m.p. muldoon, m. d. orthopedic medical group of san diego
Post on 27-Mar-2015
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M.P. Muldoon, M. D.Orthopedic Medical Group of San Diego
Hip joint is much less accessible than other joints
More technically difficult-need specialized equipment and expertise
Conditions warranting its use are rarer Use and indications are emerging
◦ Minimally invasive means of seeing inside the hip joint without cutting muscles or using big incisions much like is done in the knee or shoulder
◦ First done in 1930s but re-introduced in late 1980s by Dr. Glick of San Francisco
◦ Techniques and indications refined in mid-late 90s allowing more predictable results
◦ Even greater interest in last 4 years because of treatment of high profile athletes and improved techniques
Indications◦ Remove loose
bodies such as cartilage or bone from hip joint as on right
Indications◦ Investigate hip joint
for sources of mechanical pain and address them surgically
◦ To help diagnose hip pain sources when other test do not reveal source
Indications◦ The treatment of Femoral Acetabular
Impingement◦ Snapping Hip Syndromes◦ Recalcitrant Trochanteric Bursitis ◦ Repair or debridement of Labral tears
Indications◦ As an adjunct to other procedures in order to rule
out problems inside the hip joint or allow other procedures to be performed less invasively
Contraindications (reasons not to do hip arthroscopy)◦ Advanced arthritis ◦ Arthritis without mechanical symptoms
(catching, locking)◦ Very stiff hips◦ Fresh fractures or dislocations◦ Surgical problems in which opening the hip joint
is not necessary◦ Obesity…Sometimes the instruments are not
long enough
In order to view the hip joint without scuffing the cartilage it is necessary to use a traction device to open up the hip joint and allow instruments to be introduced
General or spinal anesthesia is preferred to allow for complete muscle relaxation
Special instruments have been designed to aid entry into hip joint and to remove damaged tissues
In Many cases surgery can be performed through two or three small incisions
In lower picture patient is draped and flouroscopy unit in position to guide procedure
29 year old woman with pain and catching after intense period of exercise 8 months previously
Xrays were normal but the MRI arthrogram showed a tear in the labrum
At surgery a torn labrum was diagnosed and excised
Patient was back to full activities at 3 months
Surgery is generally done as outpatient but more complex surgeries with longer anesthetics may stay overnight
The hip is injected with long acting anesthetic to ease transition to home.
Anti-inflammatories (NSAIDS) are prescribed for the first three weeks to aid in recovery with narcotics available for pain that does not respond to rest, ice and NSAIDS.
In Many cases you will wake up with a motion machine - CPM which helps with pain and early mobilization
Crutches for several days to weeks until strength comes back –Most patients can weight bear as tolerated
Most severe pain is experienced in first 48-72 hrs
Sutures are removed at two to three weeks
Sense of fullness that persists up to 6-8 weeks
Pain at the incision sites is similar to a bruise in intensity
Activity is progressed slowly with emphasis on low impact exercises for the first three months
In more complex cases for FAI - directed physiotherapy using a specialized rehabilitation protocol is employed
Complete recovery may take 6-9 months
◦ Temporary Nerve injuries can occur from traction on sciatic nerve or excess pressure from boot on top of foot. Most of these are markedly improved within a week but can last several weeks to months
◦ Infection or significant bleeding is extremely rare.◦ Instruments can break in the hip joint and may
require a bigger incision for removal◦ The surgery may not improve the condition and can
occasionally make an arthritic hip worse◦ Hips can become stiffer and actually form bone in
soft tissues known as Heterotopic ossification…this can be prevented by use of NSAIDS for 3 weeks postop
Summary◦ Hip arthroscopy provides a minimally invasive
approach to dealing with many sources of hip pain that are unresponsive to other treatments
◦ There is a low complication rate and a relatively rapid recovery after surgery
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