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Erik Walder URI Department of Electrical, Computer, and Biomedical Engineering BME 181. Diagnosis and treatment of Acetabular Labrum Tears. What is the Acetabular Labrum . A ring of fibrocartilage Attached to the acetabulum Is an extension of the hip socket. Why is it Important?.
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Erik Walder URI Department of Electrical, Computer, and Biomedical Engineering BME 181 Diagnosis and treatment of Acetabular Labrum Tears
What is the Acetabular Labrum • A ring of fibrocartilage • Attached to the acetabulum • Is an extension of the hip socket
Why is it Important? Force Distribution On Hip Joint • Helps to distribute the load the hip joint bears • Deepens the hip joint • Provides increased stability to the hip joint • Decreases friction within the hip joint Acetabulum
Common Causes of Tears • usually torn when the hip is bearing a load and is twisted suddenly • Trauma to the hip can also cause a tear • Some things can cause the labrum to tear more easily
Pre-dispositions to Labrum Tears • Hip dysplasia • Places more stress on the labrum • More movement in the femoral head makes a tear more likely • hip degeneration • Weakened or arthritic hips make tears more likely
Symptoms of a Labrum Tear • Pain is not usually felt directly in hip joint • Can feel like a strained groin, quadriceps, or back muscle • a catching or clicking sensation in the hip • Hips suddenly ‘giving way’ • Pain is caused by torn pieces being caught in the hip joint
Diagnosis of a Labrum Tear • A labrum tear usually has little to no impact on the range of motion • Computer Tomography (CT), Magnetic Resonance Imaging (MRI), and X-Rays will NOT detect a tear • A Magnetic Resonance Arthrogaphy (MRa) in addition to a physical examination is effective • Still cannot be 100% diagnosed until in surgery
Arthrogram / MRa • Contrast is injected into the actual labrum • This procedure (Arthrogram) takes anywhere from 15-45 minutes • The Patient then undergoes an MRI • Contrast leaks from the tears, making them visible
Repair • Labrum is not actually repaired • No blood vessels = No Growth / Regeneration • Surgeons clean any loose tissues out of the joint • Torn areas are then removed • The labrum is then ‘sculpted’ until it has a smooth surface and edge again • Removing torn tissue means less pain
Drawbacks to Repair of labrum • Less cartilage means more stress on acetabulum and femoral head • Arthritis develops earlier • Caused by more friction in the joint • Full hip replacement at an earlier age • Benefits far outweigh the drawbacks
Arthroscopic Surgery • Three incisions about one centimeter in diameter are made around the hip region • Tubes are inserted into each of the incisions to make transferring tools between incisions easier • A fiber optic camera allows the surgeon to see inside the joint • Specialized cutting and suction tools are used • Minimally Invasive
Surgical Equipment Arthroscope Traction Table Arthroscope • Arthroscope • Fiber optic Camera, Cutting tools, Suction Tools • Traction Table • Pulls Hip slightly out of Joint • Live X-Ray • Help Surgeons see that they are in the right area C-Arm X-Ray (Live X-Ray)
Recovery • Large Muscle Groups are not severed • Much Shorter recovery time (1-2 Months) • Partial Weight Bearing possible earlier than conventional surgery • Small Incisions mean less risk of infection • Much easier and shorter recovery than conventional open hip surgery
References of Pictures Used • <http://www.conservativehipsolutions.com/images/anterior_hip_joint_small.jpg> • <http://graphics8.nytimes.com/images/2009/06/01/sports/ • 0601-spt-WebHIP.gif> • <http://www.thefinalsprint.com/images/2007/05/hip.JPG> • <http://www.lawyersandsettlements.com/blog/wp-content/uploads/2009/08/mri-image.jpg> • <http://www2.imperial.ac.uk/structuralbiomechanics/projects/freebcpelvis/fixed_vm_S2S.png> • <http://americanpitbullregistry.com/images/hip%20dysplasia.jpg> • <http://littleastonoasis.com/HipArthroscopy.aspx> • <http://www.biztrademarket.com/User/174576/bb/jpx-c101-1_gbn.jpg>