Is It Safe to Perform an Early Arthroscopy After a Traumatic Hip Dislocation With an Associated Pelvic Ring Injury? Report of Our Technique.
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ABSTRACT:
SUBMITTER: Geada NG
PROVIDER: S-EPMC6020009 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The popularity of hip arthroscopy has increased significantly over the past decade. It is technically demanding and may be associated with complications such as iatrogenic damage to the articular cartilage or acetabular labrum, compression injuries to the structures in the perineum, and distraction injuries to the leg. Some of these complications can be avoided by paying meticulous attention to the technique and reducing the traction/surgical time. We describe a technique by which the risk of injury to the articular cartilage may be minimized by introduction of the surgical instruments under direct vision, rather than under radiologic control. The described technique is likely to reduce the operating time by addressing the peripheral-compartment pathologies first-without traction. Traction is only required for the central-compartment procedures. Exposure to ionizing radiation is also diminished (eliminated with practice) because the portals are established under direct vision of the arthroscopist.
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Project description:Hip arthroscopy has been increasing tremendously in the past decade and is a very common surgical procedure to repair femoroacetabular impingement. To access the hip joint, distraction is mandatory to treat intra-articular disorders such as labral tears, cartilage loose bodies, and ligamentum teres tears and to evaluate the condition of the femoral head and acetabular cartilage. To distract the hip, counterdistraction is needed, and this is achieved with placement of a bulky and cushioned perineal post. Most of the described techniques in hip arthroscopy use a perineal post, whereas others use beanbags to place the patient's body on the surgical table. Still others do not use a post at all but rather use gravity and a Trendelenburg position to achieve distraction. Our technique does not use a perineal post but instead uses heavy-duty tape over the patient's upper body, which is placed on a normal operating room table to distract the hip while entering the central compartment.
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Project description:In the realm of hip preservation, hip arthroscopy is often used to address intra-articular impingement pathology, whereas periacetabular osteotomy (PAO) is used to address dysplasia and instability. Indications to combine these 2 procedures include hip dysplasia and symptomatic instability with a concomitant symptomatic labral tear or the other symptomatic intra-articular pathology (i.e., loose body, chondral flap). The arthroscopic portion of the procedure allows repair of the injured labrum and close inspection of the hip joint, and the PAO addresses undercoverage and/or inappropriate version of the acetabulum. The open approach used in PAO also allows access to the peripheral compartment to debride a cam lesion, if present, and the subspine region is accessible to perform subspine decompression, if needed. In this technique, we highlight special considerations pertaining to hip arthroscopy that is performed in combination with a PAO. Hip arthroscopy is the first procedure that takes place in this combined case, and modifications to the standard hip arthroscopic technique can prevent unnecessary difficulty during the PAO that follows.
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Project description:Traumatic dislocation of the hip in children is a rare disease. It only represents 5% of hip dislocations in all age groups. Before 10 years, the mechanism is often a minimal domestic accident; after 10 years, the dislocation occurs with the waning of an accident of the public highway. It is different from that of the adult by its rarity, its ease of reduction and better prognosis. This is an emergency trauma: risk necrosis of the femoral head (If delayed reduction). We report a rare case of a 3 year old boy, who suffered from bipolar trauma after a fall near his height of his house causing him a detachment of the right humerus and post-traumatic dislocation of the left hip. The diagnosis was clinically confirmed by the results of standard radiographs and CT scans of the pelvis. The consultation period to emergencies was 5 hours after the trauma. We performed an hour after a closed reduction under general anesthesia for hip dislocation with establishment of a splint pelvic-pedal for analgesic keep for three weeks. The radiological outcome was satisfactory. Peeling Salter I humerus was reduced by orthopedic manner and immobilized by thoracoabdominal plaster to keep for a month. The child was discharged the next day. Reviewed in consultation after a month, the clinical examination showed a steady left hip. Traumatic dislocation of the hip in children is a rare diagnosis, the management should as urgent as possible to overcome the different possible subsequent complications dominated by coxa magna.
