hip arthroscopy - orthosouth arthroscopy brandon cincere, md 979 e 3rd street ste c430 chattanooga,...
TRANSCRIPT
Hip Arthroscopy
Brandon Cincere MD
979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Overview
bull What is Hip Arthroscopy bull Anatomy bull History and Exam bull Differential Diagnosis bull Imaging bull Indications bull The Procedure bull Post op bull Specific Roles and Results
What is it
Not this
Anatomy
bull Congruent Stable Ball and Socket
Anatomy
bull Gliding (Articular) cartilage covers majority of femoral head ndash The Ball
bull The Cupsocket - Acetabulum consists of articular or gliding cartilage
Anatomy
bull Labrum ndash the gasket runs circumferentially around the socket
bull Labrums acts as stabilizing force increasing volume and Increasing surface area creating negative IA pressure
bull Acts a seal to resist fluid flow to allow fluid to stay within the central compartment maintaining low friction environment and cartilage nutrition
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Overview
bull What is Hip Arthroscopy bull Anatomy bull History and Exam bull Differential Diagnosis bull Imaging bull Indications bull The Procedure bull Post op bull Specific Roles and Results
What is it
Not this
Anatomy
bull Congruent Stable Ball and Socket
Anatomy
bull Gliding (Articular) cartilage covers majority of femoral head ndash The Ball
bull The Cupsocket - Acetabulum consists of articular or gliding cartilage
Anatomy
bull Labrum ndash the gasket runs circumferentially around the socket
bull Labrums acts as stabilizing force increasing volume and Increasing surface area creating negative IA pressure
bull Acts a seal to resist fluid flow to allow fluid to stay within the central compartment maintaining low friction environment and cartilage nutrition
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
What is it
Not this
Anatomy
bull Congruent Stable Ball and Socket
Anatomy
bull Gliding (Articular) cartilage covers majority of femoral head ndash The Ball
bull The Cupsocket - Acetabulum consists of articular or gliding cartilage
Anatomy
bull Labrum ndash the gasket runs circumferentially around the socket
bull Labrums acts as stabilizing force increasing volume and Increasing surface area creating negative IA pressure
bull Acts a seal to resist fluid flow to allow fluid to stay within the central compartment maintaining low friction environment and cartilage nutrition
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Not this
Anatomy
bull Congruent Stable Ball and Socket
Anatomy
bull Gliding (Articular) cartilage covers majority of femoral head ndash The Ball
bull The Cupsocket - Acetabulum consists of articular or gliding cartilage
Anatomy
bull Labrum ndash the gasket runs circumferentially around the socket
bull Labrums acts as stabilizing force increasing volume and Increasing surface area creating negative IA pressure
bull Acts a seal to resist fluid flow to allow fluid to stay within the central compartment maintaining low friction environment and cartilage nutrition
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Anatomy
bull Congruent Stable Ball and Socket
Anatomy
bull Gliding (Articular) cartilage covers majority of femoral head ndash The Ball
bull The Cupsocket - Acetabulum consists of articular or gliding cartilage
Anatomy
bull Labrum ndash the gasket runs circumferentially around the socket
bull Labrums acts as stabilizing force increasing volume and Increasing surface area creating negative IA pressure
bull Acts a seal to resist fluid flow to allow fluid to stay within the central compartment maintaining low friction environment and cartilage nutrition
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Anatomy
bull Gliding (Articular) cartilage covers majority of femoral head ndash The Ball
bull The Cupsocket - Acetabulum consists of articular or gliding cartilage
Anatomy
bull Labrum ndash the gasket runs circumferentially around the socket
bull Labrums acts as stabilizing force increasing volume and Increasing surface area creating negative IA pressure
bull Acts a seal to resist fluid flow to allow fluid to stay within the central compartment maintaining low friction environment and cartilage nutrition
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Anatomy
