Hip Arthroscopy and Hip Joint Preservation Surgery

Contents
About the Editors
Section Editors
Contributors
Part I: Hip Basic Science
1 Hip Anatomy
Introduction
Bony Anatomy and Alignment
Capsular and Ligamentous Anatomy
Muscular Anatomy
Blood Supply and Innervation
Summary
References
2 Clinical Biomechanics of the Hip Joint
Introduction
Hip Kinematics and Muscle Function
Hip Patho-Morphology and Patho-Mechanics
Biomechanical Implications of FAI Syndrome
Biomechanical Implications of Acetabular Hip Dysplasia
Summary
Cross-References
References
3 Plain Radiographic Evaluation of the Hip
Introduction
Technical Principles of Radiographic Imaging
Conical Projection
Film-Tube Distance
Patient-Film Distance
Centering and Direction of the X-Ray Beam
Pelvic Orientation
Fluoroscopy
Radiographic Projections of the Hip
Anteroposterior (AP) Pelvis View
Low-Centered Pelvis View
Anteroposterior (AP) Hip View
Axial Cross-Table View
Dunn-Rippstein View and Modified Dunn View
Lauenstein and Frog-Leg Lateral View
False Profile of Lequesne and de Sèze
True Lateral Pelvis View
Functional Views
Radiographic Parameters
Acetabular Depth
Acetabular Coverage
Acetabular Orientation
Head-Neck Sphericity
Joint Congruency
Additional Findings
Computer-Assisted Evaluation of Plain Pelvis Radiographs
Summary
Cross-References
References
4 Computer Tomography Scan of the Hip and Pelvis
Introduction
Scanning Protocol
Radiation Exposure
Pathological Entities
Femoroacetabular Impingement (FAI)
Subspine Impingement
Acetabular Dysplasia
Pediatric Disorders (DDH, Perthes, SCFE)/Malalignment Syndromes
Traumatic Hip Instability/Acetabular and Avulsion Fracture
Total Hip Arthroplasty
Summary
Cross-References
References
5 Magnetic Resonance Imaging of the Hip
Introduction
MRI Basic Science
Signal and Sequences
Contrast
Quantitative MRI
dGEMRIC
T2 Mapping
Image Acquisition
Imaging Artifact
Intra-articular Structures
Labrum
Articular Cartilage
Ligamentum Teres
Synovium
Joint Capsule
Extra-articular Structures
Hip Abductors
Trochanteric Bursa
Ischiofemoral Impingement
Iliopsoas Tendon and Bursa
Hamstrings
Bone
Normal Bone
Avascular Necrosis
Subchondral Fractures
Athletic Pubalgia
Hip Pathomorphology
Cam Lesion
Pincer Lesion
Summary
Cross-References
References
6 Ultrasound of the Hip
Introduction
Technique
Hip Joint
Muscles and Tendons
Fluid Collections
Injections
Dynamic Examination
Hardware
Summary
References
7 Physical Examination of the Hip and Pelvis
Introduction
The Layers Approach to Hip Evaluation
History
The Physical Examination of the Hip
Standing Examination
Seated Examination
Supine Examination
Lateral Examination
Prone Examination
Posterior Hip Pain
Snapping Hip Tests
Summary of Femoroacetabular Congruence and Hip Instability
Summary
Cross-References
References
8 Selective and Image-Guided Injections Around the Hip and Pelvis
Introduction
Greater Trochanteric Bursitis/Greater Trochanteric Pain Syndrome
Greater Trochanteric Bursa Injection Technique
Gluteus Medius Tendon Injection Technique
Aftercare
Gluteal Bursitis
Gluteal Bursa Injection Technique
Aftercare
Iliopsoas Bursitis
Iliopsoas Bursa Injection
Aftercare
Potential Complications
Adductor Tendonitis
Adductor Tendon Injection Technique
Aftercare
Hamstring Tendon Injuries
Hamstring Injection Technique
Aftercare
Intra-articular Hip Conditions
Intra-articular Hip Injection Technique
Aftercare
Sacroiliac Joint Dysfunction
SI Injection Technique
Aftercare
Osteitis Pubis
Pubic Symphysis Injection Technique
Aftercare
Piriformis Syndrome
Piriformis Injection Technique
Lateral Cutaneous Femoral Nerve Syndrome
Lateral Cutaneous Femoral Nerve Injection Technique
Summary
Cross-References
References
9 Hip Osteoarthritis: Definition and Etiology
Introduction
The Genetics of Hip Osteoarthritis
Acetabular Dysplasia
Biomechanics of Dysplasia
