1 / 72

Application of Hip Arthroscopy

Application of Hip Arthroscopy. Nadhaporn Saengpetch, MD. Objectives. To understand the spectrum of disease that is compatibly treated with hip arthroscopy Have a basic understanding of the relevant anatomy , history and examination for hip pain

cecile
Télécharger la présentation

Application of Hip Arthroscopy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Application of Hip Arthroscopy Nadhaporn Saengpetch, MD.

  2. Objectives • To understand the spectrum of disease that is compatibly treated with hip arthroscopy • Have a basic understanding of the relevant anatomy , history and examination for hip pain • To introduce the surgical technique and its limitation

  3. Once upon a time…. • 1802 Dr. Phillipp Bozzini “Lichtleiter” • 1931 Dr. Micheal S. Burman 20 cadaveric hip joints

  4. First Clinical Application : 1939 Dr. Kenji Takagi 2 Charcot joints 1 Tbc arthritis 1 Supparative arthritis J Jpn Orthop Assoc 1939

  5. Anatomy

  6. Hip Arthrogram

  7. Tip of Physical Exams • Differential diagnosis to intra/extra-articular pain, pubic pain • One joint above and below • Gait : LLD, pelvic obliquity • foot-progression angle & muscle contraction

  8. Impingement Sign

  9. Tip of Physical Exams • Intra-articular lesion : log rolling, McCarthy hip extension sign • SI problem : FABER test • Hip flexion contracture : Thomas test • Piriformis syndrome : sit & active ER • Hip dysplasia : anterior apprehension test ( extend & ER)

  10. FABER Test

  11. Differential Diagnosis of Groin Pain 4 zones of groin pain

  12. Differential Diagnosis of Groin Pain

  13. Osteitis Pubis : Soccer Player

  14. F 20 yo. w/ hx of posterior dislocation for 4 y. PTA

  15. CT scan

  16. 3D-CT scan

  17. Disorders That May Benefit from Hip Arthroscopy

  18. Labral Tears

  19. Labral Tears • Traumatic tears posterior hip dislocation pain/catching after twisting or slipping repetitive hyperflexion

  20. Labral Tears N. America : 436 hips, 96% were anterior lesion (twist, pivot) McCarthy JC. JBJS Am May 2005 Asian hips were most postero-superior lesion (hyperflex, squat) Ikeda T. JBJS Br June 1988

  21. MRI : Labral Tears

  22. Labral Tears • Degenerative tears OA hip relieve mechanical symptom in some pts did scope in early OA pts worsen outcome (Walton NP. Int Orthop June 2004)

  23. Arthroscopic Classification of Hip Labral Tears *Radial flap Radial fibrillated Lage LA. Arthroscopy Dec 1996. Longitudinal Complex

  24. Debridement of Labral Tears

  25. Arthroscopic Labral Repair

  26. Labral Tears • Hip dysplasia • selected patient • literatures devoid of studies this patient population, open acetabular osteotomy remains reasonable & well-described treatment • shollow acetabulum subluxate & distribute abnormal stress from a head on the labrum

  27. Chondral Lesions • Lateral impact mechanism ( by GT) • Associated labral tears 55.3% (McCarthy JC. Clin Orthop 2001) • Cartilage stimulation • ACI • Future : more predictable cartilage-resurfacing procedure

  28. Chondral Flap Tear and Microfracture

  29. Labral Lesion with Chondral Lesion • Subchondral cyst • formation • Synovial fluid • burrows beneath • the delaminating • cartilage and • subchondral bone

  30. Risk Factors of 2º OA from Labral Tears • With developmental dysplasia • Tears > 5 years old • Full-thickness chondral lesion

  31. Ligamentum Teres

  32. Ligamentum Teres Rupture • Deep anterior groin pain • Mechanical symptoms • History of significant trauma • Associated pathology : labrum, LB, chondral damage • ? Incidence (Byrd JWT. Arthroscopy April 2004)

  33. Ligamentum Teres Rupture

  34. Snapping Hip(Coxa Sultans Interna) Iliopsoas bursitis

  35. Iliopsoas Tendon Release

  36. Iliopsoas Tendon Release

  37. Pipkin Fracture

  38. Loose Bodies Removal

  39. Synovial Abnormalities • Chondromatosis • Crystalline disease • RA/SLE • Ehler-Danlos : capsular shrinkage

  40. Femoral Acetabular Impingement (FAI) • Leads to OA hip • anterior head-neck offset or acetabular overcoverage

  41. Radiographic Workup • AP view • Lateral view (Cross-table) • Lateral view (Dunn, false-profile) Alpha angle Control 42º FAI pt 74 º (Notzli HP. JBJS Br March 2002)

  42. MRI : coronal plain

  43. Cam Type • Caused by shear forces of the non-spherical position of the head against the acetabulum • Anterosuperior cartilage • Predisposing factors : SCFE, abnormal epiphyseal extension, malunion neck/head fracture, and femoral retroversion

  44. Cam Type

  45. Pincer Type • Repetitive stresses of a normal neck against an abnormal acetabular rim (over-coverage) • Antero-superior labrum “coup” • Postero-inferior head “contre-coup” • Predisposing factors : acetabular protrusio/retroversion, malunion acetabulum, 2˚ from osteotomy

  46. Pincer Type Normal Cross-over sign

  47. Mixed Type • Combine head/cup lesions • Less isolated type (Cam 9%, Pincer 5%) (Beck M. JBJS Br Jan 2005)

  48. Chilectomy (Osteochondroplasty)

  49. Arthroscopic Osteochondroplasty

More Related