Injection of the Hip With Hyaluronic Acid Under Distraction Plus Neurectomy of the Femoral and Obturator Nerve.

The hip is the location for many disorders, such as osteoarthritis, femoroacetabular impingement syndrome, avascular necrosis of the hip, and cartilage injuries, all of which cause chronic pain, disability, and limitation. It is estimated that 10% of the population ≥40 years of age will present with hip pain. The line of treatment goes from nonsteroidal anti-inflammatory drugs, physical therapy, lifestyle modification, intra-articular injections, and hip surgery. This will depend on the pathology, age, lifestyle, and sport activity of each patient. Currently, hip joint intra-articular injections represent a viable option for those patients who are not candidates for surgery or simply those who do not want surgery. Among the controversial indications for a hip injection is moderate-to-severe arthritis (grades III and IV). Hip injections are considered a diagnostic and therapeutic procedure, with a sensitivity of 87% and specificity of 100% reported, and will differentiate between an intra-articular pathology versus an extra-articular pathology and a neuropathic pain arising from the lumbar spine. Radiofrequency nerve ablation or neurectomy of the femoral and obturator nerve has been implemented more frequently not only for patients with mild-to-moderate osteoarthritis but also in those who present with femoroacetabular impingement syndrome and cartilage lesions who do not wish to undergo surgery.

Hip Arthroscopy in Adolescents Through an Extra-Capsular Approach.

Hip arthroscopic treatment for femoroacetabular impingement syndrome and labral tears is the gold standard in the adult and adolescent population, as we all know the most common surgical approach to the hip is entering the central compartment with fluoroscopy and with continuous distraction. A periportal capsulotomy in traction must be done to have visibility and instrument maneuverability. These maneuvers avoid scuffing the femoral head cartilage. In adolescents, extreme care must be taken in hip distraction, as the force used can cause iatrogenic neurovascular lesions, avascular necrosis, and lacerations of the genitals and foot/ankle. Experienced surgeons around the world have developed an extracapsular approach to the hip with smaller capsulotomies with a low complication rate. This approach to the hip has brought attention in the adolescent population because it is more secure and simple. Less force of distraction is needed because the capsulotomy is done first. This surgical technique allows observation of the cam morphology while entering to the hip without distraction. We describe an extracapsular approach as an option to treat femoral acetabular impingement syndrome and labral tears in the pediatric and adolescent population.

Quantitative cotyloid fossa thickness and proximity to obturator neurovascular bundle: implications for arthroscopic ligamentum teres reconstruction.

The aim of the present study was to report the in vivo thickness of the cotyloid fossa at the acetabular ligamentum teres (LT) attachment and investigate the clearance of the obturator neurovascular bundle. Fifty-five consecutive patients undergoing a total hip arthroplasty for hip osteoarthritis were included. The thickness of the cotyloid fossa was measured at the acetabular LT attachment using a standard depth gauge. The minimal distance (clearance) of the obturator neurovascular bundle to the center of the acetabular LT attachment was measured in 7 patients (14 hips) who also underwent a computed tomography angiography. The average thickness of the cotyloid fossa at the acetabular LT attachment was 4.1 ± 2.3 (range: 1-10) mm. The obturator vein was closest to the acetabular LT attachment, but the clearance was more than the defined safe zone of 15 mm in all cases. Based on the current findings, it can be assumed that bone anchors might not be suitable for fixation of the graft in LT reconstruction (LTR) and an alternative implant such as a cortical button should be considered. Acetabular fixation of the graft with a 12-mm cortical button is relatively safe concerning injury to obturator neurovascular structures. The results of the present study provide a better understanding of the cotyloid fossa anatomy and might be relevant for surgeons who perform arthroscopic LTR.

The Yoga Mat Technique in Postless Hip Arthroscopy.

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.

Ligamentum teres reconstruction with labrum and capsule repair after posterior acetabular wall fracture: a case report.