Natural History of Dysplasia
Femoroacetabular Impingement (FAI)
Biomechanics of FAI
Natural History of FAI
Summary and Conclusions
Cross-References
References
10 Athletic Populations of Interest in Hip Arthroscopy and Hip Preservation Surgery
Introduction
General Classifications of Hip Pain in Athletes
Femoroacetabular Impingement
The Role of Hip Arthroscopy and Hip Preservation Surgery
The Contact Athlete
The Pivoting Athlete
The Overhead Athlete
The Endurance Athlete
The Hypermobile Athlete
Special Considerations
In-Season Management
General Treatment Guidelines
Summary
Cross-References
References
11 Rehabilitation of Non-operative Hip Conditions
Introduction
Modifiable Versus Non-modifiable Factors as Contributors to Hip Disorders
Extra-Articular Hip Disorders
Overuse and Overload Tendon Injuries
Anterior Hip Overuse Injuries
Gluteal Tendinopathy
Internal and External Snapping Hip Syndromes
Hamstring Injuries
Acute Hamstring Tears
Chronic Proximal Hamstring Tendinopathy
Athletic Pubalgia and Osteitis Pubis
Adductor Muscle Strains
Intra-Articular Pathologies
Chondral Injury and Osteoarthritis
Femoroacetabular Impingement (FAI) Syndrome and Acetabular Dysplasia
Labral Tear
Summary
Cross-References
References
12 Outcome Assessment of Non-Arthroplasty Hip Disease
Introduction
Outcome Assessment: Who, Why, Where, When, and What?
Who Should Measure Outcomes?
Why Should We Measure Patient Outcomes?
Where Should Patient-Reported Outcomes Be Measured?
When Should Patient-Reported Outcomes Be Measured?
What Outcomes Should Be Measured?
Patient-Reported Outcomes for Hip Joint Conditions
Copenhagen Hip and Groin Outcome Score (HAGOS)
International Hip Outcome Tool (iHOT)
Comparing the HAGOS and iHOT
Cross Cultural Adaptation and Translation into Different Languages
Summary
References
Part II: Operative Basics for Hip Arthroscopy and Open Hip Preservation Surgery
13 Operative Indications for Hip Arthroscopy and Open Hip Preservation Surgery
Introduction
Indications
Intra-articular (Central Compartment) Pathology
Femoroacetabular Impingement (FAI)
Labral Pathology
Chondral Lesions
Ligamentum Teres Injuries
Septic Arthritis
Loose Bodies/Synovial Chondromatosis
Synovial Diseases
Adhesive Capsulitis
Capsular Laxity and Instability
Staged Interventions
Total Hip Replacement
Periarticular (Peripheral Compartment) Pathology
Greater Trochanteric Pain Syndrome
Snapping Hip Syndromes
Proximal Hamstring Repair
Sciatic Nerve Entrapment
Extra-articular FAI
Contraindications
Absolute
Relative
Summary
References
14 Hip Arthroscopy: Supine Approach to Patient Positioning, Setup, and Traction
Introduction
Preoperative Planning/Anesthesia/Setup
Positioning
Traction
Application of Traction
Tractionless Hip Arthroscopy
Distraction Options
Summary
Cross-References
References
15 Hip Arthroscopy: Supine Approach to Patient Positioning, Setup with Post-less
Introduction
Physiologic Changes During Hip Arthroscopy with Perineal Post Compared with Post-Free Surgery
Intraoperative Advantages of the Post-Free Technique
Post-free Surgical Technique
Summary
Cross-References
References
16 Hip Arthroscopy: Lateral Approach to Patient Positioning, Setup, and Traction
Introduction and Brief History
Preoperative Planning/Anesthesia/Setup
Positioning
Distraction
OR Setup
Leg Position
Instruments
Pump
Tower
Procedure
Arthroscopic Anatomy
Summary
Cross-References
References
17 Hip Arthroscopy: Portal Placement
Introduction
Anatomy
Patient Setup
Portal Overview
Anterolateral Portal
Placement
Utility
Risks
Anterior Portal
Placement
Utility
Risks
Mid-Anterior Portal
Posterolateral Portal
Placement
Utility
Risks
Accessory Portals
Proximal and Distal Anterolateral Portals
Peritrochanteric Space Portals
Anterior Portal
Distal Posterior Portal
Summary
References
18 Hip Arthroscopy: Central Compartment Access
Introduction
