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Capsulotomy of hip joint

Soshi Uchida, Cecilia Pascual-Garrido, Yasuo Ohnishi, Hajime Utsunomiya, Yohei Yukizawa, Jorge Chahla, Akinori Sakai
Hip arthroscopy is promising tool for assessing and treating intra-articular pathologies including labral tears, cartilage injuries, and ligamentum teres tears of the hip. Interportal capsulotomy allows for better visualization and accessibility of the arthroscope and working instruments. The hip capsule has been defined as a crucial stabilizer of the hip joint. Thus, capsular closure is recognized as an important procedure to prevent postoperative instability after hip arthroscopic surgery. Despite the routine capsular closure during hip arthroscopy, there is a small subset of patients who complain of hip pain and dysfunction after surgery most likely because of disruption of hip closure site after routine complete capsular closure with strong suture for treating hip instability...
February 2017: Arthroscopy Techniques
Marc J Philippon, Christiano A C Trindade, Mary T Goldsmith, Matthew T Rasmussen, Adriana J Saroki, Sverre Løken, Robert F LaPrade
BACKGROUND: Although acetabular labral repair has been biomechanically validated to improve stability, capsular management of the hip remains a topic of growing interest and controversy. PURPOSE: To biomechanically evaluate the effects of several arthroscopically relevant conditions of the capsule through a robotic, sequential sectioning study. STUDY DESIGN: Controlled laboratory study. METHODS: Ten human cadaveric unilateral hip specimens (mean age, 51...
April 1, 2017: American Journal of Sports Medicine
Seper Ekhtiari, Darren de Sa, Chloe E Haldane, Nicole Simunovic, Christopher M Larson, Marc R Safran, Olufemi R Ayeni
PURPOSE: Hip arthroscopy is increasingly used to address hip joint pathology. Iatrogenic instability has been reported as a potential complication, leading to the evaluation of various capsular management strategies. The purpose of this review was to (1) report the techniques used for capsulotomy in hip arthroscopy, (2) understand techniques and indications for capsular closure, and (3) report outcomes based on capsular management strategy. METHODS: MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for relevant studies...
January 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
A Aprato, M Leunig, A Massé, T Slongo, R Ganz
AIMS: Several studies have reported the safety and efficacy of subcapital re-alignment for patients with slipped capital femoral epiphysis (SCFE) using surgical dislocation of the hip and an extended retinacular flap. Instability of the hip and dislocation as a consequence of this surgery has only recently gained attention. We discuss this problem with some illustrative cases. MATERIALS AND METHODS: We explored the literature on the possible pathophysiological causes and surgical steps associated with the risk of post-operative instability and articular damage...
January 2017: Bone & Joint Journal
M Michael Khair, Jeffrey S Grzybowski, Benjamin D Kuhns, Thomas H Wuerz, Elizabeth Shewman, Shane J Nho
PURPOSE: To quantify how increasing interportal capsulotomy size affects the force required to distract the hip and to biomechanically compare simple side-to-side suture repair to acetabular-based suture anchors as capsular repair techniques. METHODS: Twelve fresh-frozen cadaveric hip specimens were dissected to the capsuloligamentous complex of the hip joint and fixed in a material testing system, such that a pure axial distraction of the iliofemoral ligament could be achieved...
March 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
Martin Ellenrieder, Thomas Tischer, Rainer Bader, Peter Cornelius Kreuz, Wolfram Mittelmeier
INTRODUCTION: The application of traction in hip arthroscopy is associated with peri-operative complications. Within a therapeutic case series, patient-related factors correlating with high-traction forces during hip arthroscopy and occurring complications should be identified. MATERIALS AND METHODS: In 30 male and 38 female patients (mean age: 44.5 years), intra-operative traction forces were monitored continuously using a specialised measurement device. A multivariate analysis was employed to identify patient-related factors influencing the traction force...
January 2017: Archives of Orthopaedic and Trauma Surgery
Jorge Chahla, Jacob D Mikula, Jason M Schon, Chase S Dean, Kimi D Dahl, Travis J Menge, Eduardo Soares, Travis Lee Turnbull, Robert F LaPrade, Marc J Philippon
BACKGROUND: Hip capsulotomy is routinely performed during arthroscopic surgery to achieve adequate exposure of the joint. Iatrogenic instability can result after hip arthroscopic surgery because of capsular insufficiency, which can be avoided with effective closure of the hip capsule. There is currently no consensus in the literature regarding the optimal quantity of sutures upon capsular closure to achieve maximal stability postoperatively. Purpose/Hypothesis: The purpose of this study was to determine the failure torques of 1-, 2-, and 3-suture constructs for hip capsular closure to resist external rotation and extension after standard anterosuperior interportal capsulotomy (12 to 3 o'clock)...
