video: hip arthroscopy
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Video: Hip Arthroscopy. ICL 301: Femoroacetabular Impingement Thursday, February 17 th , 2011 Bryan T. Kelly, MD Co-Director Center for Hip Pain and Preservation. Bryan T. Kelly, MD Hospital for Special Surgery - PowerPoint PPT PresentationTRANSCRIPT
Video: Hip Arthroscopy
ICL 301: Femoroacetabular Impingement
Thursday, February 17th, 2011
Bryan T. Kelly, MDCo-DirectorCenter for Hip Pain and Preservation
Bryan T. Kelly, MD
Hospital for Special Surgery
Disclosure: I DO NOT have a financial interest in any commercial products or service presented in this lecture AND
DO NOT INTEND to discuss off label or investigational use of products or
services.
Types of financial relationships and the companies with whom I have relationships are as follows:
Pivot Medical, Inc.: Consultant
Smith & Nephew: Educational Consultant
A2 Surgical: Consultant
Arthroscopic FAI
1. Set up
2. Access
3. Capsule Cut
4. Rim Prep / Resection
5. Labral Refixation
6. Cam Decompression
7. Capsular Repair
1. Patient Set Up
1. Patient Set Up
• Adequate traction requires approximately 10mm of distraction across the joint.
• Careful attention to padding is critical.
2. Access – Portals
1.Anterior
2.Anterolateral
3.Posterolateral
Greatest Risk →→ Anterior Portal
– Avg. 3 mm from a branch of the lateral femoral cutaneous nerve
Primal Pictures Limited
2. Access: Expanded Portal Placement• Palpate and Outline:
– Greater Trochanter– Anterior Superior Iliac Spine (ASIS)
• Portal Placement– Anterolateral Portal (AL)
• 1cm superior and anterior to GT
– Posterolateral (PL)• 1cm superior and posterior to GT
– Anterior Portal (AP)• In line with AL portal• 1 cm lateral to ASIS
– Mid-Anterior Portal (MAP)
– Proximal Mid-Anterior Portal (PMAP)
Portal Safety
1. The Mid-Anterior and Anterior portals pass in close proximity to a small terminal branch of the ascending LCFA
2. Greatest risk still comes from the proximity of the anterior portal to the LFCN
– A slightly more lateral location may provide some
protective benefit
Safe ZoneRobertson et al, Arthroscopy 2008.
• The findings from this study seem to support the concept of a relative neurovascular safe zone for arthroscopic access to the hip joint within the outlined parameters.
2. Access / Visualization
2. Access / Visualization
2. Access / Visualization
Transition zone injury Contra-Coup injury
3. Capsule Cut
3. Capsule Cut – IA EvaluationCam Injury• Cam delamination• Loss of normal attachment of labrum to transition zone.
Rim Injury• Capsular sided injury to the labrum / capsule against the rim lesion
4. Rim Preparation
Rim Exposure
• Severe rim inflammation around the rim lesion
Rim Decompression
• Outline the rim lesion prior to decompression
4. Rim Preparation
3. Rim Resection
Pre Post
4. Labral Refixation
4. Labral Refixation
Entry into peripheral compartment
Reposition patient and fluoro for peripheral compartment work.
5. T-Cut and Visualization
6. Cam Decompression
7. Capsule Closure and Assessment
Pre and post fluoro shots of a patient with primary cam impingement
Pre and post fluoro shots of a patient with combined subspine / rim / and cam impingement
Thank You