bull Labrum ndash the gasket runs circumferentially around the socket
bull Labrums acts as stabilizing force increasing volume and Increasing surface area creating negative IA pressure
bull Acts a seal to resist fluid flow to allow fluid to stay within the central compartment maintaining low friction environment and cartilage nutrition
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Capsule
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
History and PE
bull Separated into 2 sources
bull Extra-articular - Outside
bull Intra-articular - Inside
bull ldquohiprdquo pain ndash groin lateral anterior thigh buttock lower back
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Symptoms
bull Intra-articular hip pathology bull Typical pain pattern ndash anterior
groinmedial thigh bull ldquoCrdquo sign bull Pain worse with twisting activities
ascending descending stairs or inclines
bull Catching ndash in flexion to extension (rising form a seated position) sharp
bull Difficulty sitting with hip flexed for long periods of time putting on socks shoes getting inout car
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
History and Exam
bull Abnormal Gait
bull Deep pain that canrsquot be palpated
bull Decreased range of motion
bull Tightness in muscles surrounding the hip
bull Hip muscle weakness
bull Positive Impingement tests
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Differential Diagnosis
bull Musculotendinous strain hip flexors adductors hernia bull Bony injury bull Labralchondral injury bull Tendinitis bull Stresstraumatic fracture bull Childhood deformity bull Developmental Dysplasia bull Synovitis bull Infection bull Impingement bull Arthritis bull Referred from GU Intraabdominal abdominal wall hernias bull Back pain nerve compression
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Will I need any testsscans
bull Plain Xrays
bull MRIA
bull CT scan
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Imaging
bull Plain Radiographs
ndash Arthritic changes dysplasia deformity AVN Impingement loose bodies Fx pelvis lumbar pathology
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Imaging
bull MRI
bull Anesthetic Injection ndash 90 accuracy for detecting IA pathology
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Who should have Arthroscopic Hip Surgery
bull The majority of patients are bull Young active individuals with a history of hip pain
during or after activity and of gradual onset that has not responded to non-operative treatment ndash anti-inflammatory medication andor ndash physiotherapy
bull Patients with sudden onset of hip pain after a traumatic injury
bull This procedure cannot be used to treat established arthritis effectively
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Loose Bodies
ndash Clearest Indications obvious advantages
ndash LB from Trauma OA synovial chondromatosis
ndash FB - Bullets
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Labral Lesions Most common cause of mechanical
sxrsquos
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Chondral Injuries
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications bull FAI ndash Femoral ndash Acetabular Impingement
ndash Distinct entity that results in labral tearing articular breakdown and OA
ndash + impingement decreased ROM and Pinching ndash Typically in younger more active adults ndash Results from repetitive microtrauma to labrum at extremes
of ROM
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Animation of FAI
bull Cam
bull pincer
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
FAI
bull MRA findings associated with pts with impingement
ndash 93 abnl Femoral head shape (cam)
ndash 95 acetabular chondral abnormalities
ndash 100 AS labral Tears
ndash All 3 findings in 88
ndash Kassarjian 2005
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Non ndash round object squeezing in a round object ndash like a rock in a shoe
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Synovial Disease
ndash Synovectomy for
bull Inflammatory arthritides synovial chondromatosis PVNS
bull Focal vs diffuse
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Ruptured Ligamentum Teres ndash Can be a cause of painful
hip sx
ndash From twisting injury disloc
