1. Update on Trauma and Orthopaedic Surgery
Henley Management College
8th May 2008

2. Hip arthroscopy

3. Indications for hip arthroscopy
Labral tears
Loose bodies / foreign bodies
Ligamentum teres tears
Synovial chondromatosis
Sepsis – diagnosis and treatment
Assessment of painful hip
Chondral lesions not seen on Xray / MRI

4. Pain C-sign distribution Groin Referred to L3 dermatome
(Anteromedial thigh)

5. Characteristic Hip Symptoms
Symptoms worse with activities:
Twisting / turning /changing directions
Rising from seated position (catching)
Difficulty with stairs (up and down)
Difficulty with getting in / out of cars
Difficulty with socks / toe nails / shoes etc.
Dyspareunia

6. Peripheral Compartment
Anterior neck
Medial neck
Medial head
Anterior head
Lateral head
Lateral neck
Posterior
Dienst et al (2001) Arthroscopy 17, 924

7. Central Compartment Articular cartilage Cotyloid fossa
Acetabulum
Femoral head
Cotyloid fossa
Ligamentum teres
Labrum

8. So how do we do it…

9. Central Compartment Set - Up
Problems
Large distraction force required
Specialist equipment
Operative time limited by distraction time
Complications

10. Complications Nerve traction injury
Pudendal and sciatic nerves
Direct nerve injury (portal placement)
Femoral and sciatic nerves
Perineal oedema / bruising / tears
Chondral scuffing

11. Supine Position Patient positioned supine on fracture table
Oversized padded perineal post
12cm outer diameter
Positioned laterally against the thigh

12. Table Options
S&N Hip Positioning System
Maquet Fracture Table

13. Lateral Position

14. Working Portals

15. Establishing Portals - 1
Anterolateral portal first – (safe zone)

16. Establishing Portals - 2

17. Establishing Portals - 3
Subsequent portals under direct vision

18. Labral Tears

19. Loose Bodies

20. Femoroacetabular impingement
Abutment of anterior femoral head-neck junction against anterior aspect of acetabular rim or labrum

21. Femoroacetabular impingement
First recognised as consequence of PAO
Dysplastic acetabulum repositioned in more anterior and lateral position
Proximal femur (insufficient head-neck offset) abutted against newly positioned anterior aspect of the acetabular rim in flexion, IR and adduction

22. Femoroacetabular impingement
Subsequently recognised in young active adults who presented with groin pain, and who had not had PAO
Arthrotomies revealed damage to the anterior aspect of the acetabular labrum and articular cartilage
Similar to what is seen in Perthes and SCFE
All have reduction in femoral head-neck offset

23. Imaging of FAI Femoral neck bump on Xray or MRI
Acetabular retroversion
Coxa profunda
Protrusio acetabuli
Ossification of rim

24. Alpha angle – fat sat T1 MRI
Kassarjlan et al: Radiology 2005; 236:
Abnormal if > 55 degrees

25. Cam and Pincer Impingement

26. Symptoms of FAI Slow onset of groin pain
Pain after trivial traumatic incident
Exacerbated by periods of activity
Pain on prolonged sitting and walking
Limited range of motion
IR and adduction in flexion

27. Peripheral Compartment

30. Controversies Will hip arthroscopy delay onset of arthritis
Is it better than mini-open procedures for FAI

32. www.readingorthopaediccentre.com Any questions….
Thank You!
Any questions….