Limited Retinacular Vessel Damage Does Not Compromise Femoral Head Perfusion During Hip Arthroscopy - Can the Vascular Safe Zone be Extended?

AbstractProsthetic joint instability is a challenging concern for a minority of total hip arthroplasty (THA) patients. Placement of the acetabular component within the traditional safe zone does not eliminate dislocation, and the relative contribution of femoral length and offset to instability risk has not been well defined. The authors compared 53 dislocated primary THAs treated against an age- and gender-matched cohort of 134 stable primary THAs. Anteroposterior and cross-table lateral radiographs were used to determine whether reconstructions met targets for acetabular inclination (30–50 degrees), acetabular anteversion (5–30 degrees), femoral length (0–9.9 mm) and femoral offset (0–9.9 mm). Statistical analysis was performed to assess univariate and multivariate relationships with an instability event; statistical significance was set using a two-sided p-value < 0.05. Forty-seven (88.7%) of the dislocating hips had nonoptimal acetabular or femoral reconstructions. While a similar proportion of patients in the study and control groups had acetabular reconstruction within the safe zone (51.5 vs. 47.2%, p = 0.63) patients with unstable hips were more likely to have acetabular component inclination outside of the target zone (30.2 vs. 7.5%, p < 0.01), acetabular anteversion < 15 degrees (30.2 vs. 3.7%, p < 0.0001), reduced femoral length (35.9 vs. 3.7%, p < 0.0001), and reduced femoral offset (41.5 vs. 7.46%, p < 0.0001). Stepwise multivariate logistic regression was performed and identified femoral head size less than 32 mm (OR 2.9, 95% CI 1.4–6.2) and higher inclination angle (OR 1.1, 95% CI 1.04–1.2) as significant independent risk factors for hip instability. The authors' study findings suggest that insufficient acetabular anteversion, femoral length, and femoral offset reconstruction contribute significantly to instability risk following THA. Using a larger femoral head is protective, but should be balanced against long-term volumetric wear risk.

Download Full-text

The Safe Zone for Hip Arthroscopy: A Cadaveric Assessment of Central, Peripheral, and Peritrochanteric Compartment Portal Placement (SS-01)

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2008.04.002 ◽

2008 ◽

Vol 24 (6) ◽

pp. e1

Author(s):

William J. Robertson ◽

Bryan T. Kelly

Keyword(s):

Hip Arthroscopy ◽

Safe Zone ◽

Portal Placement

Download Full-text

The effects of venting and capsulotomy on traction force and hip distraction in hip arthroscopy

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa035 ◽

2020 ◽

Author(s):

Dillon C O’Neill ◽

Matthew L Hadley ◽

Temitope F Adeyemi ◽

Stephen K Aoki ◽

Travis G Maak

Keyword(s):

Femoral Head ◽

Hip Arthroscopy ◽

Traction Force ◽

Substantial Improvement ◽

Head Size ◽

Femoral Head Size ◽

Post Intervention ◽

Before And After ◽

Hip Distraction

Abstract This study evaluated the effects of venting and capsulotomy on the ratio of normalized distraction distance to traction force, correlating this trend with patient demographic factors. A ratio was chosen to capture the total effect of each intervention on the hip joint. During primary hip arthroscopy, continuous traction force was recorded, and fluoroscopic images were acquired to measure joint distraction before and after the application of traction, venting and interportal capsulotomy. Distraction–traction force ratios were compared using a one-sided paired t-test. A linear regression model was used to determine the relationship between age, sex and body mass index and pre- and post-intervention distraction–traction force ratios. Seventy-two adult patients and 73 hips were included. There was an increase in hip distraction with a decrease in traction force post-venting and capsulotomy (both P’s <0.001). Mean normalized distraction distance increased 1.5% of femoral head size after venting and an additional 2.2% of femoral head size after capsulotomy. Mean traction force decreased 2.2% (14.7 N) after venting and 2.3% (15.3 N) after capsulotomy. Female sex significantly correlated with larger differences in both pre- and post-venting capsulotomy ratios. Venting and capsulotomy both independently improve the ratio of normalized distraction distance to traction force when performed in vivo. However, the effect sizes of each intervention are small and of questionable clinical significance. Specifically, when adequate distraction for safe surgical hip access cannot be obtained despite application of significant traction force, venting and capsulotomy after the application of traction may not afford substantial improvement.

