Operative Hip Arthroscopy

J.W. Thomas ByrdEditor

Operative Hip Arthroscopy

Third Edition

EditorJ.W. Thomas Byrd, M.D.Nashville Sports Medicine FoundationNashville, TNUSA

ISBN 978-1-4419-7924-7 ISBN 978-1-4419-7925-4 (eBook)DOI 10.1007/978-1-4419-7925-4Springer New York Heidelberg Dordrecht London

Library of Congress Control Number: 2012940854

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This third edition remains dedicated to my family, Donna, Allison, and Ellen, and to the two fi nest surgeons that I have known, the late Benjamin Franklin Byrd, Jr., and James Reuben Andrews.

My father, B.F. Byrd, Jr., dedicated his entire life to fi ghting cancer, a much more admirable pursuit than anything that I will do. He detoured only brie fl y from this battle to champion another cause, as a highly decorated medical of fi cer overseeing the care of wounded from Normandy Beach through the fi elds of Europe. Through his lifelong example, he showed me what being a physician is all about. As he put it, “A surgeon is just a regular doctor, with a few special skills.”

Dr. Andrews taught me the art and the philosophy of sports medicine. He also taught me much about how to treat patients as people and, fortunately, he shared with me a few of his remarkable surgical skills. Perhaps more importantly, through his example, he instilled in me the burning desire to make the most of my abilities.

vii

Foreword to the Third Edition

One may be surprised to fi nd a foreword from an orthopedic surgeon who is not an expert in arthroscopy. However, the motivation comes from the mutual interest in joint preserving sur-gery of the hip.

Dr. Byrd merits to be one of the fi rst to describe the different technical aspects of hip arthroscopy in a textbook and editions one and two were well received by the orthopedic com-munity. The third edition is urgently awaited because it merges the latest technical progress with the pathophysiological concept of hip impingement, yet enhancing hip arthroscopy to a larger basis of raison d’etre and vice versa, offering an additional approach to the surgical treatment of hip impingement.

The book covers all technical aspects of today’s hip arthroscopy, and Dr. Byrd’s arthroscopic technique is safe, ef fi cient, and reproducible. The reader, however, should take into consider-ation that it pertains especially for the anterior impingement and it is very successful when this is the only localization. The more complex deformities, particularly when extra-articular com-ponents are hidden behind the intra-articular ones, may be better treated with open surgery; such complex deformities are less seen in a sports medicine practice but rather frequent in general and pediatric orthopedics.

It is foreseeable that ongoing progress of hip arthroscopy will necessitate in a few years time a further edition. The reader may then additionally wish to get information about the relevance of this treatment beyond the revival of athletic activities.

Switzerland Reinhold Ganz, M.D.

ix

Foreword to the Second Edition

Dr. Byrd’s textbook, Operative Hip Arthroscopy , is a must-have for every physician and sur-geon who cares for patients with hip problems. Dr. Byrd is to be complimented for advancing the art and science of medicine with this comprehensive dissertation that not only illustrates what is possible in the diagnosis and treatment of hip pathology but teaches a procedure that was thought to be impossible in the not too distant past.

This second edition is another major step forward in the application of minimally invasive procedures that, until recently, would only have been undertaken with great hesitation because of the magnitude of the surgical exposure. This text includes a comprehensive review of the pertinent anatomy and pathological processes that are potentially amenable to the ever widen-ing application of arthroscopy as well as the critical aspects of the physical examination and postoperative care.

Physicians and surgeons face the challenge of bringing these diagnostic tools and surgical treatments into the real world of everyday practice. This is no easy task, but this text goes a long way in helping to prepare them for this adventure. It continues the revolution in orthope-dic hip surgery that has been advanced by Dr. Byrd and his colleagues. It provides the best opportunity for learning these techniques outside of a personal visit and observation and will undoubtedly encourage others to join Dr. Byrd in advancing the techniques of arthroscopy in the hip.

