Download Video: Hip Arthroscopy ICL 301: Femoroacetabular

Video: Hip Arthroscopy
ICL 301: Femoroacetabular Impingement
Thursday, February 17th, 2011
Bryan T. Kelly, MD
Co-Director
Center for Hip Pain and Preservation
Bryan T. Kelly, MD
Hospital for Special Surgery
Disclosure: I DO NOT have a financial
interest in any commercial products or
service presented in this lecture AND
DO NOT INTEND to discuss off label or
investigational use of products or
services.
Types of financial relationships and the companies
with whom I have relationships are as follows:
Pivot Medical, Inc.: Consultant
Smith & Nephew: Educational Consultant
A2 Surgical: Consultant
Arthroscopic FAI
1.
2.
3.
4.
Set up
Access
Capsule Cut
Rim Prep /
Resection
5. Labral Refixation
6. Cam
Decompression
7. Capsular Repair
1. Patient Set Up
1. Patient Set Up
• Adequate traction
requires approximately
10mm of distraction
across the joint.
• Careful attention to
padding is critical.
2. Access – Portals
1.Anterior
2.Anterolateral
3.Posterolateral
Greatest Risk →→ Anterior Portal
Primal Pictures Limited
– Avg. 3 mm from a branch of the lateral femoral
cutaneous nerve
2. Access: Expanded Portal Placement
• Palpate and Outline:
– Greater Trochanter
– Anterior Superior Iliac Spine (ASIS)
• Portal Placement
– Anterolateral Portal (AL)
• 1cm superior and anterior to GT
– Posterolateral (PL)
• 1cm superior and posterior to GT
– Anterior Portal (AP)
• In line with AL portal
• 1 cm lateral to ASIS
– Mid-Anterior Portal (MAP)
– Proximal Mid-Anterior Portal (PMAP)
Portal Safety
1.
2.
The Mid-Anterior and Anterior portals pass in
close proximity to a small terminal branch of the
ascending LCFA
Greatest risk still comes from the proximity of
the anterior portal to the LFCN
– A slightly more lateral location may provide some
protective benefit
Safe Zone
Robertson et al, Arthroscopy 2008.
• The findings from
this study seem to
support the concept
of a relative
neurovascular safe
zone for arthroscopic
access to the hip
joint within the
outlined parameters.
2. Access / Visualization
2. Access / Visualization
2. Access / Visualization
Transition zone injury
Contra-Coup injury
3. Capsule Cut
3. Capsule Cut – IA Evaluation
Cam Injury
• Cam delamination
• Loss of normal
attachment of labrum to
transition zone.
Rim Injury
• Capsular sided injury to
the labrum / capsule
against the rim lesion
4. Rim Preparation
Rim Exposure
• Severe rim inflammation
around the rim lesion
Rim Decompression
• Outline the rim lesion
prior to decompression
4. Rim Preparation
3. Rim Resection
Pre
Post
4. Labral Refixation
4. Labral Refixation
Entry into peripheral
compartment
Reposition patient and fluoro for peripheral
compartment work.
5. T-Cut and Visualization
6. Cam Decompression
7. Capsule Closure and Assessment
Pre and post fluoro shots of a patient
with primary cam impingement
Pre and post fluoro shots of a patient
with combined subspine / rim / and cam
impingement
Thank You