General Considerations
Patient Setup
Portal Placement
Anterolateral Portal
Risks
Anterior Portal
Risks
Midanterior Portal (MAP)
Risks
Posterolateral Portal
Risks
Challenges to Central Compartment Access
Revision Cases
Combined Procedures
Hip Arthroscopy and Periacetabular Osteotomy
Hip Arthroscopy and Femoral Derotational Osteotomy
Capsulotomy
Summary
Cross-References
References
19 Hip Arthroscopy: Peripheral Compartment Access
Introduction
Methods
Summary
Cross-References
References
20 Hip Arthroscopy: Peritrochanteric Space Access
Introduction
Anatomy of the Peritrochanteric Compartment
Endoscopic Techniques
Summary
Cross-References
References
21 Rehabilitation of Post-Operative Hip
Introduction
Phase 1: Protection Phase
Protection of Repaired Tissue
Reduction of Pain, Inflammation, and Fibrosis
Restoring Passive and Active Ranges of Motion
Proper Neuromuscular Control Patterns
Criteria to Advance to Phase 2
Phase 2
Gait Progression
Aquatic Therapy
Criteria to Progress to Phase 3
Phase 3
Criteria to Advance to Phase 4
Phase 4
Summary
References
22 Hip Arthroscopy Techniques: Deep Gluteal Space Access
Introduction
Anatomy of Deep Gluteal or Subgluteal Space
Surgical Technique
Summary
References
23 Posterolateral Approach to the Hip
Introduction
History
Indications
Contraindications
Key Anatomy
Surgical Technique
Positioning
Superficial Exposure
Deep Exposure
Avoiding Complications
Summary
Cross-References
References
24 Surgical Approach to Open Hip Surgical Dislocation
Introduction
Surgical Technique
Set-Up
Positioning and Draping
Bony Landmarks
Incision
Superficial Dissection
Deep Dissection
Trochanteric Osteotomy
Capsulotomy
Dislocation and Femoral Head and Acetabular Exposure
Capsular Closure
Trochanter Reattachment
Pearls
Summary
Cross-References
References
25 Smith-Petersen Approach to the Hip
Introduction
Surgical Technique
Landmarks and Incision
Exposure
Capsulotomy
Closure
Potential Complications
Summary
Cross-References
References
26 Mini-Open Approach to the Hip
Introduction
Patient Positioning and Preparation
Approach
Capsulotomy
Conclusion
Cross-References
References
27 Surgical Approach for Periacetabular Osteotomy
Introduction
Setup and Positioning
Skin Incision
Deep Dissection
Anatomical Structures at Risk During Exposure
Avoiding Pitfalls
Summary
References
28 Complications with Hip Arthroscopy and Open Hip Surgery
Introduction
Surgical Anatomy
Complications
Iatrogenic Chondrolabral Injury
Iatrogenic Instability
Neurovascular Injury
Heterotopic Ossification
Periacetabular Osteotomy and Concomitant Intra-articular Morphology
Other Minor Complications
Other Rare, but Severe, Complications
Classification Systems in Orthopedic and Hip Preservation Surgery
Summary
Cross-References
References
Part III: Pediatric Hip Conditions
29 Surgical Technique: Pavlik Harness and Closed Reduction for Developmental Dysplasia of the Hip
Introduction
Indications
Newborn to 6 Months of Age
6-18 Months of Age
18 Months of Age and Older
Nonsurgical Techniques
Pavlik Harness
Technique
Closed Reduction and Spica Casting
Technique
Discussion
Summary
References
30 Surgical Technique: Anterior Open Reduction for Developmental Dysplasia of the Hip and Salter Innominate Osteotomy
Introduction
Planning and Positioning
Open Reduction
Femoral Osteotomy
Salter Innominate Osteotomy
Closure
Postoperative Management
Complications
Case Example
Summary
Cross-References
References
31 Surgical Technique: Modified Bernese Triple Innominate Osteotomy
Introduction
Planning and Positioning
Medial Exposure and Ischial Cut
Anterior Exposure and Pubis Cut
Iliac Cut
Mobilization of the Fragment and Fixation
Closure
Postoperative Management
Pearls and Pitfalls
Case Example
Summary
Cross-References
References
32 Legg-Calvé-Perthes Disease
Introduction
History
Incidence and Demographics
Etiology