Download Full-text

Central Acetabular Impingement Is Associated With Femoral Head and Ligamentum Teres Damage: A Cross-Sectional Matched-Pair Analysis of Patients Undergoing Hip Arthroscopy for Acetabular Labral Tears

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2017.08.254 ◽

2018 ◽

Vol 34 (1) ◽

pp. 135-143 ◽

Cited By ~ 3

Author(s):

Parth Lodhia ◽

Chengcheng Gui ◽

Timothy J. Martin ◽

Sivashankar Chandrasekaran ◽

Carlos Suarez-Ahedo ◽

...

Keyword(s):

Femoral Head ◽

Hip Arthroscopy ◽

Ligamentum Teres ◽

Matched Pair ◽

Cross Sectional ◽

Matched Pair Analysis ◽

Labral Tears ◽

Pair Analysis

Download Full-text

Internal fixation of femoral head fractures (Pipkin I) using hip arthroscopy

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-013-2821-4 ◽

2014 ◽

Vol 22 (4) ◽

pp. 898-901 ◽

Cited By ~ 16

Author(s):

Myung-Sik Park ◽

In-Sung Her ◽

Hong-Man Cho ◽

Young-Yool Chung

Keyword(s):

Femoral Head ◽

Internal Fixation ◽

Hip Arthroscopy

Download Full-text

Joint Space Width and Osteoarthritis in Patients Undergoing Hip Arthroscopy

The Journal of Hip Surgery ◽

10.1055/s-0037-1603963 ◽

2017 ◽

Vol 01 (02) ◽

pp. 099-104

Author(s):

Tyler Pidgeon ◽

Jonathan Schiller ◽

Peter Evangelista ◽

Jason Machan ◽

Ramin Tabaddor ◽

...

Keyword(s):

Femoral Head ◽

Hip Joint ◽

Hip Arthroscopy ◽

Joint Space Width ◽

Joint Space ◽

High Grade ◽

Grade 3 ◽

Outerbridge Grade ◽

Space Width ◽

Rule Out

AbstractPreoperative hip joint space width (JSW) of ≤2 mm on plain radiography has been shown to be predictive of intraoperative findings of osteoarthritis, worse functional outcomes, and failure to total hip arthroplasty following hip arthroscopy. However, there is no evidence to suggest that hip joint space greater than 2 mm can definitively rule out the presence of osteoarthritis. We hypothesize that a preoperative JSW of 2 mm or greater does not reliably rule out the presence of high-grade arthritis on hip arthroscopy. Retrospective review of 50 patients who underwent hip arthroscopy between January 11, 2010, and January 3, 2015, at a single institution was performed. Preoperative, standing anteroposterior hip radiographs were reviewed to determine the minimum hip JSW of each operative hip. Operative notes and images were reviewed to determine the Outerbridge classification of cartilage changes on both the acetabulum and femoral head for each patient. High-grade arthritis was defined as a minimum of grade 3 changes on either the femoral head or the acetabulum, which was required for inclusion in the study. The sensitivity of a JSW of 2 mm or less on preoperative radiographs to diagnose a patient with grade 3, grade 4, and grade 3 or 4 arthritis was calculated. Linear regression was used to test for an association between Outerbridge grading and the radiographic minimum JSW. The mean JSW for all patients was 3.5 ± 1.2 mm (range: 0–5.5 mm). Regression found an inverse relationship between joint space and the arthroscopic grading of the articular surfaces (p = 0.0031). However, a preoperative JSW of ≤ 2 mm was only 14.3% sensitive (95% confidence interval [CI] 2.6–51.3%) for predicting Outerbridge grade 3 changes, 7.3% sensitive (95% CI: 2.5–19.4%) for predicting Outerbridge grade 4 changes, and 8.3% sensitive (95% CI: 3.3–20.6%) for predicting Outerbridge grade 3 or 4 changes. The threshold of ≤2 mm of hip JSW on plain radiographs has poor sensitivity for predicting the existence of high-grade arthritis.

Download Full-text