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Project description:Hip distractor devices or hip fracture tables (HFTs) are vital to perform a reliable hip arthroscopy (HA) for the treatment of femoroacetabular impingement, especially when labral tears, chondral-labral delaminations, ligamentum teres tears, and other intraarticular disorders are present. Adequate hip distractors were not available in the early days of HA; most of HFTs being used those days were rigid, cumbersome, and did not allow us to properly perform an arthroscopic dynamic impingement test to evaluate and assess the femoral head and its site of impingement. The mayo table technique was developed because of the lack of appropriate hip instrumentation and an HFT when the author (A.P.S.) started to perform HA. This easy technique allows the surgeon to control hip maximal range of motion and also to assess completely the cam deformity in the posterolateral, superolateral, anterior, and anteroinferior aspects. It also allows the surgeon to revise where the cam is impinging and afterward perform a complete bony resection and decompression. We strongly believe that with the mayo table technique HA can be performed simply and reliably in old rigid and cumbersome HFTs and also hip distractors that do not allow an adequate dynamic assessment of the hip with maximal range of motion.
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Project description:Femoroacetabular impingement syndrome caused by slipped capital femoral epiphysis (SCFE) can be successfully treated arthroscopically and with the minimally invasive, outside-in surgical technique. The advantages of the technique are that the residual cam-type deformity caused by the slippage can be corrected and reconstructed reliably and reproducibly before distracting the hip joint; and radiation with fluoroscopy is used for only definitive reduction and reconstruction, which is obtained with cannulated screws. In addition, this safe technique allows distraction of the hip after screw placement, without affecting the reconstruction, to address labral tears and chondrolabral delaminations caused by the impingement.
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Project description:The hip capsule and acetabular labrum are critical structures that function to protect and stabilize the hip joint. As the use of hip arthroscopy increases, there is increasing interest in the integrity of the hip capsule and labrum in optimizing postoperative function and outcomes. In this report, we describe the surgical technique for capsular reconstruction with dermal allograft and labral augmentation with tibialis anterior allograft for the treatment of gross instability after hip arthroscopy. This technique may be applied in situations with large capsular defects and deficient labral tissue.
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Project description:Hip arthroscopy has recently become a common procedure to treat central and peripheral hip pathology. Capsulotomies are necessary in these procedures, and negotiating adequate visualization, as well as capsular preservation, is a challenge. We describe a capsular suspension technique that allows for adequate visualization of the central and peripheral compartments while facilitating preservation of the native hip capsule. This technique eliminates the need for additional personnel for retraction, potentially decreases iatrogenic hip injury, eliminates the need for excessive capsular debridement, and allows for capsular closure under minimal tension.
| S-EPMC4680905 | biostudies-other
Project description:Advanced hip joint-preserving arthroscopic techniques have been shown to improve patient-reported functional outcomes with low rates of postoperative complications. Prior work has shown that formation of adhesive scar is a potential source of persistent pain and cause for revision surgery. As resources for postoperative in-studio physical therapy become scarce, a home-based strategy to avoid scar formation without adding formal therapy cost may be beneficial. The purpose of this technical note is to introduce a patient-centered educational video technique for home-caregiver delivery of manual hip pendulum exercises in the postoperative setting. This video technique offers access to our method for pendulum exercise as part of early recovery after advanced hip arthroscopy.
| S-EPMC5040594 | biostudies-literature
Project description:Hip arthroscopy for the treatment of femoroacetabular impingement syndrome with anti-sliding techniques and without the use of a perineal post to achieve hip distraction has increased greatly in the past 5 to 10 years. To access the hip joint, distraction is mandatory to treat intra-articular disorders such as labral tears, acetabular cartilage defects, loose bodies, ligamentum teres tears, and avascular necrosis of the hip. In hip distraction, counter-distraction is needed, and this is achieved with a bulky and cushioned perineal post. Most of the described techniques in hip arthroscopy worldwide use a perineal post, but iatrogenic pudendal nerve, genital lacerations, hematomas, and groin complications have been reported to occur. In Latin American countries, disposable hip pad devices are expensive, and not all the arthroscopic companies provide them. Our yoga mat technique provides enough countertraction to achieve adequate hip distraction. Labral repair, labral reconstruction, and decompression of femoroacetabular impingement syndrome have been achieved properly, reliably, and reproducibly, and no Trendelenburg position is needed. Postless hip arthroscopy is made simple, and positioning the patient is not difficult. Hip surgeons can adapt this technique to a fracture table, a hip distractor, and a standard operating room table.
| S-EPMC8252824 | biostudies-literature