Lanny L. Johnson, M.D.

xi

Foreword to the First Edition

The hip is a site of pathology ranging from degenerative disorders to work- and sports-related injuries. The hip is also one of the fi nal frontiers for arthroscopic intervention.

Unique anatomic considerations challenge the hip arthroscopist and have slowed the advancement of hip arthroscopy. The dense soft tissue encasing the joint, the relatively non-compliant capsule, and the ball-and-socket architecture constrain both access and maneuver-ability of instrumentation.

The evolution of hip arthroscopy has followed a different course from other joints. In the knee, for example, standard practice for recognized pathology evolved from open techniques to less invasive arthroscopic procedures. Conversely, in the hip, standard practice evolved from no treatment at all because of the failure to recognize the existence of these lesions. Arthroscopic assessment de fi ned the presence of symptomatic hip pathology amenable to something other than a total hip replacement, which is the major surgical procedure for patients with hip disease.

Rarely has arthrotomy been an accepted practice for elusive sources of hip pathology. However, arthroscopy for certain causes of hip pain offers an alternative where previously the only option was living within the constraints of the symptoms.

There are several merits to hip arthroscopy. First, arthroscopic assessment has identi fi ed previously unrecognized disorders. Second, arthroscopy is a less invasive alternative to arthro-tomy for certain pathologies. Third, for such elusive causes of hip pain as labral or chondral injuries, arthroscopy offers a de fi nitive treatment where none existed before. Fourth, it has a role as a staging procedure for osteotomy candidates and patients with avascular necrosis. Finally, arthroscopy may have a role as a palliative and temporizing procedure for select patients with degenerative hip disease.

The authors have prepared a comprehensive text covering all facets of hip arthroscopy. I believe the reader will fi nd this work informative and helpful in the care of patients and in the understanding of the principles of arthroscopic surgery of the hip. I congratulate the authors on their excellent work and wish the reader success in the challenging and rewarding endeavor of hip arthroscopy.

James R. Andrews, M.D.

xiii

Preface

Seven years elapsed between the fi rst and second editions of Operative Hip Arthroscopy . That period signaled a wave of growing attention to the hip. It has been another 7 years to the pub-lication of the third edition. During this time, there has been an explosion of interest in hip arthroscopy with exponential growth in the understanding of hip disorders and technology available for treatment. All of these latest advancements are contained within the pages of this third edition.

The earlier editions set the foundation for the proven fundamentals that have facilitated continuing intellectual and technological revolution. These many arthroscopic innovations have been garnered by a legion of brilliant young clinical scientists with a passion for hip arthroscopy, as well as insight from surgeons who perform open techniques. The revolution of less invasive arthroscopic and endoscopic methods is far from complete, but this third edition of Operative Hip Arthroscopy covers all the latest technology available for our patients.

This edition contains the newest advancements in atraumatic access to the joint and pro-vides an understanding of the numerous disorders to be encountered, ranging from FAI and beyond and the current treatments for preservation, restoration, and reconstruction. Management of problems in the central and peripheral compartments is detailed, and we have long been dealing with issues outside the joint such as the iliopsoas tendon. These less invasive methods have now expanded into the surrounding soft tissue regions of the hip. Arthroscopy has evolved into endoscopic techniques for the peritrochanteric space and subgluteal region and even ham-string disorders. We have rede fi ned some disorders such as greater trochanteric pain syndrome, abductor tendinopathies, and subgluteal syndrome previously described with open technology and have newly de fi ned some previously unrecognized problems.

There are unique challenges to hip arthroscopy that should discourage casual consideration of this procedure without clear indication and purpose. The dos and don’ts are clearly empha-sized in this text. If you prepare to embark on a case of arthroscopic surgery of the hip, be sure of your indications, be versed in the technique, but read about the complications twice. As my father’s chief, Barney Brooks, M.D., chief of surgery at Vanderbilt University, 1925–1952, was quoted as saying to one of his residents “Son, you don’t have to learn all the complications for yourself, you can read about a few of them.”

