scholarly journals Deep neuromuscular paralysis during hip arthroscopic surgery: influence on perineal tissue pressures and hip joint width

2020 ◽  
Author(s):  
Thomas Ledowski ◽  
Tao Shan Lim ◽  
Artur Kotov ◽  
Shaun Hontomin ◽  
Francis Winfield ◽  
...  
Keyword(s):  
Hip Joint ◽  
Muscle Relaxation ◽  
Arthroscopic Surgery ◽  
Patient Positioning ◽  
Joint Space ◽  
Maximum Pressure ◽  
Joint Width ◽  
Male Patients ◽  
Induction Of Anaesthesia ◽  
Neuromuscular Paralysis

Abstract Pudendal nerve injuries are not an uncommon side effect of patient positioning on a traction table, and muscle relaxation has been suggested to mitigate this risk by reducing pressure on the perineum. A total of 40 patients scheduled for hip arthroscopic surgery under general anaesthesia were recruited. After induction of anaesthesia, pressures on the perineum were measured in 20 subjects by means of an ultra-thin pressure sensor mat wrapped around the perineal post. Perineal pressures were assessed after the induction of anaesthesia, after leg traction and after deep muscle relaxation. In 22 subjects, the hip joint width was measured radiographically at the same time points. Pressures on the perineum were high after traction (median maximum pressure 2540 g cm−2). Neuromuscular paralysis reduced perineal pressures only minimally, but significantly (−5 g cm−2; P = 0.007). Traction increased hip joint width significantly [mean 66 (12)%; P = 0.001) and muscle relaxation further increased joint width by a mean of 3.2 (0–20)% (P = 0.001). Muscle relaxation was more beneficial for male patients (joint width increase 6.8% versus 2.8%; P = 0.04), as well as patients in whom traction alone did not achieve sufficient joint width. Muscle relaxation reduced the perineal pressure during hip arthroscopic surgery by only a negligible amount. With regard to joint space, relaxation may be of highest benefit in male patients and/or patients in whom traction alone produces only a relatively small increase in joint width (trial registration: ANZCTR 12617000191392).

scholarly journals Does hip preservation surgery prevent arthroplasty? Quantifying the rate of conversion to arthroplasty following hip preservation surgery

2020 ◽  
Vol 7 (2) ◽  
pp. 168-182
Author(s):  
Mark Andrew Sohatee ◽  
Mohammed Ali ◽  
Vikas Khanduja ◽  
Ajay Malviya
Keyword(s):  
Hip Joint ◽  
Hip Arthroplasty ◽  
Periacetabular Osteotomy ◽  
Arthroscopic Surgery ◽  
Joint Space ◽  
Joint Preserving Surgery ◽  
Conversion Rates ◽  
Provide Pain Relief ◽  
Conversion Time ◽  
The Mean

Abstract Hip arthroscopic surgery for femoroacetabular impingement and periacetabular osteotomy (PAO) for dysplasia is the most commonly used contemporary treatment for these conditions and has been shown to provide pain relief and restore function. What is less understood and perhaps of more interest to health economists, is the role of these procedures in preserving the hip joint and avoiding hip arthroplasty. The aim of this systematic review was to determine whether hip joint preservation surgery, indeed, preserves the hip joint by looking at conversion rates to total hip arthroplasty (THA). Two separate searches were undertaken, using PRISMA guidelines and utilizing PubMed and Open Athens search engines, identifying manuscripts that looked at conversion to THA following either hip arthroscopy (HA) or PAO. When considering HA, we found 64 eligible papers. Out of these studies, there were 59 430 hips with 5627 undergoing conversion to THA (9.47% [95% CI 9.23–9.71%]) with a mean conversion time of 24.42 months. Regarding PAO, there were 46 eligible papers including 4862 patients who underwent PAO with subsequent conversion to THA in 404 patients (8.31% [95% CI 7.54–9.12%]). with a mean conversion time of 70.11 months. Certain features were associated with increased conversion rates, including increasing age, worsening arthritis and joint space <2 mm. This study demonstrates that the mean conversion rates to be <10% for HA and PAO, during the mean follow-up periods of included manuscripts. Joint preserving surgery appears to defer or at least delay the need for THA.

