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Hip Arthroscopy

Hip Arthroscopy. M.P. Muldoon, M. D. Orthopedic Medical Group of San Diego. Hip Arthroscopy Why have I not heard of it and why is it not done more frequently?. Hip joint is much less accessible than other joints More technically difficult-need specialized equipment and expertise

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Hip Arthroscopy

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  1. Hip Arthroscopy M.P. Muldoon, M. D. Orthopedic Medical Group of San Diego

  2. Hip ArthroscopyWhy have I not heard of it and why is it not done more frequently? • 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

  3. Hip Arthroscopy • 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

  4. Hip Arthroscopy • Indications • Remove loose bodies such as cartilage or bone from hip joint as on right

  5. Hip Arthroscopy • 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

  6. Hip Arthroscopy • Indications • The treatment of Femoral Acetabular Impingement • Snapping Hip Syndromes • Recalcitrant Trochanteric Bursitis • Repair or debridement of Labral tears

  7. Hip Arthroscopy • 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

  8. Hip Arthroscopy • 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

  9. Technique • 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

  10. Technique • Special instruments have been designed to aid entry into hip joint and to remove damaged tissues

  11. Technique • 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

  12. Hip arthroscopy Example • 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

  13. Hip Arthroscopy Example • At surgery a torn labrum was diagnosed and excised • Patient was back to full activities at 3 months

  14. Hip ArthroscopyDay of Surgery …what to expect • 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

  15. Hip ArthroscopyAfter surgery …. what to expect • 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

  16. Hip ArthroscopyAfter surgery …. what to expect • 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

  17. Hip Arthroscopy - Complications • 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

  18. Hip Arthroscopy • 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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