In summary, this textbook details the clinical assessment including examination and imag-ing that is necessary for patient selection in the decision making process for arthroscopy. The numerous forms of pathology and their treatment are detailed including expectations of out-comes and results. Of equal importance, efforts have been made to discern the underlying eti-ology and how to address this with the goal of genuinely improving the natural history and progression of many of these disorders.

xv

Acknowledgment

Sharon Simmons and Kay Jones have been involved since the beginning. They along with every member of the Nashville Sports Medicine team have been an essential element of every-thing that we have accomplished. Sharon has deftly orchestrated every manuscript and educa-tional endeavor, while Kay has tirelessly cared for and followed all the patients. Lisa Donnelly, fueled by her passion and drive, has reached iconic status within industry through her contribu-tions. Encouraged and supported by her mentors at Smith & Nephew, Lisa has raised the bar on industry commitment to hip arthroscopy. A legion of talented individuals have contributed to everything that we have done in surgery, including Jim who has assisted in more hip arthros-copy cases than any other known person. This just scratches the surface of those who have touched the lives of our patients and in fl uenced the treatment of patients worldwide. It takes a village.

J.W. Thomas Byrd

xvii

Contents

1 Overview and History of Hip Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1J.W. Thomas Byrd

2 Patient Selection and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7J.W. Thomas Byrd

3 Adult Hip Imaging for the Arthroscopist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Roy E. Erb

4 My Approach to Athletic Pubalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Michael Brunt and Raymond Barile

5 Current Understanding of Core Muscle Injuries (Athletic Pubalgia, “Sports Hernia”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67William C. Meyers, Adam Zoga, Tina Joseph, and Marcia Horner

6 Sportsmen’s Groin: Groin Pain: Always a Case for the Orthopedic Surgeon? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Ulrike Muschaweck and Luise Berger

7 Gross Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Oscar Fariñas Barberá and Ivan Sáenz Navarro

8 Portal Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99Oscar Fariñas Barberá and Ivan Sáenz Navarro

9 Arthroscopic Anatomy of the Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Carlos A. Guanche

10 Position and Distraction Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121Allston J. Stubbs and Austin V. Stone

11 Routine Arthroscopy and Access: Central and Peripheral Compartments, Iliopsoas Bursa, Peritrochanteric, and Subgluteal Spaces . . . 131J.W. Thomas Byrd

12 Loose Bodies: Tips and Pearls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Benjamin Domb and Itamar Botser

13 Labral Management: An Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171J.W. Thomas Byrd

14 Hip Arthroscopy: Management of Chondral Injuries. . . . . . . . . . . . . . . . . . . . . 185Christopher M. Larson, Rebecca M. Stone, and Corey A. Wulf

15 Lesions of the Acetabular Fossa (Ligamentum Teres and Pulvinar) . . . . . . . . . 197G. Peter Maiers II

16 Synovial Disease and Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203J.W. Thomas Byrd

xviii Contents

17 My Approach to Femoroacetabular Impingement . . . . . . . . . . . . . . . . . . . . . . . 215J.W. Thomas Byrd

18 My Approach to Femoroacetabular Impingement . . . . . . . . . . . . . . . . . . . . . . . 237Trevor R. Gaskill and Marc J. Philippon

19 Computer Navigation in Hip Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249Michael Knesek, Jack G. Skendzel, and Asheesh Bedi

20 Decision Making with Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263Thomas G. Sampson

21 Iliopsoas Tendon Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279Victor M. Ilizaliturri Jr., Humberto Gonzalez Ugalde, and Javier Camacho-Galindo

22 Iliotibial Band Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291Allston J. Stubbs and Phillip Mason

23 Abductor Tendinopathies and Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299Patrick Jost, Christopher Walsh, Asheesh Bedi, and Bryan T. Kelly