scholarly journals Postless Hip Arthroscopy: A Safer Alternative for Treatment of Femoracetabular Impingement Syndrome

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110067
Author(s):  
Michael B. Held ◽  
Liana J. Tedesco ◽  
Mario H. Lobao ◽  
T. Sean Lynch
Keyword(s):  
Hip Joint ◽  
Hip Arthroscopy ◽  
Pudendal Nerve ◽  
Patient Positioning ◽  
Central Compartment ◽  
Operating Table ◽  
Complication Rates ◽  
Iatrogenic Complications ◽  
Diagnostic Arthroscopy ◽  
Hip Distraction

Background: Hip arthroscopy for femoroacetabular impingement (FAI) syndrome continues to gain popularity and indications for its use are expanding. Though low complication rates have previously been reported, there are iatrogenic complications specific to the use of the perineal post, such as pudendal nerve injuries, and possible pressure skin necrosis that warrant concern in the healthy young patient. The risk of these complications are increased during simultaneous bilateral hip arthroscopy. Indications: We describe a new technique, which will prevent such problems by using a postless pink pad technique in order to achieve adequate hip distraction. Technique Description: Arthroscopic investigation begins with proper, safe patient positioning in order to gain access to the hip joint with sufficient joint distraction. In the postless technique, a dense foam pad is utilized in lieu of a perineal post. The static friction between the pad, bed, and the patient counters the manual gross traction necessary to distract the hip joint while preventing the patient from sliding down or off of the operating table. The postless technique avoids pressure to the perineum and also allows for greater range of motion during dynamic intraoperative examination and femoroplasty. After hip distraction, standard portal placement allows for access to the central compartment in order to assess intraarticular pathology. Once identified on diagnostic arthroscopy, appropriate techniques are utilized to correct acetabular-sided pincer lesions, labral tears, and femoral-sided cam deformities. Results: When discussing this technique with patients, it is important to highlight that it diminishes the possibility of iatrogenic pressure injury to the pudendal nerve and skin of the perineum. The risk of these injuries typically occurs when the pudenal nerve is compressed against the post during traction and abduction. As such, postless technique prevents any compression and pressure to these regions. Discussion/Conclusion: Hip arthroscopy is a minimally invasive, low morbidity technique for treating a variety of chondral, ligamentous, and bony conditions of the hip. However, studies suggest that pudenal nerve injury is seen in up to 4.3% of patients following hip arthroscopy. Given avoidance of iatrogenic post complications, we describe a postless technique for achieving hip distraction during hip arthroscopy.

scholarly journals Assessment of the duration and effectiveness of intra-articular lidocaine injections for groin pain in patients with labral tears involving early osteoarthritis

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 4
Author(s):  
Kensuke Fukushima ◽  
Gen Inoue ◽  
Ayumu Kawakubo ◽  
Kentaro Uchida ◽  
Tomohisa Koyama ◽  
...  
Keyword(s):  
Complete Remission ◽  
Hip Joint ◽  
Groin Pain ◽  
Arthroscopic Surgery ◽  
Early Osteoarthritis ◽  
Labral Tears ◽  
Symptom Remission ◽  
Lidocaine Injection

Introduction: Intra-articular lidocaine injections have been used to confirm the hip pathology and may predict the efficacy of arthroscopic surgery. We have routinely performed the injections as a surgical indicator. The aim of this study was to assess the duration and effectiveness of these diagnostic intra-articular lidocaine injections on groin pain in patients with labral tears involving early osteoarthritis. Methods: A total of 113 patients were included in this study. All patients received one injection of 10 ml of 1% lidocaine into the hip joint under fluoroscopy. The duration and effectiveness of the injection were assessed 2 weeks after the injection and at a minimum of 1 year of follow-up. The effect of the injection was graded as 0: unchanged or worse; 1: an effect only on the day of injection; 2: the effect lasted a few days; 3: the effect lasted about a week; and 4: symptom remission. In addition, we recorded whether hip arthroscopic surgery was eventually performed. Results: The effect was rated as 0 in 19 patients (16.8%), as 1 in 30 patients (26.5%), as 2 in 38 patients (33.6%), as 3 in 13 patients (11.5%), and as 4 in 13 patients (11.5%). Seventy-two patients (63.7%) underwent hip arthroscopic surgery. No relationship with patients’ characteristics was found. Conclusion: In total, 83% of patients experienced some effect of the lidocaine injection. Furthermore, 11.5% of patients experienced complete remission of their symptoms.