The aim of this case study is to present arthroscopic treatment of recurrent hip instability after acute post-traumatic posterior hip dislocation with a fracture of the posterior acetabular wall. A male patient aged 35 suffered a dislocation of the right hip joint with a fracture of the posterior acetabular wall due to an accident. The fracture was stabilized during emergency surgery with a locking compression plate, and the patient was released home in a hip brace. Multiple dislocations of the hip joint followed with the implant being confirmed as stable. Decision was made to qualify the patient for a right hip arthroscopy. During the surgery, ligamentum teres was reconstructed using gracilis and semitendinous muscle grafts, followed by the labrum and joint capsule repair, where the surgery that stabilized the acetabular wall fracture had damaged them. There were no complications following the procedure. Short-term follow-up of 3 months demonstrates the patient has a stable hip, reduced pain and has returned to pre-injury activities.

Arthroscopic utilization of ChondroFiller gel for the treatment of hip articular cartilage defects: a cohort study with 12- to 60-month follow-up.

ChondroFiller gel is an absorbable collagen implant. It serves as a protective cover for the cartilage defects, allowing chondrocyte migration into the lesion. The implant consists of collagen (Type I) and is derived from veterinary monitored rats. This study evaluates the use of ChondroFiller gel in the treatment of cartilage lesions during hip joint arthroscopy. A prospective study was conducted on a group of 26 adult patients. All patients had an existing femoroacetabular impingement together with acetabular cartilage lesions >2 cm2. All patients underwent hip arthroscopic surgery and the lesions were treated using ChondroFiller gel. The cartilage tissue healing was evaluated postoperatively using MRI. A total of 26 patients, including 5 females and 21 males, all with articular cartilage lesions, were included in the study. Cartilage healing conditions were evaluated for all patients, and the difference between pre- and post-surgery conditions was statistically significant. The follow-up scores have been acquired from 21 out of initial 26 patients (2 were disqualified after receiving THR, 3 could not be reached by researchers) after 3, 4 and 5 years consecutively with 17/21 patients having good/excellent results. The use of ChondroFiller gel during arthroscopy of the hip for acetabular cartilage lesions is an effective treatment technique. Encouraging long-term results have been observed, but further research on larger group of patient is required to better assess the full value of this technique. Patients with pre-existing osteoarthritis (Tönnis 2-3) have poor results.

Hip Arthroscopy and Core Decompression for Avascular Necrosis of the Femoral Head Using a Specific Aiming Guide: A Step-by-Step Surgical Technique.

Avascular necrosis of the femoral (AVN) head is a disabling disease that affects function, mobility, and quality of life in the young adult. Its pathology involves blood circulation disruption of the femoral head and subchondral infarction. This leads to cartilage thinning, femoral head depression, and cartilage breakage, which results in hip osteoarthritis. In the past decade the prevalence of intraarticular pathology has been almost 95%, this revealed with hip arthroscopy (HA). HA and core decompression (CD) of the femoral head can be used effectively and concomitantly to treat AVN with excellent results, HA allows for excellent visualization of the hip joint cartilage, allowing treatment of femoroacetabular impingement syndrome (FAIS) and intra-articular pathology. Our technique demonstrates that retrograde core decompression with allograft and mixed bone matrix is an excellent choice of treatment in the early stages of AVN/ONFH. The femoral head-specific aiming guide is very reliable, is simple to use arthroscopically if placed in the posterolateral portal of the hip, and offers exact pin placement at the necrotic site, as well as less operative time and less radiation to the patient and surgical team.

The Outside-In Technique for Slipped Capital Femoral Epiphysis: A Safe and Reproducible Approach in Hip Arthroscopy.

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.

Arthroscopic acetabular labral reconstruction with rectus femoris tendon autograft: Our experiences and early results.