Vascular Abnormalities
Coagulopathies
Developmental Causes
Environmental Causes
Genetic Causes
Direct Injury
Pathological Findings
Pathogenesis
Histopathology
Radiographic Findings
Waldenstrom Classification
Catterall Classification
Stulberg Classification
Herring Classification
Advanced Imaging
Clinical Findings
Natural History
Prognosis
Differential Diagnosis
Other Causes of Avascular Necrosis in Pediatric Patients
Epiphyseal Dysplasias
Syndromes
Treatment
Containment and Goals of Treatment
Nonoperative Management: Symptomatic Treatment and Orthotics
Surgical Management: Femoral Varus Osteotomy
Surgical Management: Pelvic Osteotomy
Conclusion
Cross-References
References
33 Surgical Technique: Arthroscopic Treatment of Perthes Disease
Introduction
Epidemiology
Presentation
Pathoanatomy
Indications and Decision-Making
Surgical Technique
Pearls and Pitfalls
Outcomes
Summary
Cross-References
References
34 Surgical Technique: Treatment of Residual Perthes-Like Deformities
Introduction
Etiology/Risk Factors
Pathomorphology/Anatomic Considerations
Clinical Presentation and Physical Examination
Radiographic and Advanced Imaging Findings
Surgical Indications and Treatment Options
Outcomes
Conclusion
Cross-References
References
35 Surgical Technique: Trochanteric Advancement
Introduction
Clinical Presentation and Imaging Studies
Indications for Surgery
Surgical Technique
Postoperative Management
Outcomes
Summary
Cross-References
References
36 Slipped Capital Femoral Epiphysis: Acute and Chronic
Introduction
Pathophysiology
Vascular Anatomy
Osseous and Physeal Anatomy
Related Conditions
Clinical Evaluation
Radiographic Evaluation
Classification
Treatment
Closed Reduction and Spica Casting
Open Reduction and Physiodesis
In Situ Fixation
Contemporary Surgical Treatments
Complications
Summary
References
37 Surgical Technique: Open Reduction Using the Modified-Dunn Technique
Introduction
Technical Evolution
Surgical Indications
Patient Evaluation
Surgical Technique
Setup and Equipment
Procedure
Postoperative Care
Summary
References
38 Surgical Technique: In Situ Pinning of Unstable Slipped Capital Femoral Epiphysis
Introduction
Etiology
Classification
Clinical Presentation
Treatment
Authors Preferred Operative Technique
Summary
Cross-References
References
39 Surgical Technique: Proximal Femoral Osteotomies in Residual Childhood Disease
Introduction
Modified Dunn Procedure for Unstable SCFE
Patient Selection
Procedure
Complications
Postoperative Care and Rehab
Outcomes
Subcapital Femoral Neck Osteotomy for Chronic Healed SCFE
Patient Selection
Procedure
Complications
Postoperative Care and Rehabilitation
Outcomes
Femoral Derotation Osteotomy in Adolescents and Adults
Patient Selection
Procedure
Complications
Postoperative Care and Rehabilitation
Outcomes
Summary
Cross-References
References
40 Surgical Technique: Arthroscopic Treatment of Chronic Slipped Capital Femoral Epiphysis
Introduction
Epidemiology
Presentation
Pathoanatomy
Indications
Technique
Setup and Diagnostic Arthroscopy
Central Compartment
Peripheral Compartment
Postoperative Care
Pearls and Pitfalls
Outcomes
Summary
Cross-References
References
41 Neuromuscular Hip Disorders: Focus on Cerebral Palsy
Introduction
Epidemiology and Classification
Pathogenesis
Clinical Evaluation
Radiologic Evaluation
Treatment
The At-Risk Hip
Hip Subluxation Without Acetabular Dysplasia
Hip Subluxation with Acetabular Dysplasia
Summary
References
42 Surgical Technique: Tendon Releases in Neuromuscular Hip Conditions
Introduction
Anatomic Considerations
Surgical Management
Open Adductor Lengthening and Psoas Release
Percutaneous Adductor Lengthening
Postoperative Care
Complications
Summary
References
43 Surgical Technique: Reconstruction with a Proximal Varus Derotational Osteotomy with Blade Plate Fixation and a Volume-Redu...
