Hip arthroscopy
The hip arthroscopy is a method for minimally invasive examination and surgical treatment of disorders of the hip joint is used.
history
As early as 1977 there was a report on the use of arthroscopy of the hip in the case of slipping of the epiphysis ( epiphyseolysis capitis femoris ). The necessary forces (approx. 300 to 500 Newtons ) that are necessary for hip arthroscopy were described as early as 1986.
anatomy
Difficulties in hip arthroscopy in contrast to knee arthroscopy arise from the anatomical peculiarities of the hip joint . In contrast to the knee joint, the hip joint is a ball joint . The important structures outside the joint are
- ventral : the cutaneous nerve lateralis , the femoral nerve , the femoral artery and the femoral vein
- The sciatic nerve ( nervus ischiadicus ) and the nervus gluteus inferior lie dorsally
these structures can be injured during arthroscopy.
Storage and access
There are two types of positioning, the side position and the supine position. Regardless of the position, the leg must be pulled. The femur should be retracted an inch and the leg abducted .
Possible approaches are anterior, anterolateral and posteolateral. The greater trochanter serves as a reference point for the lateral approaches . In the anterior approach, which lies at the intersection of a sagital line from the anterior superior iliac spine and a transverse line over the superior edge of the greater trochanter, the lateral cutaneous nerve can be injured.
Indications
Selected indications for hip arthroscopy (after)
- femoro-acetabular impingement
- incipient hip arthrosis
- free joint bodies
- Injuries to the acetabular labrum (joint lip)
- Injury to the ligamentum capitis femoris (headband)
- Cartilage damage
- unclear pain in the hip joint
- internal hip snap ( Coxa saltans interna )
- Joint mucosal diseases
- Infection of the hip joint
Complications
Cartilage damage caused by the doctor, injuries to vessels and nerves and the pull on the leg. Iatrogenic cartilage injuries (caused by the doctor) can also occur. Nerve lesions, in particular injuries to the sciatic nerve and the lateral femoral cutaneous nerve , are mostly only temporary and reversible within a few weeks. The frequency with which this procedure is performed, and thus the experience of the surgeon, also minimizes the risks of the procedure.
In a case series of sixty patients who were operated on by experienced orthopedic surgeons in San Francisco, 58% found intraoperative sciatic nerve dysfunctions when measuring evoked potentials , and 7% (four patients) had a clinically relevant sciatic nerve lesion after the operation which, however, regressed in the short to medium term in all patients and in no case caused permanent damage. A nerve change occurred particularly with a higher traction weight and was less dependent on the traction time.
literature
- M. Dienst, D. Kohn: Hip arthroscopy. Minimally invasive diagnosis and therapy of the diseased or injured hip joint. In: trauma surgeon. 104 (1), Jan 2001, pp. 2-18. PMID 11381758
- J. Duparc et al. (Ed.): Surgical techniques in orthopedics and traumatology. Volume 6: pelvic ring and hip. Elsevier, 2005, ISBN 3-437-22556-1 , pp. 425ff.
- Mark D. Miller: Surgical Atlas of Sports Orthopedics - Sports Traumatology. Elsevier, 2004, ISBN 3-437-23660-1 , pp. 247ff.
- Individual evidence
- ^ Eriksson et al: Diagnostic and operative arthroscopy of the hip. Diagnostic and operative arthroscopy of the hip. In: Orthopedics. 9 (2), Feb 1986, pp. 169-176. PMID 3960759
- ↑ F. Bachelier, D. Pape, M. Wettstein, M. Dienst: Useful indications for arthroscopy of the hip joint. In: Zentralbl Chir. 131, 2006, pp. W2-W16.
- ↑ Jessica JM Telleria, Marc R. Safran, John N. Gardi, Alex HS Harris, James M. Glick: Risk of Sciatic Nerve Traction Injury During Hip Arthroscopy - Is It the Amount or Duration? An Intraoperative Nerve Monitoring Study. In: Journal of Bone and Joint Surgery. Volume 94-Am, Issue 22, November 21, 2012, pp. 2025-2032. doi: 10.2106 / JBJS.K.01597 .