BACKGROUND: The native labrum has been shown to play a critical role in the maintenance of overall health of the cartilage of the hip. Disruption of the labral seal could be detrimental to the overall nutrition of the cartilage, leading to its premature degeneration. PURPOSE: This study sought to investigate patients undergoing labral reconstruction with indirect head of rectus femoris autograft, to determine the subjective improvement in pain they experienced, the complications and reoperation rates including conversion to Total hip replacement(THR). METHOD: We retrospectively reviewed all 7 patients who underwent labral reconstruction using indirect head of the rectus femoris tendon autograft between January 2013 to October 2015. We assessed improvement in pain and function, complications, and subsequent surgery. The minimum follow-up was 12 months (average, 15 months; range, 12-18 months). RESULTS: All patients reported subjective improvement in preoperative pain and function. The mean modified Harris Hip Score (mHHS) improved significantly from 56 (54-60) preoperatively to 93 (90-97)) at mean latest follow-up. The mean change of mHHS was 36 (30-43) and mean postoperative patient satisfaction score was 9.1. We observed no radiological progression of arthritis as well as no patient had revision procedure including total hip replacement. CONCLUSION: Acetabular labrum reconstruction for irreparable labral tears in young patients with no significant arthritis, using indirect head of the rectus femoris tendon autograft is a new technique that shows improvement in pain and function post-operatively. Long-term follow-up results with higher quality studies will be necessary to further define the role of labral reconstruction in hip preservation surgery.

Unrecoverable bi-products of drilling titanium alloy and tantalum metal implants: a pilot study.

BACKGROUND: Trabecular metal implants with a porous architecture that allows for the incorporation of bone into the implant during healing are gaining popularity in alloplastic revision procedures. The bi-products of drilling titanium alloy (Ti) and tantalum (Ta) implants have not been previously assessed. METHODS: Four holes were drilled in each of 2 spatially porous trabecular implants, one Ta and the other Ti alloy (Ti-6Al-7Nb), for this pilot in vitro study. The particles were flushed out with a continuous flow of saline. The particles' weight and the volume were then measured using a Radwag XA 110/2X (USA) laboratory balance. The total volume of the obtained metal fines was measured by titration using a 10 mm3 measurement system. RESULTS: A cobalt carbide bit was used since the holes could not be made with a standard bone drill. Each Ti and Ta implant lost 1.26 g and 2.48 g of mass, respectively. The volume of free particles recovered after each stage was 280 mm3 and 149 mm3, respectively. Approximately 0.6% of the total implant mass was not recovered after drilling (roughly 2% of the mass of the particles created by drilling), despite the use of 5 µm filters. CONCLUSIONS: It is technically difficult to drill holes in Ti and Ta implants using standard surgical tools. The drilling process creates a considerable amount of metal particles, which cannot be recovered despite intensive flushing. This may have an adverse influence on the bio-functionality (survival) of the endoprosthesis and present deleterious systemic consequences.

The Tutankhamun Technique in Hip Arthroscopy.

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.

Arthroscopic Acetabular Labral Reconstruction with Fascia Lata Allograft: Clinical Outcomes at Minimum One-Year Follow-Up.

BACKGROUND: The integrity of the acetabular labrum is crucial to normal biomechanics of the hip joint. Disruption of the labral seal could be detrimental to the overall nutrition of the cartilage, leading to its premature degeneration. PURPOSE: The aim of this study is to determine the clinical effectiveness of arthroscopic hip labral reconstruction using fascia lata allograft. The hypothesis is that labral reconstruction would provide good clinical outcomes. METHODS: We retrospectively reviewed all 10 patients who underwent labral reconstruction with fascia lata allograft from January 2013 to October 2015. We assessed improvement in pain and function, complications, and subsequent surgery. The minimum follow-up was 12 months (average, 22.9 months; range, 16-36 months). RESULTS: All patients reported subjective improvement in preoperative pain and function. The mean modified Harris hip score improved significantly from 58 (55-60) to 95 (91-98). The mean change of modified Harris hip score was 36 (31-41) and mean post-operative patient satisfaction score was 9.5(8-10). We observed no radiological progression of arthritis as well as no patient had revision procedure including total hip replacement. CONCLUSION: Arthroscopic labral reconstruction using a fascia lata tendon allograft is an effective and safe procedure that not only provides excellent clinical outcomes in short term but also potentially prevent continued cartilage degeneration by restoring acetabular labral seal in patients with deficient or resected labrums.

[Arthroscopy scapulothoracic articulation (introduction of this method)]. / Endoskopia przestrzeni lopatkowo-zebrowej (prezentacja metody).

The authors have introduced arthroscopy of scapulothoracic. They have treated 37 years old patient who suffer from bursitis with pain and crepitus. They have used arthroscopy procedure. The first publication about scapulothoracic arthroscopy was in 1992. The method has been written very rarely by foreigner authors in medical journals.