24 Subgluteal Space and Associated Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309Hal David Martin

25 Endoscopic Hamstring Repair and Ischial Bursectomy . . . . . . . . . . . . . . . . . . . 331Carlos A. Guanche

26 Hip Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339Carlos A. Guanche

27 Adhesive Capsulitis and Arthrofibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349J.W. Thomas Byrd

28 Total Hip Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359J.W. Thomas Byrd

29 Hip Arthroscopy in Adolescence and Childhood . . . . . . . . . . . . . . . . . . . . . . . . . 367Yi-Meng Yen and Mininder S. Kocher

30 Complex Hip Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377Trevor R. Gaskill and Marc J. Philippon

31 Compensatory Disorders Around the Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385Sommer Hammoud, Erin Magennis, James E. Voos, Asheesh Bedi, and Bryan T. Kelly

32 Complications of Hip Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403Richard C. Mather III, Avinish Reddy, and Shane J. Nho

33 Rehabilitation of the Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411Erica M. Coplen and Michael L. Voight

34 Perioperative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441Kay S. Jones, Elizabeth A. Potts, and J.W. Thomas Byrd

Appendix: Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545

xix

Contributors

Oscar Fariñas Barberá , M.D. Transplant Services Foundation, Musculoskeletal Tissue Unit , Sant Boi de Llobregat, Barcelona , Spain

Ray Barile , M.S. St. Louis Blues Hockey Club, Scottrade Center , St. Louis , MO , USA

Asheesh Bedi , M.D. Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery , Hospital for Special Surgery , Ann Arbor , MI , USA

MedSport , Ann Arbor , MI , USA

Luise Berger , M.D. Department of Plastic Surgery and Hand Surgery , Klinikum rechts der Isar , Munich , Bavaria , Germany

Itamar Botser , M.D. Hinsdale Orthopaedics Associates , Westmont , IL , USA

Loyola Stritch School of Medicine , Chicago , IL , USA

Michael Brunt , M.D. Section of Minimally Invasive Surgery , Barnes-Jewish Hospital, Washington University School of Medicine , St. Louis , MO , USA

J. W. Thomas Byrd , M.D. Nashville Sports Medicine Foundation , Nashville , TN , USA

Javier Camacho-Galindo , M.D. Adult Joint Reconstruction Service, Hip and Knee , National Rehabilitation Institute of Mexico , Mexico City , DF , Mexico

Department of Hip and Knee Surgery , Universidad Nacional Autónoma de México , Mexico City , DF , Mexico

Erica M. Coplen , DPT Department of Physical Therapy , Nashville Sports Medicine Physical Therapy , Nashville , TN , USA

Benjamin Domb , M.D. Hinsdale Orthopaedics Associates , Westmont , IL , USA

Loyola Stritch School of Medicine , Chicago , IL , USA

Roy E. Erb , M.D. Department of Medical Imaging , St. Mary’s Hospital , Grand Junction , CO , USA

Trevor R. Gaskill , M.D. Bone and Joint Sports Medicine Institute, Naval Medical Center Portsmouth , Portsmouth , VA , USA

Steadman Philippon Research Institute, The Steadman Clinic , Vail , CO , USA

Carlos A. Guanche , M.D. Southern California Orthopedic Institute , Los Angeles, Van Nuys , CA , USA

Sommer Hammoud , M.D. Department of Sports Medicine , Massachusetts General Hospital , Boston , MA , USA

xx Contributors

Marcia Horner , B.A. Vincera Core Physicians , Philadelphia , PA , USA

Victor M. Ilizaliturri , Jr. M.D. Adult Joint Reconstruction Service, Hip and Knee , National Rehabilitation Institute of Mexico , Mexico City , DF , Mexico

Department of Hip and Knee Surgery , Universidad Nacional Autónoma de México , Mexico City , DF , Mexico

Kay S. Jones , MSN, RN Nashville Sports Medicine Foundation , Nashville , TN , USA

Tina Joseph , M.D. Department of Surgery , Drexel University, College of Medicine/Hahnemann Hospital , Philadelphia , PA , USA

Patrick Jost , M.D. Milwaukee Orthopedic Group , Milwaukee , WI , USA

Bryan T. Kelly , M.D. Center for Hip Preservation , Hospital for Special Surgery , New York , NY , USA