Introduction
Indications for Surgery
Equipment
Technique of Femoral Varus Derotational Osteotomy
Positioning and Preparation
Adductor Tenotomy
Surgical Approach for VDRO
Osteotomy Technique (90 Blade Plate)
Determining Rotation and Neck-Shaft Angle
Achieving Varus: Guidewire Placement
Chisel Placement and Osteotomy
Placement of the Blade Plate and Achieving Derotation
Discussion Points
Technique of Pelvic Osteotomy
Indications
Approach
Technique
Summary
References
44 Surgical Technique: Resection Arthroplasty
Introduction
Technique
Conclusion
Cross-References
References
Bibliography/Additional References
Part IV: Approach to Hip and Pelvis Disorders
45 Introduction to Static and Dynamic Overload of Hip Pathology
Introduction
Dynamic Factors
Cam Lesions (Loss of Femoral Head-Neck Junction and Loss of Offset)
Acetabular Overcoverage
Focal Rim Impingement
Mixed Impingement
Global Acetabular Retroversion
Global Acetabular Overcoverage
Femoral Retroversion
Extra-articular Impingement
Coxa Vara and Trochanteric-Pelvic Impingement
Ischiofemoral Impingement
Static Factors
Acetabular Dysplasia
Excessive Femoral Anteversion
Femoral Valgus
Combined Patterns
Compensatory Injury Patterns
Summary
References
46 Skeletally Mature Acetabular Dysplasia: Anatomy, Pathomorphology, Pathomechanics, Clinical Presentation, and Imaging Studies
Introduction
Anatomy
Biomechanics
Clinical Presentation
History
Examination
Imaging
Summary
Cross-References
References
47 Surgical Technique: Hip Arthroscopy for Hip Dysplasia
Introduction
Labral Pathology
Inside-Out Labral Repair Technique
Native Everted Labrum
Labral Augmentation or Reconstruction
Femoroacetabular Impingement and Hip Dysplasia
Arthroscopic Femoral Osteoplasty Technique
Acetabular Subchondral Cysts
Arthroscopic Bone Grafting of Acetabular Subchondral Cysts
Borderline Dysplasia and Capsular Management
Capsular Plication
Capsular Defects and Capsular Reconstruction
Ligamentum Teres Pathology
All-Arthroscopic Ligamentum Teres Reconstruction
Concomitant Periacetabular Osteotomy
Conclusion
Cross-References
References
48 Surgical Technique: Endoscopic Shelf Acetabuloplasty
Introduction
Indication and Contraindication
Preoperative Planning
Instruments (Fig. 2)
Portal Placement
Surgical Technique
Harvesting Bone Graft
Making the Transverse Slot for Shelf Graft
Placing the New Shelf
Pearls and Pitfalls
Postoperative Rehabilitation
Complications and Salvage
Clinical Outcomes
Cross-References
References
49 Surgical Technique: Periacetabular Osteotomy
Introduction
Basic Science
Principles of Pelvic Osteotomy
Preoperative Assessment and Planning
History
Physical Examination
Medical Imaging/Diagnostic Studies
Conventional Radiography
Anteroposterior Pelvis Radiograph
Cross Table Lateral Radiograph
False Profile View
Abduction AP Hip Radiograph
Computed Tomography (CT)
Magnetic Resonance Imaging
Indications for Periacetabular Osteotomy
Contraindications for Periacetabular Osteotomy
Competence of the Surgeon
Surgical Technique for Periacetabular Osteotomy
Postoperative Rehabilitation
Results of Periacetabular Osteotomy
Results and Outcomes for Dysplasia
Long-Term Results
Intermediate Results
Periacetabular Osteotomy for Acetabular Retroversion
Complications
Summary
Cross-References
References
50 Surgical Technique: University of Colorado Periacetabular Osteotomy (CU-PAO)
Introduction
CU PAO Technique
Indications
Surgical Treatment:
First Stage: Hip Arthroscopy
Second Stage: CU PAO
Anesthesia, Patient Positioning, and Other General Considerations
Posterior Approach and Bony Cuts
Anterior Approach and Bony Cuts
Outcomes Per Our Original Patients´ Series
Comparison to Other PAO Techniques
Summary
Cross-References
References
51 Surgical Technique: Eccentric Rotational Acetabular Osteotomy for Adult Hip Dysplasia
Introduction
Basic Science
The Key Point with the ERAO
Surgical Instruments and Preoperative Planning
Prerequisites for Eccentric Rotational Acetabular Osteotomy
Surgical Technique for Eccentric Rotational Acetabular Osteotomy
Complications
Postoperative Care and Rehabilitation
Indications
Best Candidates
Relative Indications
Contraindications
Indications for ERAO Concomitant Valgus Femoral Osteotomy
Results of Long-Term Outcomes of ERAO and RAO
Failed Periacetabular Osteotomy
Advantage and Disadvantage of ERAO
Conclusion
Cross-References
References
52 Surgical Technique: Reverse Periacetabular Osteotomy