Normal radiological unossified hip joint space and femoral head size development during growth in 675 children and adolescents

2016 ◽  
Vol 30 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Veronika Wegener ◽  
Gabriele Jorysz ◽  
Andreas Arnoldi ◽  
Sandra Utzschneider ◽  
Bernd Wegener ◽  
...  
Keyword(s):  
Femoral Head ◽  
Children And Adolescents ◽  
Hip Joint ◽  
Joint Space ◽  
Head Size ◽  
Femoral Head Size

Changes in The Temporomandibular Joint after Occlusal Deprogramming

2020 ◽  
pp. 1-21
Author(s):  
Rohit Kulshrestha ◽  
Keyword(s):  
Controlled Trial ◽  
Arthroscopic Surgery ◽  
Mandibular Condyle ◽  
Mouth Opening ◽  
Signs And Symptoms ◽  
Joint Space ◽  
Pharmacological Intervention ◽  
Occlusal Splints ◽  
Condylar Position ◽  
Surgery Education

Common signs and symptoms of TMD include masticatory muscle pain, TMJ sounds, limited mouth opening, and deviations in mandibular movements. Treatment generally involves some combination of occlusal splints, physiotherapy, relaxation therapy, pharmacological intervention, arthroscopic surgery, education, and behavioural counselling. One randomized controlled trial indicated that an occlusal deprogramming splint is more effective than other methods in treating TMD, although another study produced contradictory results. Measurements of the radiographic joint space a radiolucent area between the mandibular condyle and the temporal bone were introduced by Ricketts to describe condylar position. The clinical significance of condyle-fossa relationships in the TMJ is controversial, but several studies have suggested an association between eccentric condylar position and TMD. This chapter describes key changes in the condyle-fossa relationship after the use of an occlusal deprogramming splint in patients with TMD.

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

2019 ◽  
Vol 23 (03) ◽  
pp. e58-e67 ◽  
Author(s):  
Georgina Allen ◽  
Marina Obradov ◽  
Vito Chianca ◽  
Carmelo Messina ◽  
Luca Maria Sconfienza
Keyword(s):  
Hip Joint ◽  
Ultrasound Guidance ◽  
Pubic Symphysis ◽  
Joint Space ◽  
Common Condition ◽  
Sacroiliac Joints ◽  
Ultrasound Guided ◽  
Therapeutic Procedures

AbstractPain around the hip and pelvis is a very common condition. Pain may be generated within the joint space (i.e. the hip joint itself, the sacroiliac joints or the pubic symphysis) or from surrounding myotendinous, bursal, or nerve structures. Over the years, percutaneous musculoskeletal procedures have become increasingly popular to diagnose and treat painful conditions around the hip and the pelvis. Most intra- and extra-articular procedures are performed under ultrasound guidance. This article reviews the most common diagnostic and therapeutic procedures that can be performed around the hip and the pelvis under ultrasound guidance.

scholarly journals Relationship between osteophyte and arthroscopic findings in osteoarthritis of ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0027
Author(s):  
Munekazu Kanemitsu ◽  
Tomoyuki Nakasa ◽  
Mikiya Sawa ◽  
Masahiro Yoshikawa ◽  
Yusuke Tsuyuguchi ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Weight Bearing ◽  
Arthroscopic Surgery ◽  
Joint Space ◽  
Cartilage Injury ◽  
Radiographic Findings ◽  
Tibiotalar Joint ◽  
Arthroscopic Findings ◽  
Articular Cartilage Injury ◽  
Mortise View

