Hip Arthroscopy | Hip Surgery
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Hip Arthroscopy is a conservative surgical approach to cure hip pain. Arthroscopy allows for minimal scarring, faster recovery, and helps to diagnose and treat early causes of arthritis, in many cases preventing it altogether. Hip Arthroscopy surgery is done to treat mechanical symptoms such as popping, painful clicking and catching and demonstrate a reduced range of motion of the hip. Here we have explained the procedures involved in hip arthroscopy.
Acetabular Labral Repair using the PushLock Knotless Anchor System
Introduction:
Diagnosis of acetabular labral tear pathology is mostly clinical and presents in a similar manner as meniscal pathology in
the knee. Patients can present with complaints of mechanical symptoms such as popping, painful clicking and catching and
demonstrate a reduced range of motion of the hip.
Prior treatment guidelines suggested that debridement and resection of the torn labral tissue was appropriate for pain relief.
Though effective, this often compromised the function of the acetabular labrum.<
Longitudinal, peripheral and intrasubstance tears are amenable to repair. By repairing the torn labrum, the following
physiological functions can be preserved:
• Joint Compressive Forces
• Cartilage Consolidation
• Vacuum Sealing Mechanism
• Joint Stability and Congruity
Imaging Studies:
Magnetic resonance arthrography (MRA) is currently the most sensitive method for imaging a labral tear.
Patient Positioning and Traction:
Arthroscopic repair of the acetabular labrum can be performed in either the supine or lateral decubitus position, according to
surgeon preference. The perineal post and pad are attached to the operating table with a Clark Rail Adapter on the nonoperative
side of the patient and positioned between the legs to provide adequate abduction prior to application of weighted traction. The
Hip Distractor System is assembled in a sterile manner and attached to the table with a Clark Rail Adapter on the operative side
of the patient near the ankle.
The foam leg sleeve is applied to the operative side using
the provided Coban™. The traction pulley is set at a height
that allows for 10 - 15˚ of hip flexion. Traction is applied
incrementally between 25 and 50 pounds until the vacuum
seal of the joint is broken and 8-10 mm of femoral distraction
from the acetabulum is achieved. The leg is brought
back into slight adduction to gain adequate lateral traction
of the femoral head. Prior to portal placement a 14 gauge needle is inserted into the joint to further break the vacuum seal and provide greater distraction of the joint.
Portal Placement:
Repair of the acetabular labral tear is performed through
the anterolateral and standard anterior portals in many cases.
Establish the anterolateral portal first for the arthroscope
using a percutaneous approach with or without fluoroscopic
guidance. Once a spinal needle is in place in the joint using
a “loss of resistance” method, a long Nitinol wire is advanced
through the spinal needle and the needle is removed. A
Cannulated Obturator, used in conjunction with the arthroscope
sheath, is passed over the wire and into the joint.
Once the wire and Cannulated Obturator are removed,
the scope can be placed through the sheath and into the
joint. Establish the anterior working portal under direct
arthroscopic visualization in an outside/in fashion using a
spinal needle, being mindful of neurovascular structures in
the vicinity. These portals can be atraumatically enlarged to
accommodate varying cannula sizes by using the Portal
Dilation System. Additionally, in cases of tough capsule
resistant to dilation, a Beaver Blade can be inserted through
the cannula and capsulotomy performed to accommodate
cannulas and instruments.
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After preparing the anchor placement site with a mechanical
burr, insert the Metal Offset Guide into the joint. In many
cases this is performed through the anterior or anterolateral
cannula. The guide should be positioned on the acetabular
rim at the point of labral detachment. Remove the trocar
to allow the fish-mouth design of the guide tip to remain
securely on the acetabular rim. Insert the PushLock drill on
power through the guide and advance it into the bone until
the drill bit hub "bottoms-out" on the back of the guide
handle. Remove the drill and the offset guide, making note
of the general location of the pilot hole. |
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Insert the long 22° BirdBeak™ w/WishBone Handle,
preloaded with #2 FiberWire®, into the cannula. Pass the
sharp tip through or around the capsulolabral complex
near the pilot hole until the tip is visualized exiting near
the acetabular face. |
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Release the #2 FiberWire that is now forming a loop and
back the BirdBeak tip out of the tissue, but not out of the
joint. Reach over the labrum and retrieve the #2 FiberWire
loop and pull it out of the cannula. |
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Drop both free limbs of the FiberWire outside of the cannula through the retrieved loop and pull the free ends. This will
form a “cinch” stitch around the labrum for added stability. |
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An alternative step to passing suture around the labrum is advancing a #2 FiberStick™ into the joint gently through
a Low Profile SutureLasso™. Remove the lasso, leaving the
FiberStick in the joint. Through the cannula, retrieve the
FiberStick using the KingFisher™ Suture Retriever/Tissue
Grasper. Both limbs of the FiberStick should be exiting the
cannula. |
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Outside of the joint, pass both limbs of the FiberWire
through the tip of the PushLock anchor and slide the anchor
down through the cannula. Push the tip into the pilot hole
while keeping gentle tension on the suture limbs. Stop
advancing the tip of the driver into the pilot hole when the
main body of the anchor reaches the cortex. Note, full tissue
tension should be achieved at this time and the suture limbs
can be relaxed. If the tissue tension is either too great or too
relaxed, the anchor tip can be backed out of the pilot hole
and proper tension can be achieved by pulling on or relaxing
the suture tails. |
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Mallet the metal button on the back of the PushLock
handle to advance the main anchor body over the driver
tip and into the pilot hole, trapping the suture. Stop
malleting when the black laser line on the distal anchor
insertion shaft is flush with bone. Unscrew the handle
from the anchor by turning the handle six complete
counterclockwise revolutions then pull back.
Insert a FiberWire Suture Cutter into the joint and cut
each suture strand flush with bone. Repeat this process if multiple anchors are required. |

Hip Arthroscopic Surgeon Florida - Dr Kevin MurphyDr. Kevin Murphy one of the finest orthopedic surgeons based in Jacksonville, Florida, specializes in sports medicine, upper extremities, hip arthroscopy, knee surgery and shoulder arthroscopy. |