Introduction
Radiographic Evaluation
Indication for Reverse PAO
PAO Versus Surgical Hip Dislocation
Surgical Technique
Postoperative Regimen
Results in Literature
Summary
Cross-References
References
53 Acetabular Protrusion and Surgical Technique
Introduction
Surgical Technique
Surgical Hip Dislocation
Head Dislocation and Rim Trimming
Labral Refixation/Reconstruction
Relative Neck Lengthening and Trochanteric Advancement
Summary
Cross-References
References
54 Femoral Deformities: Varus, Valgus, Retroversion, and Anteversion
Introduction
The History of Femoral Osteotomy
Patient History
Physical Examination
Imaging
Plain Radiographs
MRI Scanning
CT Scan
Pathoanatomy of Femoral Deformity
The Rationale of Femoral Osteotomy
Varus Intertrochanteric Osteotomy
Results of Varus Intertrochanteric Osteotomy
Valgus Intertrochanteric Osteotomy
Results of Valgus Intertrochanteric Osteotomy
Femoral Osteotomy for the Correction of Retroversion or Excessive Anteversion
Results of Derotation Femoral Osteotomy
Varus Intertrochanteric Osteotomy: Surgical Technique
Valgus Intertrochanteric Osteotomy: Surgical Technique
Derotation Femoral Osteotomy: Surgical Technique
Summary
Cross-References
References
55 Femoroacetabular Impingement: Definition, Pathophysiology, and Etiology
Introduction
Definition
Pathophysiology
Additional Causative Factors for Impingement
Etiology
Summary
Cross-References
References
56 New Concepts in Femoroacetabular Impingement Syndrome
Introduction
Clinical Examination
The ``Impingement Test´´
Contemporary Clinical Range of Motion Testing
Pain Location
Clinical Assessment of Femoral Maltorsion
Evaluation of Hyperlaxity
Leg Length Discrepancy
Radiographic Evaluation
X-ray Acquisition Technique
Normal Values
CT Scan
MR Analysis
3D Dynamic Imaging
Fossa-Foveal Tracking
Morphology
Pathomechanism
Classifications of Joint Degeneration
Peripheral Chondrolabral Lesions
Central Lesions of the Fossa-Ligament Complex
Surgical Treatment
Arthroscopy Versus Surgical Hip Dislocation
Rim Trimming Versus Acetabular Reorientation
Treatment of Femoral Maltorsion
Labrum Overtreatment
Associated Tendinitis
Prognostic Factors
Summary
Cross References
References
57 Surgical Technique: Open Acetabular Rim Trimming, Labral Refixation, and Open Femoral Osteochondroplasty
Introduction
Surgical Approach Selection
Outcomes from Open Surgical Approach
Surgical Technique
Surgical Approach
Acetabular Rim Trimming and Labral Refixation
Open Femoral Osteochondroplasty
Complications and Postoperative Management
Cross-References
References
58 Surgical Technique: Mini-Open Acetabular Rim Trimming, Labral Refixation, and Femoral Osteochondroplasty
Introduction
Preoperative Planning
Surgical Technique
Acetabular Rim Debridement
Femoral Neck Osteoplasty
Labral Reattachment
Postoperative Management
Summary
Cross-References
References
59 Surgical Technique: Arthroscopic Management of the Acetabulum
Introduction
Patient Evaluation and Selection
Technique
Intraoperative Setup and Assessment
Surgical Technique
Postoperative Management
Outcomes
Summary
References
60 Surgical Technique: Arthroscopic Management of the Os Acetabuli
Introduction
Background
Epidemiology
Imaging
Treatment of Os Acetabuli
Results
Summary
Cross-References
References
61 Surgical Technique: Arthroscopic Management of Global Pincer
Introduction
Indications
Arthroscopic Technique
Summary
Cross-References
References
62 Surgical Technique: Arthroscopic Labral Management
Introduction
Anatomy
Pathology
Biomechanical Considerations
Surgical Considerations
Labral Debridement Technique
Labral Repair Technique
Rehabilitation
Summary
Cross-References
References
63 Surgical Technique: Arthroscopic Femoral Osteochondroplasty
Introduction
Anatomy/Pathoanatomy
Patient Selection
History and Physical Examination
Diagnostic Imaging
Indications/Contraindications
Conservative Treatment
Surgical Technique
Case Reports
Rehabilitation
Results
Summary
Cross-References
References
64 Surgical Technique: Arthroscopic Femoral Osteochondroplasty Using T-Capsulotomy
Introduction
Surgically Relevant Anatomy and Biomechanics
Preoperative Workup and Surgical Indications
T-Capsulotomy Technique and Indications
Femoral Osteochondroplasty and Dynamic Exam
Summary
Cross-References
References
65 Surgical Technique: Arthroscopic Femoral Osteochondroplasty Using Articular-Sided Release of the Zona Orbicularis and Perip...