February 2017: American Journal of Sports Medicine
Joshua D Harris
The hip capsule is a highly complex anatomic structure, which influences normal hip motion and biomechanics. A dynamic stabilizing capsular contribution exists in the iliocapsularis and gluteus minimus, among other musculotendinous structures crossing the joint. Variable types and sizes of capsulotomy are necessary to sufficiently visualize and address the bony and soft tissue pathologic source of symptoms. Unrepaired capsulotomies may leave the hip significantly unstable to variable degrees. Capsular closure is a necessary part of a comprehensive arthroscopic hip preservation procedure...
July 2016: Clinics in Sports Medicine
Thomas H Wuerz, Sang H Song, Jeffrey S Grzybowski, Hal D Martin, Richard C Mather, Michael J Salata, Alejandro A Espinoza Orías, Shane J Nho
PURPOSE: To evaluate the effect of capsulotomy size and subsequent repair on the biomechanical stability of hip joint kinematics through external rotation of a cadaveric hip in neutral flexion. METHODS: Eight fresh-frozen cadaveric hip specimens were used in this study. Each hip was tested under torsional loads of 6 N·m applied by a servohydraulic frame and transmitted by a pulley system. The test conditions were (1) neutral flexion with the capsule intact, (2) neutral flexion with a 4-cm interportal capsulotomy, (3) neutral flexion with a 6-cm capsulotomy, and (4) neutral flexion with capsulotomy repair...
August 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Antonio Porthos Salas
Hip arthroscopy (HA) is considered to be a very difficult and demanding surgical procedure, special instruments, an image intensifier and a fracture table or hip distractor are required to access the hip joint, the most common and worldwide used HA technique is entering blindly to the central compartment with the use of fluoroscopy and continuous distraction; with the potential danger if performed in unskillful hands of labral penetrations, labral resections and scuffing of the femoral head cartilage. Our technique describes the arthroscopic management of femoroacetabular impingement (FAI), performing a preoperative planning using radiographic and anatomic landmarks to approach the anterior capsule without the use of fluoroscopy...
December 2015: Journal of Hip Preservation Surgery
Peng-cheng Wang, Dong Ren, Bing Zhou
A 66-year-old woman had sustained crush injury 3 hours prior to her presentation to our hospital. The diagnosis was defined as lateral tibial plateau fracture of the right knee (Schatzker III). Supine position was set up and a pad was put under the affected hip. After sterilization of the surgical field the sterilized sheets were placed beneath the leg in order to be higher than the other side. A rolled sheet was put under the knee joint so that the knee joint was flexed around 30° to 40°. After the surgical field was draped the skin was incised...
November 2015: Orthopaedic Surgery
Simon Lee, Marc S Haro, Andrew Riff, Charles A Bush-Joseph, Shane J Nho
Open synovectomy remains the treatment of choice for pigmented villonodular synovitis (PVNS) of the hip but has shown modest results compared with the treatment of other joints. Recent advances in hip arthroscopy permit a thorough evaluation of the joint surfaces, improved access, and decreased postoperative morbidity. We describe an arthroscopic synovectomy technique for PVNS of the hip. The use of additional arthroscopic portals and creation of a large capsulotomy enable successful visualization and extensive synovectomy of the entire synovial lining of the hip...
February 2015: Arthroscopy Techniques
Frank McCormick, Kyle Alpaugh, Bryan Haughom, Shane Nho
Pigmented villonodular synovitis (PVNS) is a benign synovial tumor of unknown etiology with a predilection for the large joints of the appendicular skeleton. The poor prognosis for patients with hip disease is partially imparted by current surgical techniques. Recent advances in hip arthroscopy technique and instrumentation may enable arthroscopic treatment for PVNS in the hip. The authors report the first case where hip arthroscopy was used to surgically excise a biopsy-confirmed local PVNS lesion in the hip...