Category: Ankle Introduction/Purpose: Mortise view weight-bearing radiograph is widely used for the diagnosis of osteoarthritis of ankle. Thickness of the articular cartilage cannot be accurately evaluated in the evaluation of joint space from weight-bearing radiograph, because lateral tibiotalar joint space is maintained in valgus type osteoarthritis in some cases. There are few reports on the relation between osteophyte and the articular cartilage injury. We considered that it might be possible to estimate the cartilage injury more accurately by examining osteophytes. The purpose of this study is to analyze the relationship between the location and grade of osteophytes in weight-bearing radiograph and cartilage injury in arthroscopic findings was analyzed. Methods: Twenty-one anklets of 21 patients consisted of 10 males and 10 females, with mean age of 61.4 years (31-79 years), who underwent arthroscopic surgery for osteoarthritis in our department were included. Weight-bearing radiograph were taken before surgery. Location and grade of osteophytes were evaluated using Ankle and Hindfoot Radiographic Osteoarthritis Scoring reported by Kraus et al. Arthroscopic findings were evaluated with International Cartilage Repair Society (ICRS) Grade at a total of 20 sites (9 areas of tibia and talar in tibiotalar joint, medial malleolus and lateral malleolus). The correlation between radiographic findings and arthroscopic findings were analyzed. Results: In Mortise view, strong correlations were found between lateral tibial osteophyte grade and ICRS grade of the center (talus R = 0.69, tibia R = 0.76), the central lateral (tibia R = 0.79), the posterior center (talus R = 0.72, tibia R = 0.74) and the posterior lateral of the tibiotalar joint (talus R = 0.63, tibia R = 0.76). There are moderate correlations between distal fibular osteophyte grade and ICRS grade of the medial inner (tibia R = 0.74) and the posterior medial of the tibiotalar joint (talus R = 0.61, tibia = 0.63). In lateral view, there are moderate correlations between posterior talar osteophyte grade and ICRS grade at the center of the tibiotalar joint (talus R = 0.61, tibia R = 0.60). Conclusion: From this study, there was a strong correlation between location and grade osteophyte and the articular cartilage injury. Osteoarthritis progression is caused by degeneration of the cartilage because of the joint instability, and osteophytes were formed by traction force or impaction. This study showed that local cartilage injury is thought to be related to osteophytes. By evaluating the location and size of osteophytes, the articular cartilage injury might be predicted accurately before arthroscopic surgery.

Distance Between the Anterior Distal Tibial Edge and the Anterior Tibial Artery in Distraction and Nondistraction During Anterior Ankle Arthroscopy: A Cadaveric Study

2017 ◽  
Vol 39 (1) ◽  
pp. 113-118 ◽  
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Arthroscopic Surgery ◽  
Joint Space ◽  
Ankle Arthroscopy ◽  
Anterior Tibial Artery ◽  
Saline Injection ◽  
Ct Scanner ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Fresh Frozen ◽  
Space Expansion

Background: Anterior ankle arthroscopy is widely applied for various osteoarthropathies. However, distraction of the ankle may put the anterior tibial artery (ATA) at risk of injury during the procedure. The purpose of this study was to assess the difference in the distance between the anterior distal tibial edge and the ATA in distraction and nondistraction of the ankle with joint space expansion by saline injection into the joint. Methods: Eight whole fresh-frozen cadaveric feet (mean age 78.9 years) were used. Barium sulfate suspension was injected into the popliteal artery of each specimen, and the distance from 3 aspects of the anterior distal tibial edge to the ATA was measured to evaluate the possibility of damage to the ATA based on computed tomography (CT) scans, in ankle distraction and nondistraction, using a traction device developed for reproducible ankle positioning inside the CT scanner. Results: The distance between the ATA and the most proximal, middle, and distal parts of the anterior distal tibial edge was 0.5 mm, 3.9 mm, and 7.4 mm, respectively, without saline injection, and 3.7 mm, 7.2 mm, and 11.6 mm, respectively, with saline injection, in nondistraction. The distance was 2.2 mm, 5.9 mm, and 9.8 mm, respectively, with 5-kg distraction, and 1.7 mm, 5.1 mm, and 8.8 mm, respectively, with 10-kg distraction, both with saline injection, respectively. Conclusion: The distance between the anterior distal tibial edge and the ATA with joint space expansion by saline injection into the joint increased, and that distance in distraction of the ankle decreased during anterior arthroscopic surgery. Clinical Relevance: The anatomic relationship of the ATA to its surrounding structures may be at more risk without saline injection or with distraction during anterior ankle arthroscopy.

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