and extra-articular procedures to address associated hip pathology.

Section: Discussionmentioning

confidence: 99%

Arthroscopic Femoral Osteochondroplasty for Cam-Type Femoroacetabular Impingement: The Trough Technique

Aoki

Beckmann

Wylie

2016

“…For viewing and palpation of the central side of the acetabular rim, traction and arthroscopy of the central compartment are needed. 6,7 Arthroscopy of the central compartment under traction with assessment of the chondrolabral junction can be performed when the diagnostics and potential treatment of the PC are completed. However, knowledge of the condition of the acetabular labrum during the diagnostic assessment through the PC is beneficial for different reasons: (1) The pattern of pathologic changes of the labrum is an important piece in the "diagnostic puzzle" in determining the underlying osseous pathology.…”

Section: Discussionmentioning

confidence: 99%

Compression and Flip Test for Diagnosis of Unstable Acetabular Labral Tears Using a Peripheral Compartment Approach

Apivatgaroon

Dienst

2016

Assessment of integrity of the acetabular labrum is generally done via the central compartment under distraction of the femoral head from the acetabulum. With the technique of raising the extra-articular and peripheral compartment first, there is a need for testing the stability and function of the labrum from the peripheral side in a nondistracted position of the joint. The authors report on the compression and flip test (i.e., the flip test) for the detection of unstable, intrasubstance tears of the labrum or unstable chondrolabral separations. The test can be performed by compressing the labrum with blunt instruments. We grade the labral conditions as follows: grade 0 for firm resistance and elasticity to palpation, grade 1þ as easily compressed by the probe, grade 2þ for eversion of the body of the labrum under compression), and grade 1 for ossified, hard resistance without any elasticity and compressibility. This test can be performed directly after accessing the peripheral compartment through a 2-portal technique without extensive capsular work.

“…Several cases of dislocation or subluxation of the joint after hip arthroscopy have been reported in the literature. 15 A frequent problem is postoperative microinstability, especially in patients with hyperlaxity or an alteration in the normal bony anatomy. Bedi et al, 6 who advocate performing a T-capsulotomy to increase the view in the peripheral compartment, highlight the importance of iliofemoral ligament repair after surgery to prevent residual joint instability.…”

Section: Discussionmentioning

confidence: 99%

A Less-Invasive Technique for Capsular Management During Hip Arthroscopy for Femoroacetabular Impingement

Fiz

Sánchez

Pérez

et al. 2014

The aim of this work is to describe a new arthroscopic technique for the treatment of femoroacetabular impingement that allows a complete articular joint view with maximum protection of the capsuloligamentous complex. This arthroscopic technique avoids injury to the capsuloligamentous complex, preventing the risk of postoperative instability. The diagnosis of femoroacetabular impingement was based on clinical and radiographic grounds. An alpha angle greater than 50 was considered pathologic. In this technique, the use of intra-articular devices (retractors) allows us to separate the capsular tissue from the femoral head-neck junction and mobilize the capsule, achieving an adequate joint view without performing a capsulotomy and, consequently, avoiding the complications of capsular damage.