Michael Knesek , M.D. Department of Orthopaedic Surgery , University of Michigan , Ann Arbor , MI , USA

Mininder S. Kocher , M.D., MPH Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA

Division of Sports Medicine, Department of Orthopaedic Surgery , Children’s Hospital Boston , Boston , MA , USA

Christopher M. Larson , M.D. Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics , Edina , MN , USA

Erin Magennis , B.A. Center for Hip Preservation , Hospital for Special Surgery , New York , NY , USA

G. Peter Maiers II M.D. Methodist Sports Medicine – The Orthopedic Specialists , Indianapolis , IN , USA

Department of Orthopaedic Surgery , Indiana University , Indianapolis , IN , USA

Hal David Martin , DO The Hip Clinic , Oklahoma Sport Science and Orthopaedics , Oklahoma City , OK , USA

Phillip Mason , M.D. Department of Orthopaedic Surgery , Wake Forest University , Winston-Salem , NC , USA

Richard C. Mather III M.D. Department of Orthopaedic Surgery , Duke University Medical Center , Durham , NC , USA

William C. Meyers , M.D. Departments of Surgery, Drexel University College of Medicine and Thomas Jefferson University , Philadelphia , PA , USA

Duke University Health System , Durham , NC , USA

Core Performance Physicians , Philadelphia , PA , USA

Ulrike Muschaweck , M.D., Ph.D. Hernienzentrum Dr. Muschaweck , Munich , Bavaria , Germany

Ivan Sáenz Navarro , M.D. Department of Human anatomy and Embriology , Facultat de Medicina , Barcelona , Spain

Shane J. Nho , M.D., M.S. Department of Orthopedic Surgery , Rush University Medical Center, Midwest Orthopaedics at Rush , Chicago , IL , USA

xxiContributors

Marc J. Philippon , M.D. Department of Hip Arthroscopy , Steadman Philippon Research Institute and Steadman Clinic , Vail , CO , USA

Elizabeth A. Potts , MSN, APN, ACNP-BC Nashville Sports Medicine Foundation, Nashville , TN , USA

Avinish Reddy , B.S. Department of Orthopedic Surgery , Rush University Medical Center , Chicago , IL , USA

Thomas G. Sampson , M.D. Department of Hip Arthroscopy , Post Street Surgery , San Francisco , CA , USA

Jack G. Skendzel , M.D. Department of Orthopaedic Surgery , University of Michigan , Ann Arbor , MI , USA

Austin V. Stone , M.D. Department of Orthopaedic Surgery , Wake Forest University , Winston-Salem , NC , USA

Rebecca M. Stone , M.S., ATC Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics , Edina , MN , USA

Allston J. Stubbs , M.D. Department of Orthopaedic Surgery , Wake Forest University , Winston-Salem , NC , USA

Humberto Gonzalez Ugalde , M.D. Adult Joint Reconstruction Service, Hip and Knee , National Rehabilitation Institute of Mexico , Mexico City , DF , Mexico

Department of Hip and Knee Surgery , Universidad Nacional Autónoma de México , Mexico City , DF , Mexico

Michael L. Voight , DHSc, PT, OCS, SCS, ATC, FAPTA School of Physical Therapy , Belmont University , Nashville , TN , USA

James E. Voos , M.D. Department of Orthopaedic Surgery , Orthopaedic and Sports Medicine Clinic of Kansas City , Leawood , KS , USA

Christopher Walsh , M.D. Department of Orthopaedic Surgery , University of Michigan Health System , Ann Arbor , MI , USA

Corey A. Wulf , M.D. Department of Orthopedics , CNOS , Dakota Dunes , SD , USA

Yi-Meng Yen , M.D., Ph.D. Division of Sports Medicine, Department of Orthopaedic Surgery , Children’s Hospital Boston, Harvard Medical School , Boston , MA , USA

Adam Zoga , M.D. Department of Radiology , Thomas Jefferson University , Philadelphia , PA , USA