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Update on Trauma and Orthopaedic Surgery Henley Management College 8 th May 2008.

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Presentation on theme: "Update on Trauma and Orthopaedic Surgery Henley Management College 8 th May 2008."— Presentation transcript:

1 Update on Trauma and Orthopaedic Surgery Henley Management College 8 th May 2008

2 Hip arthroscopy

3 Indications for hip arthroscopy Labral tears Loose bodies / foreign bodies Ligamentum teres tears Synovial chondromatosis Sepsis – diagnosis and treatment Assessment of painful hip – Chondral lesions not seen on Xray / MRI

4 Pain C-sign distribution Groin Referred to L3 dermatome – (Anteromedial thigh)

5 Characteristic Hip Symptoms Symptoms worse with activities: Twisting / turning /changing directions Rising from seated position (catching) Difficulty with stairs (up and down) Difficulty with getting in / out of cars Difficulty with socks / toe nails / shoes etc. Dyspareunia

6 Peripheral Compartment 1.Anterior neck 2.Medial neck 3.Medial head 4.Anterior head 5.Lateral head 6.Lateral neck 7.Posterior Dienst et al (2001) Arthroscopy 17, 924

7 Central Compartment Articular cartilage – Acetabulum – Femoral head Cotyloid fossa Ligamentum teres Labrum

8 So how do we do it…

9 Central Compartment Set - Up Problems Large distraction force required Specialist equipment Operative time limited by distraction time Complications

10 Nerve traction injury – Pudendal and sciatic nerves Direct nerve injury (portal placement) – Femoral and sciatic nerves Perineal oedema / bruising / tears Chondral scuffing

11 Supine Position Patient positioned supine on fracture table Oversized padded perineal post – 12cm outer diameter – Positioned laterally against the thigh

12 Table Options Maquet Fracture Table S&N Hip Positioning System

13 Lateral Position

14 Working Portals

15 Establishing Portals - 1 Anterolateral portal first – (safe zone)

16 Establishing Portals - 2

17 Establishing Portals - 3 Subsequent portals under direct vision

18 Labral Tears

19 Loose Bodies

20 Femoroacetabular impingement Abutment of anterior femoral head-neck junction against anterior aspect of acetabular rim or labrum

21 Femoroacetabular impingement First recognised as consequence of PAO – Dysplastic acetabulum repositioned in more anterior and lateral position – Proximal femur (insufficient head-neck offset) abutted against newly positioned anterior aspect of the acetabular rim in flexion, IR and adduction

22 Femoroacetabular impingement Subsequently recognised in young active adults who presented with groin pain, and who had not had PAO Arthrotomies revealed damage to the anterior aspect of the acetabular labrum and articular cartilage – Similar to what is seen in Perthes and SCFE – All have reduction in femoral head-neck offset

23 Imaging of FAI Femoral neck bump on Xray or MRI Acetabular retroversion Coxa profunda Protrusio acetabuli Ossification of rim

24 Alpha angle – fat sat T1 MRI Kassarjlan et al: Radiology 2005; 236: Abnormal if > 55 degrees

25 Cam and Pincer Impingement

26 Symptoms of FAI Slow onset of groin pain Pain after trivial traumatic incident Exacerbated by periods of activity Pain on prolonged sitting and walking Limited range of motion – IR and adduction in flexion

27 Peripheral Compartment

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30 Controversies Will hip arthroscopy delay onset of arthritis Is it better than mini-open procedures for FAI

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32 Thank You! Any questions….


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