Introduction
Patient Selection
Operative Treatment
Principles
Arthroscopic Technique of Cam Resection
Cam Resection: Principles and General Considerations
Strategies for Access and Operative FAI Treatment
Portals
Steps of Cam Resection
Exposure of the Cam Deformity (PC)
Identification of Landmarks and Delineation of the Cam (PC)
Anterolateral Cam Resection (PC)
Lateral Cam Resection (PC)
Posterior/Posterolateral Cam Resection (CC)
Arthroscopic and Fluoroscopic Control of Adequate Cam Resection
Postoperative Care
Pitfalls
Literature Overview
Cross-References
References
66 Surgical Technique: Capsular Repair of Extensile Interportal Capsulotomy
Introduction
Interportal Capsular Repair
Hip Capsule Anatomy
Technique
Summary
Cross-References
References
67 Surgical Technique: Capsular Repair of T-Capsulotomy
Introduction
Anatomy and Biomechanics of Hip Capsule Management
Clinical Outcomes
Surgical Technique
Portal Placement
T-Capsulotomy
Repair of Vertical Limb
Repair of the Interporal Limb
Conclusion
Cross-References
References
68 Approach to the Failed Hip Surgery
Introduction
Diagnostic Evaluation
History
Physical Examination
Imaging
Causes of Failed Hip Arthroscopy
Surgical Indications
Patient-Specific Factors
Rehabilitation-Related Factors
Technical Factors
Management
Conclusions
Cross-References
References
69 Surgical Technique: Post-less, Single-Table Combined Periacetabular Osteotomy and Arthroscopy
Introduction
FAI Anatomy in DDH
Intra-articular Pathology
Outcomes of Arthroscopy Alone in DDH
Mid- and Long-Term Outcomes in DDH
Outcomes of Arthrotomy/Arthroscopy and Concurrent PAO
Post-less Hip Arthroscopy
Concomitant Hip Arthroscopy and Periacetabular Osteotomy
Author´s Preferred Technique
Arthroscopy: Central
Arthroscopy: Peripheral
Periacetabular Osteotomy
Discussion
Summary
Cross-References
References
Part V: Enthesopathy and Neuromuscular Disorders
70 Core Muscle Injury: Open your Eyes - It´s the Core
Introduction
Anatomy of the Core Muscles
The Pubic Bone
The Rectus Abdominis
The Adductors
The Iliopsoas
The Rectus Femoris
The Posterior Core
The Interconnectivity of the Core
Diagnosing Core Muscle Injuries
Physical Exam
Imaging
Plain Radiographs
MRI
Treating Core Muscle Injuries
Corticosteroids
Platelet-Rich Plasma (PRP)
Summary
Cross-References
References
71 How the Hip Fits Within the Core
Introduction
Association Between Femoroacetabular Impingement and Core Muscle Injuries
Anatomic Considerations
Biomechanical Relationship Between the Hip and Core Muscles
Kinetic Chain
``Chicken or the Egg´´?
Primary Intra-articular Hip Dysfunction
Primary Core Muscle Dysfunction
Management of Intra-articular Hip Dysfunction with Concomitant Core Muscle Injury Symptoms
Diagnostic Traps
Summary
Cross-References
References
72 Layered Concept of the Hip and Pelvis
Introduction
Layer 1: Osteochondral Layer
Topographic Bony Anatomy
Osteology of the Hip Joint
Layer 2: Inert Layer
Capsular Structure and Function
Labral Structure and Function
Ligamentum Teres Structure and Function
Layer 3: Contractile Layer
Iliopsoas Structure and Function
Iliocapsularis Structure and Function
Gluteus Minimus and Medius Structure and Function
Hamstring Structure and Function
Additional Layer 3 Pathology
Layer 4: Neurokinetic Layer
Summary
References
73 Osteitis Pubis
Introduction
Anatomy
Patient Presentation
Physical Exam
Imaging
Radiographic Analysis
Magnetic Resonance Imaging (MRI)
CT
Bone Scan
Treatment
Nonoperative
Operative
Complications
Conclusion
Cross-References
References
74 Surgical Technique: Reconstruction of Pubic Symphysis
Introduction
Anatomy
History and Physical Examination
Imaging
Treatment
Surgical Reconstruction
Endoscopic Reconstruction of Pubic Symphysis
Clinical Outcome
Cross-References
References
75 Surgical Technique: Osteosynthesis for Pelvic Instability and Osteitis Pubis
Introduction
Definitions and Epidemiology
Anatomy and Biomechanics
Clinical Evaluation
Preoperative Imaging
Conservative Management
Surgical Fixation for Pelvic Instability
Surgical Indications
Surgical Goals
Anterior Pelvic Fixation: Surgical Technique
Posterior Pelvic Fixation: Surgical Technique
Postoperative Care
Outcomes for Fixation
Pelvic Fusion: Surgical Technique
Outcomes for Symphyseal Fusion
Outcomes for Posterior Fixation/Fusion
Surgical Management of Osteitis Pubis
