Endoscopic Lesser Trochanter Resection With Refixation of the Iliopsoas Tendon for Treatment of Ischiofemoral Impingement.

Ischiofemoral impingement is a source of hip pain derived from impingement between the lesser trochanter and the ischium. Lesser trochanter excision has been recommended for recalcitrant ischiofemoral impingement through either an anterior or posterior approach. However, neither of these approaches involves refixation of the iliopsoas tendon.

Multicenter Outcomes of Endoscopic Pubic Symphysectomy for Osteitis Pubis Associated With Femoroacetabular Impingement.

Purpose: To investigate outcomes of athletic patients treated with concurrent femoroacetabular impingement (FAI) and osteitis pubis (OP) surgery including endoscopic pubic symphysectomy.

Methods: We performed a multicenter retrospective case series of 7 consecutive adult patients (4 men) with a mean age of 33 years with symptomatic FAI and OP who underwent arthroscopic surgery for the former and endoscopic pubic symphysectomy for the latter with a mean follow-up period of 2.9 years (range, 2.

Arthroscopy of the nondistractable hip: a novel extracapsular approach.

Adequate traction to achieve hip joint distraction is essential for avoiding iatrogenic injury to the joint during hip arthroscopy. An inability to distract the joint is a relative contraindication for hip arthroscopy. This report describes a novel technique involving an extracapsular approach to gain safe access to a hip joint that fails a trial of traction during positioning for hip arthroscopy.

Hip Arthroscopy for Synovial Chondromatosis: Tips and Tricks.

Hip arthroscopy is an important diagnostic and therapeutic tool in the management of synovial chondromatosis. Removal of osteochondral fragments (OCFs) from the central and peripheral compartments is crucial for the relief of mechanical symptoms and subsequent joint destruction. Direct access to the central compartment is often limited because of the ball-and-socket morphology and limitation of traction.

The modified mid-anterior portal for hip arthroscopy.

The modified mid-anterior portal is a utilitarian hip arthroscopy working portal that permits dual-portal comprehensive surgery for femoroacetabular impingement and related chondrolabral procedures without the need for interportal exchange. Its distal location facilitates labral reparative and reconstructive procedures while minimizing iatrogenic acetabular chondral damage. The relatively lateral location permits instrument navigation not only along the anterosuperior acetabular rim and anterolateral proximal femur typically required for acetabuloplasty and femoroplasty but even to the posterior regions of the hip in cases of global pincer femoroacetabular impingement and posterior extensions of cam morphology and the anteromedial proximal femur while avoiding direct injury to the lateral femoral cutaneous nerve.

Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement.

Pincer femoroacetabular impingement occurs in focal or global forms, the latter having more generalized and typically more extreme acetabular overcoverage. Severe global deformities are often treated with open surgical dislocation of the hip. Arthroscopic technical challenges relate to difficulties with hip distraction; central-compartment access; and instrument navigation, acetabuloplasty, and chondrolabral surgery of the posterior acetabulum.

Closed intramedullary derotational osteotomy and hip arthroscopy for cam femoroacetabular impingement from femoral retroversion.

Femoral retroversion is an uncommon cause of cam femoroacetabular impingement that may require surgical treatment beyond arthroscopic or open femoroplasty. We present the case of a young adult with bilateral severe femoral retroversion in whom such treatment failed. We discuss the rationale, surgical technique, and outcome of this patient, who underwent bilateral closed intramedullary derotational proximal femoral osteotomies and interlocked nailing with adjunctive pre- and post-osteotomy hip arthroscopies.

Arthroscopic labralization of the hip: an alternative to labral reconstruction.

Labralization, which may be performed by open or arthroscopic means, may be an attractive alternative to hip labral reconstruction. By preserving the articular cartilage in the region of labral deficit with meticulous rim trimming, the resultant undermined free chondral margin ("pseudolabrum") may immediately restore a fluid seal function and may theoretically enhance hip preservation. Arthroscopic hip labralization is a relatively simple and fast procedure without graft harvest morbidity.

Arthroscopic osteosynthesis of femoral head malunion.

We present the case of a femoral head malunion with lateral cephalic femoroacetabular impingement managed by arthroscopic osteotomy/takedown, bone grafting, internal fixation, and cephaloplasty. The treatment rationale and surgical technique are presented. A successful outcome at 3 years was obtained with radiographic evidence of union without osteonecrosis.

The critical corner of cam femoroacetabular impingement: clinical support of an emerging concept.

Purpose: The purpose of this study was to evaluate the concept of cam femoroacetabular impingement (FAI) occurring medial to the classic anterolateral (AL) quadrant.

Methods: Forty-four patients met the inclusion criteria of cam FAI and underwent arthroscopic AL femoroplasty. Goniometric measurements of intraoperative hip internal rotation (HIR) in 90° of hip flexion and 0° of adduction were obtained.

Hip arthroscopy for challenging deformities: posterior cam decompression.

Since the classic description of cam femoroacetabular impingement occurring in the anterolateral quadrant of the proximal femur, there has been growing evidence of cam impingement extending outside of this region. Although anteromedial cam decompression may be performed, posterior cam decompression is at higher theoretic risk of vascular embarrassment with osteonecrosis and/or tensile failure with fracture, leading some investigators to believe that these major deformities require open surgical correction. We present a less invasive method of arthroscopic posterior cam decompression using the modified midanterior portal while avoiding the posterolateral vasculature of the proximal femur.