ndash Catching senstation
ndash 3rd most common pathology found in athletes undergoing arthroscopy
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Posttraumatic Osteophytes
ndash Impinging bone fragments secondary to trauma
Or Rim bone spurs blocking motion
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Instability
ndash Most commonly found in hyperlaxity states with normal joint geometry
bull Collegen vascular disorders ndash Ehlers-Danlos
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Adhesive Capsulitis (Frozen Hip)
ndash Rarely described in the hip
ndash Painful restricted ROM
ndash Precipitated by twisting or fall
ndash Post-surgical adhesions
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Indications
bull Septic Arthritis ndash Joint Infection
ndash With proper patient selection has advantage of reduced morbidity
ndash Successful in acutely infected Total hip replacement
bull Early diagnosis
bull Well-fixed components
bull Sensitive bacterial
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Who should NOT have this
bull Patient Not healthy enough for surgery
bull Severe arthritis
bull Severe deformity
bull Severe obesity
bull Superficial infection in the area
bull Previous hip surgery that blocks access
bull Avascular necrosis of the bonefracture
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Who should NOT have this
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
The Procedure
bull Steep Learning Curve ndash not just any surgeon bull General Anesthesia helliphelliphellipcomplete paralysis bull Traction bull Fluoroscopy ndash live x-ray bull Most important is consistency of the setup and comfort level of the surgeonstaff bull Evaluation
ndash Femoral Head ndash Acetabulum ndash Pulvinar ndash Ligamentum teres ndash Labrum ndash circumferential ndash Zona orbicularis ndash Femoral Neck ndash Peripheral Head and neck junction ndash Iliopsoas attachment ndash Central and peripheral compartments
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Incisions
bull 3 standard portals
ndash small incisions
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Central
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Peripheral Compartment
synovium labral seal vessels head deformity
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Peritrochanteric Space
bull Lateral Compartment
bull IT band
bull Bursa
bull Tendon tears
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Post ndash Op Rehab bull Based on DX amp TX bull Outpatient procedure ndash no hospital
stay ndash go home same day bull Early Physical Therapy- not aggressive bull Passive motion on Stationary bike
immediately elliptical pool bull Crutches ndash
ndash Debridementrepair ndash 2-4 wks short tem until functional AROM
ndash Microfracture ndash TTWB 6 ndash 8 wks
bull Back to Work 1-2 weeks based on comfort and occupation
bull Running ndash not allowed until pain and swelling are gone good hip stability ndash 2-3mos
bull Back to sport specific activities ndash 6 mos
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Potential Complications bull All surgery carries a risk Specific risks to hip arthroscopy are
bull Infection
bull Thrombosis
bull Bleeding
bull Stiffness
bull Fracture
bull Residual symptoms
bull Other - due to the fact the procedure is performed using traction muscular discomfort around the hip and lower back and very occasionally temporary numbness in the groin and thigh can occur
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Complications
bull AANA reviewed 1491 published cases
ndash Reported 134 complication rate
ndash Decreased with
bull Modern distractor
bull Traction time monitoring
bull Padding perineal posts greater than 9 cm
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Labrum Results
bull Debridement - labral tissue from the hip joint may remove its protective effect on joint cartilage leading to eventual chondral damage and premature osteoarthritis ndash Outcomes for Debridement 68-82 Successful
bull Worse outcomes with associated articular damage ndash 21 (Byrd 2000 2 year fu)(Farjo 1999)
ndash gt50 associated with some type of articular damage bull Preop Studies for associated articular findings relatively
