[Synovial disorders and loose bodies in the hip joint. Arthroscopic diagnostics and treatment]. / Synoviale Erkrankungen und freie Körper des Hüftgelenks. Arthroskopische Diagnostik und Therapie.

Synovial disorders and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for loose bodies, synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis. One major advantage in comparison to radiologic imaging is the ability to inspect, biopsy, and treat within one procedure. In contrast to an arthrotomy, hip arthroscopy avoids the potential risks of extensive surgical exposure and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with loose bodies, synovial plicae, initial septic arthritis and, to a certain extent, PVNS curative therapy and "restitutio ad integrum" can be achieved. In contrast, in patients with synovial chondromatosis and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis and to provide symptomatic relief and maintain or improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.

Hip arthroscopy without traction: In vivo anatomy of the peripheral hip joint cavity.

PURPOSE: To describe the in vivo anatomy of the peripheral compartment of the hip joint using a systematic sequence of examination without traction. TYPE OF STUDY: Case series. METHODS: We performed 35 hip arthroscopies without traction from an anterolateral portal in the supine position. Free draping and a good range of movement of the hip joint were used to relax parts of the capsule and increase the intra-articular volume of the area that was inspected. Each procedure was documented on a standard protocol including detailed information on technical features and normal and pathologic intra-articular findings. RESULTS: A comprehensive inspection of the peripheral compartment was obtained from the anterolateral portal. A systematic sequence of examination was developed separating the periphery of the hip joint into 7 areas: anterior neck area, medial neck area, medial head area, anterior head area, lateral head area, lateral neck area, and posterior area. The arthroscopic in vivo anatomy of each area is described. In 3 patients, 1 to 3 loose bodies were removed. In 1 patient with a synovial chondromatosis, 40 chondromas were retrieved. In osteoarthritis, impinging osteophytes were trimmed in 3 cases and partial synovectomy was performed in 10 patients. The following complications were observed: a temporary sensory deficit of the lateral femoral cutaneus nerve in 1 patient, scuffing of the anterior surface of the femoral head in 3 patients, detaching of an osteophyte in 1 patient, and partial tears of the anterior synovial fold in 10 patients. CONCLUSIONS: Arthroscopy without traction allows for a complete evaluation of hip anatomy without the loaded articular surfaces, the acetabular fossa, and the ligamentum teres. For a complete overview of both the central and peripheral part of the hip, traction is necessary for the central part.

Fracture of the proximal tibia six months after Fulkerson osteotomy. A report of two cases.

The Fulkerson osteotomy has proved to be a reliable treatment for subluxation of the patella due to malalignment. Aggressive rehabilitation in the early postoperative period is unwise since the proximal tibia is weakened by the oblique osteotomy. Early weight-bearing and unrestricted activity have caused fractures in a few patients. Even late in the postoperative period the osteotomy may adversely influence the biomechanical properties of the proximal tibia. We describe two athletes who sustained a fracture of the proximal tibia, during recreational activities, six months after a Fulkerson osteotomy. Both had been bearing full weight for about ten weeks without complaint. Bony healing of the osteotomy had been demonstrated on plain radiographs at ten and at 12 weeks. After a Fulkerson osteotomy, jogging and activities which impose considerable impact force should be discouraged for at least nine to 12 months.

Blood loss in anterior cruciate ligament (ACL) reconstruction with and without intercondylar notchplasty: does it affect the clinical outcome?

Blood loss is associated with any surgical procedure and should be reduced wherever possible. It was our impression that notchplasty adds to the amount of postoperative bleeding after anterior cruciate ligament (ACL) reconstruction. With posterior placement of the tibial tunnel, notchplasty is optional in many cases. This study aimed to quantify blood loss with and without notchplasty after arthroscopically assisted ACL reconstruction using bone-patellar tendon-bone autografts. We performed a prospective clinical study of 58 patients, who had undergone arthroscopically assisted autogenous patellar tendon ACL reconstruction. In group I, a notchplasty was necessary according to the local anatomical criteria (intraoperative impingement test). In group II, ACL replacement could be performed without notchplasty. Single and total day drainage volume, serum and suction drain hemoglobin (Hb) and hematocrit (Hct) levels were monitored. One year after surgery, the patients were reviewed to assess the outcome according to the IKDC and Lysholm scores and the KT-1000 arthrometer. The total drainage volume was 448 ml (range 150-550 ml) in group I and 299 ml (range 50-420 ml) in group II (p < 0.001). The serum hematocrit (Hct) decrease was 9.7% in group I and 7.4% in group II (p < 0.001). At 12 months after surgery, the IKDC and Lysholm score evaluations and the KT-1000 arthrometer measurements revealed no clinical differences between the notchplasty and non-notchplasty groups. Despite a 30% increase in blood loss, notchplasty has been shown to be a useful procedure to prevent graft impingement without negative side-effects.

[Arthroscopy for diagnosis and therapy of early osteoarthritis of the hip]. / Hüftarthroskopie bei radiologisch beginnender bis mässiggradiger Koxarthrose. Diagnostische und therapeutische Wertigkeit.

Failure to conservative treatment in patients with less advanced radiographic signs of osteoarthritis of the hip (Danielsson grade 2-5) confronts with the decision of further treatment. Since radiographic imaging has not been proved very useful in demonstrating intraarticular structures and results of hip arthroscopies have been promising, arthroscopies have been performed in 17 hips from November 1997 to September 1998. Arthroscopic findings were exceeding preoperative imaging. In addition to cartilage degeneration, concomitant loose bodies, impinging osteophytes, degeneration of the labrum and synovial disease were found. Removal of loose bodies and osteophytes, partial resection of labral tears and partial synovectomy were performed. 1 month after arthroscopy (n = 15), mean Harris-Hip-Score was increased by 13 points und pain reduced by 39 % on average. 6 months after arthroscopy (n = 9), mean Harris-Hip-Score was increased by 14 points and pain reduced by 32 % on average. In addition to its therapeutic benefit, arthroscopy offers direct visualisation of the hip providing important information for the decision of further treatment.

Arthroscopy for diagnosis and therapy of early osteoarthritis of the hip.

Failure to conservative treatment in patients with less advanced radiographic signs of osteoarthritis of the hip (Danielsson grade 2-5) confronts with the decision of further treatment. Since radiographic imaging has not been proved very useful in demonstrating intraarticular structures and results of hip arthroscopies have been promising, arthroscopies have been performed in 17 hips from November 1997 to September 1998. Arthroscopic findings were exceeding preoperative imaging. In addition to cartilage degeneration, concomitant loose bodies, impinging osteophytes, degeneration of the labrum and synovial disease were found. Removal of loose bodies and osteophytes, partial resection of labral tears and partial synovectomy were performed. 1 month after arthroscopy (n = 15), mean Harris-Hip-Score was increased by 13 points und pain reduced by 39 % on average. 6 months after arthroscopy (n = 9), mean Harris-Hip-Score was increased by 14 points and pain reduced by 32 % on average. In addition to its therapeutic benefit, arthroscopy offers direct visualisation of the hip providing important information for the decision of further treatment.