The clamshell fracture and adjunctive acetabuloplasty in the arthroscopic osteosynthesis of femoral head fractures with femoroacetabular impingement.

The clamshell fracture of the femoral head and its arthroscopic osteosynthesis are described. This suprafoveal osteochondral fracture may have folded onto itself during closed reduction of the associated anterior hip dislocation. The resultant fracture fragment had almost circumferential chondral coverage that required arthroscopic manipulation to "pry apart the clamshell," permitting arthroscopic reduction.

Arthroscopic labral reconstruction with gracilis autograft.

Despite growing interest in hip arthroscopy and labral preservation, some patients have severely damaged, degenerative, or deficient labrums and may be candidates for arthroscopic labral reconstruction. The ligamentum teres has been used as a graft source for open hip labral grafting, and the iliotibial band has been used in the arthroscopic setting. We present an alternative method of hip labral reconstruction using the gracilis autograft, which does not require post-harvest manipulation.

Arthroscopic internal fixation of osteochondritis dissecans of the femoral head.

Osteochondritis dessicans of the femoral head is an uncommon problem. Limited literature reports the incidence of osteochondritis dessicans and its treatment. The surgical technique used and outcomes for a 40-year-old man with symptomatic femoral head osteochonditis dissecans who was treated 11 years previously with retrograde drilling and hip arthroscopy are discussed.

Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes.

Background: There is high interest but very little evidence to support labral reconstruction of the hip. Purpose/

Hypothesis: The purpose of this study was to determine the clinical effectiveness of arthroscopic hip labral reconstruction using gracilis autograft in the multistep surgeries for femoroacetabular impingement (FAI). The hypothesis was that patients undergoing arthroscopic hip labral reconstruction with gracilis autograft would have improvement in symptoms and function attributable to this procedure.

Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia.

Recent reports of poor clinical outcomes after arthroscopic surgery in hips with marked dysplasia have emerged. Arthroscopic resection of the hypertrophic labrum in cases of dysplasia, especially in the absence of periacetabular osteotomy (PAO), has been implicated. Some patients will refuse PAO because it is a major open procedure, opting for a less invasive arthroscopic procedure.

Emergent hip arthroscopy: life-saving intervention for septic hip and secondary multiorgan failure.

This article describes the case of a 27-year-old female athletic trainer who presented to the emergency department in acute renal failure with rhabdomyolysis and disseminated intravascular coagulation following a brief onset of right hip pain and staphylococcal facial infection. Despite the absence of fever, peripheral leukocytosis, or organisms on gram stain from emergent joint aspiration, magnetic resonance imaging revealed a large hip effusion; a presumptive diagnosis of septic hip was made. Emergent hip arthroscopy was performed in the middle of the night within 3 hours of presentation.

Protrusio acetabuli: contraindication or indication for hip arthroscopy? And the case for arthroscopic treatment of global pincer impingement.

Protrusio acetabuli has been considered a contraindication for hip arthroscopy. We present the case of a 33-year-old man with bilateral symptomatic protrusio acetabuli-the most extreme form of global pincer femoroacetabular impingement-and cam femoroacetabular impingement. We demonstrate the feasibility of the arthroscopic correction of severe deformities and describe key surgical steps permitting central compartment access, subtotal acetabuloplasty, labral reconstruction, and femoroplasty of the right hip, followed by later subtotal acetabuloplasty, labral refixation, and femoroplasty of the left hip, with improved outcomes at 2 and 1 years, respectively, as measured by the nonarthritic hip score.

The case for cam surveillance: the arthroscopic detection of cam femoroacetabular impingement missed on preoperative imaging and its significance.

Classification of femoroacetabular impingement is typically determined by preoperative imaging. Despite measurements such as the alpha angle and anterior offset ratio, cam dysmorphisms may be missed. We present 2 cases of femoroacetabular impingement classified as pincer subtypes where significant cam lesions were not detected until surgery.

Fluoroscopic templating technique for precision arthroscopic rim trimming.

Arthroscopic rim trimming for femoroacetabular impingement can be technically challenging to perform with precision. Intraoperative assessment of the extent of acetabular rim resection is very important. Over-resection can lead to hip instability and even iatrogenic dislocation.

Acute iatrogenic dislocation following hip impingement arthroscopic surgery.

This is the first case report of an iatrogenic anterior hip dislocation after arthroscopic surgery for femoroacetabular impingement with over 1 year of follow-up. This case report describes the clinical course of a patient with symptomatic cam-pincer femoroacetabular impingement. She underwent arthroscopic rim trimming, labral debridement after a failed attempt at labral refixation from suture cut-through, and femoral head-neck resection osteoplasty.

Total shoulder arthroplasty: long-term survivorship, functional outcome, and quality of life.

This study examines long-term outcomes of total shoulder arthroplasty (TSA) via survivorship analysis, patient questionnaires, and minimum 10-year physical examinations. The study group consisted of 320 consecutive TSAs performed in 267 patients between 1974 and 1988. Diagnoses included rheumatoid arthritis (69%), osteoarthritis (22%), and juvenile rheumatoid arthritis (4.