ineffective bull 436 consecutive scopes 261 labral tears 73 assoc with
chondral damage (McCarthy 2001)
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Labrum Results
bull Larsen Arthroscopy 2009 ndash Labral refixation resulted in
better Modified HHS and a greater of good to excellent results compared to debridement with min 1 yr fu
bull Philippon JBJS BR 2009 ndash Min 2 yr fu repair was
statistically significant independent predictor of better functional scores
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Labrum
bull Clinical Outcomes 48 year fu
bull Traumatic cause secondary gain smokers were significant negative predictors
bull Preop activity level predictor of outcome and return to activity
bull Chondral (Gliding cartilage) damage and arthritis significant predictors of outcome
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Results
bull Philippon JBJS Br 2009 bull Outcomes following Hip Arthroscopy for FAI with
associated chondrolabral dysfunction min 2 year fu ndash Predictors of better outcome
bull Better Pre-op modified HHS bull Joint space gt2mm bull Repair labral pathology instead of debridement
ndash 10 of 112 pts went on to THA within ave 16 months bull Pts significantly older at time of scope bull Had less joint space - arthritis bull Lower mean preop mod HHS bull Poor cartilage condition bull No difference in gender body mass index or cam size
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
bull Philippon 2007
ndash 45 professional athletes underwent arthroscopic treatment for FAI
bull 93 rtn to professional level
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Treat the FAI lesion and the Labrum
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Arthroscopic txrsquos overall do
better than open txrsquos
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Further Outcome Studies
bull Demonstrating prevention or slowing the progression of arthritis
bull Labral reconstruction like ACL reconstruction
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Thank you
Brandon Cincere MD OrthoSouth 979 E 3rd Street Ste C430 Chattanooga TN 37403 Phone 423-624-6584 Fax 423-624-6588
Sports Medicine and Orthopaedic Surgery Treating Sports related injuries fractures Shoulder Hip amp Knee Arthroscopy University of Tennessee Clinical Instructor - Orthopaedics and Sports Medicine
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Bibilography
bull Matsuda DK A rare fracture an even rarer treatment the arthroscopic reduction and internal fixation of an isolated femoral head fracture Arthroscopy 2009 Apr25(4)408-12
bull Nouh MR Schweitzer ME Rybak L Cohen J Femoroacetabular impingement can the alpha angle be estimated AJR Am J Roentgenol 2008 May190(5)1260-2
bull Hack K Di Primio G Rakhra K Beauleacute PE Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers J Bone Joint Surg Am 2010 Oct 2092(14)2436-44
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Yen YM Briggs KK Kuppersmith DA Maxwell RB Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient a preliminary reportJ Pediatr Orthop 2008 Oct-Nov28(7)705-10
bull Larson CM Giveans MR Arthroscopic management of femoroacetabular impingement early outcomes measuresArthroscopy 2008 May24(5)540-6 Epub 2008 Jan 7
bull Bedi A Chen N Robertson W Kelly BT The management of labral tears and femoroacetabular impingement of the hip in the young active patient Arthroscopy 2008 Oct24(10)1135-45
bull Lodhia P Slobogean GP Noonan VK Gilbart MK Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology a systematic review of the clinimetric evidence Arthroscopy 2011 Feb27(2)279-86 Epub 2010 Oct 29
bull Botser IB Smith TW Jr Nasser R Domb BG Open surgical dislocation versus arthroscopy for femoroacetabular impingement a comparison of clinical outcomes Arthroscopy 2011 Feb27(2)270-8
bull Larson CM Guanche CA Kelly BT Clohisy JC Ranawat AS Advanced techniques in hip arthroscopy Instr Course Lect 200958423-36
bull Potter BK Freedman BA Andersen RC Bojescul JA Kuklo TR Murphy KP Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement Am J Sports Med 2005 Jun33(6)864-70 Epub 2005 Apr 12
bull Kamath AF Componovo R Baldwin K Israelite CL Nelson CL Hip arthroscopy for labral tears review of clinical outcomes with 48-year mean follow-up Am J Sports Med 2009 Sep37(9)1721-7 Epub 2009 Jul 22
