Video: Hip Arthroscopy ICL 301: Femoroacetabular Impingement Thursday, February 17 th, 2011 Bryan T....

Video: Hip Arthroscopy

ICL 301: Femoroacetabular Impingement

Thursday, February 17th, 2011

Bryan T. Kelly, MDCo-DirectorCenter 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. Set up

2. Access

3. Capsule Cut

4. 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

– Avg. 3 mm from a branch of the lateral femoral cutaneous nerve

Primal Pictures Limited

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. The Mid-Anterior and Anterior portals pass in close proximity to a small terminal branch of the ascending LCFA

2. 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 ZoneRobertson 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 EvaluationCam 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