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M.P. Muldoon, M. D. Orthopedic Medical Group of San Diego.

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Presentation on theme: "M.P. Muldoon, M. D. Orthopedic Medical Group of San Diego."— Presentation transcript:

1 M.P. Muldoon, M. D. Orthopedic Medical Group of San Diego

2 Hip joint is much less accessible than other joints More technically difficult-need specialized equipment and expertise Conditions warranting its use are rarer Use and indications are emerging

3 Minimally invasive means of seeing inside the hip joint without cutting muscles or using big incisions much like is done in the knee or shoulder First done in 1930s but re-introduced in late 1980s by Dr. Glick of San Francisco Techniques and indications refined in mid-late 90s allowing more predictable results Even greater interest in last 4 years because of treatment of high profile athletes and improved techniques

4 Indications Remove loose bodies such as cartilage or bone from hip joint as on right

5 Indications Investigate hip joint for sources of mechanical pain and address them surgically To help diagnose hip pain sources when other test do not reveal source

6 Indications The treatment of Femoral Acetabular Impingement Snapping Hip Syndromes Recalcitrant Trochanteric Bursitis Repair or debridement of Labral tears

7 Indications As an adjunct to other procedures in order to rule out problems inside the hip joint or allow other procedures to be performed less invasively

8 Contraindications (reasons not to do hip arthroscopy) Advanced arthritis Arthritis without mechanical symptoms (catching, locking) Very stiff hips Fresh fractures or dislocations Surgical problems in which opening the hip joint is not necessary Obesity…Sometimes the instruments are not long enough

9 In order to view the hip joint without scuffing the cartilage it is necessary to use a traction device to open up the hip joint and allow instruments to be introduced General or spinal anesthesia is preferred to allow for complete muscle relaxation

10 Special instruments have been designed to aid entry into hip joint and to remove damaged tissues

11 In Many cases surgery can be performed through two or three small incisions In lower picture patient is draped and flouroscopy unit in position to guide procedure

12 29 year old woman with pain and catching after intense period of exercise 8 months previously Xrays were normal but the MRI arthrogram showed a tear in the labrum

13 At surgery a torn labrum was diagnosed and excised Patient was back to full activities at 3 months


15 Surgery is generally done as outpatient but more complex surgeries with longer anesthetics may stay overnight The hip is injected with long acting anesthetic to ease transition to home. Anti-inflammatories (NSAIDS) are prescribed for the first three weeks to aid in recovery with narcotics available for pain that does not respond to rest, ice and NSAIDS. In Many cases you will wake up with a motion machine - CPM which helps with pain and early mobilization

16 Crutches for several days to weeks until strength comes back –Most patients can weight bear as tolerated Most severe pain is experienced in first 48- 72 hrs Sutures are removed at two to three weeks Sense of fullness that persists up to 6-8 weeks

17 Pain at the incision sites is similar to a bruise in intensity Activity is progressed slowly with emphasis on low impact exercises for the first three months In more complex cases for FAI - directed physiotherapy using a specialized rehabilitation protocol is employed Complete recovery may take 6-9 months

18 Temporary Nerve injuries can occur from traction on sciatic nerve or excess pressure from boot on top of foot. Most of these are markedly improved within a week but can last several weeks to months Infection or significant bleeding is extremely rare. Instruments can break in the hip joint and may require a bigger incision for removal The surgery may not improve the condition and can occasionally make an arthritic hip worse Hips can become stiffer and actually form bone in soft tissues known as Heterotopic ossification…this can be prevented by use of NSAIDS for 3 weeks postop

19 Summary Hip arthroscopy provides a minimally invasive approach to dealing with many sources of hip pain that are unresponsive to other treatments There is a low complication rate and a relatively rapid recovery after surgery

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