April 2015: Orthopedics
N Capuano, A Del Buono, N Maffulli
OBJECTIVE: The goals of a tissue-preserving minimally invasive approach to the hip are to allow early short-term recovery, achieve hip joint stability, minimize muscle strength loss from surgery, spare the peri-articular soft tissues, and allow unrestricted motion in the long term. INDICATIONS: Hip arthroplasty in patients with no pre-existing hardware, with a sufficient space between the acetabular rim and greater trochanter; management of subcapital femoral fractures in older patients...
August 2015: Operative Orthopädie und Traumatologie
Geoffrey D Abrams, Michael A Hart, Kaosu Takami, Christopher O Bayne, Bryan T Kelly, Alejandro A Espinoza Orías, Shane J Nho
PURPOSE: To determine the effect of different types of capsulotomies on hip rotational biomechanical characteristics. METHODS: Seven fresh-frozen cadaveric hip specimens were thawed and dissected, leaving the hip capsule and labrum intact. The femur was transected and potted, and each specimen was placed in a custom loading apparatus that allowed for adjustment of flexion, extension, and axial rotation of the femur. Six reflective infrared markers were attached to the specimens to track the motion of the femoral head with respect to the acetabulum in real time, and external rotation was produced by applying a torque of 10 Nm to the hip specimens...
August 2015: Arthroscopy: the Journal of Arthroscopic & related Surgery
Pisit Lertwanich, Anton Plakseychuk, Scott Kramer, Monica Linde-Rosen, Akira Maeyama, Freddie H Fu, Patrick Smolinski
PURPOSE: Knowledge of the effect of hip pathologies on hip biomechanics is important to the understanding of the development of osteoarthritis, and the contribution of the labrum to hip joint stability has had limited study. The purpose of this study was to evaluate the effect of labral injury to stability of the femoral head in the acetabular socket. METHODS: Ten cadaver hip specimens were tested using a robotic system under four different loading conditions: axial loading (80 N) along the femoral axis and axial loading (80 N) combined with either anterior, posterior or lateral loading (60 N)...
July 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Ranajit Panigrahi, Biswajit Sahu, Amita Kumari Mahapatra, Nishit Palo, Ashok Priyadarshi, Manas Ranjan Biswal
PURPOSE: Paediatric femur neck fractures are exceedingly rare owing to dense bone surrounded by a strong periosteum; they account for 1 % of paediatric fractures and are usually associated with high energy trauma. METHODS: This was a prospective multicenter therapeutic study on pediatric femoral neck fractures from June 2004 to September 2013 at three centres in Odisha, India. Children with femoral neck fractures (Delbet type 2 and 3) who were operated and completed a minimum one-year follow-up were included...
June 2015: International Orthopaedics
Benjamin G Domb, Christine E Stake, Zachary J Finley, Tian Chen, Brian D Giordano
PURPOSE: The primary objective of this study was to determine whether capsular management technique influences clinical outcomes at a minimum of 2 years after arthroscopic hip preservation surgery. METHODS: A retrospective review of prospectively collected data was conducted to determine the relative influence of 2 capsular management strategies on clinical outcomes: unrepaired capsulotomy (group A) and capsular repair (group B). Four hundred three patients who had undergone arthroscopic hip preservation surgery met the inclusion criteria and had 2-year outcome data available...
April 2015: Arthroscopy: the Journal of Arthroscopic & related Surgery
Brian D Dierckman, Carlos A Guanche
A variety of complications, including iatrogenic anterior hip instability, have been reported after hip arthroscopy. We present a case of a patient sustaining a postoperative anterior hip dislocation after cam resection for treatment of femoroacetabular impingement. Our patient developed persistent instability and required anterior capsuloligamentous reconstruction with iliotibial autograft. We present a comprehensive review of the literature on postoperative hip instability after hip arthroscopy, including the role of capsulotomy closure, and use of postoperative orthotics and weight-bearing restrictions...
December 2014: American Journal of Orthopedics
Mathieu Thaunat, Colin G Murphy, Romain Chatellard, Bertrand Sonnery-Cottet, Nicolas Graveleau, Alain Meyer, Frédéric Laude
Capsulotomy during hip arthroscopy improves the mobility of arthroscopic instruments and helps gain greater access to key areas of the hip. During the past decade, its use has expanded dramatically as the complexity of hip arthroscopy has advanced. We report a novel approach for hip arthroscopy that consists of performing an extra-articular capsulotomy under endoscopic control before exploration of the hip joint. The principle of this new concept is to replicate an anterior Hueter approach of the hip joint...
October 2014: Arthroscopy Techniques
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