bull Philippon MJ Schroder e Souza BG Briggs KK Labrum resection repair and reconstruction sports medicine and arthroscopy reviewSports Med Arthrosc 2010 Jun18(2)76-82 Review
bull Vaughn ZD Safran MR Arthroscopic femoral osteoplastychielectomy for cam-type femoroacetabular impingement in the athlete Sports Med Arthrosc 2010 Jun18(2)90-9 Review
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Bibliography
bull Ilizaliturri VM Jr Camacho-Galindo J Endoscopic treatment of snapping hips iliotibial band and iliopsoas tendon Sports Med Arthrosc 2010 Jun18(2)120-7 Review
bull Larson CM Arthroscopic management of pincer-type impingement Sports Med Arthrosc 2010 Jun18(2)100-7
bull Ilizaliturri VM Jr Complications of arthroscopic femoroacetabular impingement treatment a review Clin Orthop Relat Res 2009 Mar467(3)760-8 Epub 2008 Nov 19 Review
bull Salvo JP Troxell CR Duggan DP Incidence of venous thromboembolic disease following hip arthroscopy Orthopedics 2010 Sep 733(9)664 doi 10392801477447-20100722-10
bull Philippon MJ Stubbs AJ Schenker ML Maxwell RB Ganz R Leunig M Arthroscopic management of femoroacetabular impingement osteoplasty technique and literature review Am J Sports Med 2007 Sep35(9)1571-80 Epub 2007 Apr 9 Review
bull Shindle MK Voos JE Nho SJ Heyworth BE Kelly BT Arthroscopic management of labral tears in the hip J Bone Joint Surg Am 2008 Nov90 Suppl 42-19
bull Safran MR The acetabular labrum anatomic and functional characteristics and rationale for surgical intervention J Am Acad Orthop Surg 2010 Jun18(6)338-45 Review
bull Rylander L Froelich JM Novicoff W Saleh K Femoroacetabular impingement and acetabular labral tears Orthopedics 2010 May33(5)342-52 doi 10392801477447-20100329-21
bull Byrd JW Hip arthroscopy in athletes Instr Course Lect 200352701-9 Review
bull Byrd JW Jones KS Hip arthroscopy in athletes 10-year follow-up Am J Sports Med 2009 Nov37(11)2140-3 Epub 2009 Aug 14
bull Bartlett CS DiFelice GS Buly RL Quinn TJ Green DS Helfet DL Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture J Orthop Trauma 1998 May12(4)294-9
bull Larson CM Swaringen J Morrison G A review of hip arthroscopy and its role in the management of adult hip pain Iowa Orthop J 200525172-9
bull Glick JM Sampson TG Gordon RB Behr JT Schmidt E Hip arthroscopy by the lateral approach Arthroscopy 19873(1)4-12
bull Carreira D Bush-Joseph CA Hip arthroscopy Orthopedics 2006 Jun29(6)517-23 quiz 524-5
bull Byrd JW Hip arthroscopy the supine position Instr Course Lect 200352721-30 Review
bull McCarthy JC Hip Arthroscopy Applications and Technique J Am Acad Orthop Surg 1995 May3(3)115-122
bull Clohisy JC Zebala LP Nepple JJ Pashos G Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement J Bone Joint Surg Am 2010 Jul 2192(8)1697-706
bull Byrd JW Hip arthroscopy J Am Acad Orthop Surg 2006 Jul14(7)433-44
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33
Bibliography
bull Shetty VD Villar RN Hip arthroscopy current concepts and review of literature Br J Sports Med 2007 Feb41(2)64-8
bull Byrd JW Hip arthroscopy patient assessment and indications Instr Course Lect 200352711-9 Review
bull McCarthy JC The diagnosis and treatment of labral and chondral injuries Instr Course Lect 200453573-7 Review
bull Philippon MJ Briggs KK Yen YM Kuppersmith DA Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up J Bone Joint Surg Br 2009 Jan91(1)16-23
bull Bardakos NV Vasconcelos JC Villar RN Early outcome of hip arthroscopy for femoroacetabular impingement the role of femoral osteoplasty in symptomatic improvement J Bone Joint Surg Br 2008 Dec90(12)1570-5
bull Allen D Beauleacute PE Ramadan O Doucette S Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement J Bone Joint Surg Br 2009 May91(5)589-94
bull Noumltzli HP Wyss TF Stoecklin CH Schmid MR Treiber K Hodler J The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement J Bone Joint Surg Br 2002 May84(4)556-60
bull Horisberger M Brunner A Herzog RF Arthroscopic treatment of femoroacetabular impingement of the hip a new technique to access the joint Clin Orthop Relat Res 2010 Jan468(1)182-90
bull Haviv B Singh PJ Takla A ODonnell J Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damageJ Bone Joint Surg Br 2010 May92(5)629-33