Summary
Cross-References
References
76 Surgical Technique: Endoscopic Core Muscle Injury Repairs of the Distal Rectus and Prepubic Aponeurotic Complex
Introduction
Technique
Discussion
Cross-References
References
77 Surgical Technique: Endoscopic Excision of Osteitis Pubis
Introduction
Surgical Procedure
Discussion
Cross-References
References
78 Surgical Technique: Endoscopic Proximal Adductor Lengthening
Introduction
Clinical Assessment
MRI Imaging Protocol
Nonoperative Management
Surgical Technique
Patient Positioning
Portal Placement
Adductor Lengthening
Postoperative Management
Discussion
Conclusion
Cross-References
References
79 Pelvic Floor Dysfunction
Introduction
Pathophysiology
Epidemiology and Risk Factors for PFD
Anatomy of the Pelvic Floor
Bones and Ligaments That Form the Pelvic Floor
Nerves to the Pelvic Floor
Understanding the Presentation of Hip Preservation Surgery Patients with Pelvic Floor Dysfunction
History
Physical Examination
Observation
Neurological Exam
Pelvic Floor Muscle Exam
Joint Range of Motion/Special Tests
Treatment of Pelvic Floor Pain
Medications
Physical Therapy
Summary
Cross-References
References
80 Coxa Saltans: Iliopsoas Snapping and Tendonitis
Introduction
External Snapping Hip Syndrome (ESHS)
Internal Snapping Hip Syndrome (ISHS)
Iliopsoas Tendinitis
Summary
Cross-References
References
81 Surgical Technique: Arthroscopic Iliopsoas Lengthening in the Central and Peripheral Compartments
Introduction
Iliopsoas Tendinitis
History and Physical Exam Findings
Imaging
Indications for Arthroscopic Release
Surgical Techniques
Release from the Central Compartment
Release from the Peripheral Compartment
Postoperative Rehabilitation
Results
Complications
Summary
References
82 Surgical Technique: Iliopsoas Tendon Release from Lesser Trochanter
Introduction
Internal Snapping Hip Syndrome
Iliopsoas Impingement
Triple Impingement
Endoscopic Release of the Iliopsoas Tendon
Iliopsoas Tendon Release at the Lesser Trochanter
Cross-References
References
83 Surgical Technique: Arthroscopic Iliopsoas Lengthening After THA
Introduction
Anatomical Considerations
Total Hip Arthroplasty and Iliopsoas Impingement
Static Issues
Dynamic Issues
Clinical Assessment
Arthroscopic Intervention
Tips and Tricks
Post-Operative Rehabilitation
Risks and Complications
Summary
References
84 Subspine Impingement and Surgical Technique
Introduction
Systematic Approach to the Evaluation and Surgical Treatment
Clinical Presentation
Imaging Modalities
Treatment: Arthroscopic Approach
Surgical Technique
Outcomes Following Arthroscopic AIIS/Subspine Decompression
Summary
Cross-References
References
85 Greater Trochanteric Pain Syndrome
Introduction
Relevant Anatomy
Disease Presentation
Patient History
Physical Examination
Diagnostic Imaging
Nonoperative Treatment
Surgical Outcomes
Limitations and Potential Complications of Surgery
Summary
Cross-References
References
86 Surgical Technique: Endoscopic Trochanteric Bursectomy
Introduction
Patient History and Examination
Imaging
Treatment
Surgical Technique
Portal Placement
Diagnostic Arthroscopy and Bursectomy
Results
Summary
References
87 Surgical Technique: Endoscopic Repair of Partial-Thickness Gluteus Tears
Introduction
Physical Examination
Radiographic Findings
Treatment and Indications
Surgical Technique
Cross-References
References
88 Surgical Technique: Endoscopic Repair of Full-Thickness Gluteus Tears
Introduction
Indications
Outcomes
Surgical Technique
Diagnostic Endoscopy and Trochanteric Bursectomy
Gluteus Medius Repair
Rehabilitation
Summary
Cross-References
References
89 Surgical Technique: Endoscopic Iliotibial Band Lengthening
Introduction
Technique
Results
Conclusion
Cross-References
References
90 Surgical Technique: Open Gluteus Medius Repair
Introduction
Anatomy
Clinical Presentation
Imaging
Surgical Intervention
Authors Preferred Surgical Technique
Rehabilitation
Outcomes
Summary
Cross-References
References
91 Surgical Technique: Superior Gluteal Reconstruction
Introduction
Surgically Relevant Anatomy and Biomechanics
Preoperative Workup and Surgical Indications
Surgical Technique
Postoperative Rehabilitation
Outcomes
Pearls and Pitfalls
Conclusion
Cross-References
References
92 Surgical Technique: Gluteus Maximus Transfer
Introduction
Clinical Exam and Imaging
Surgical Management
Surgical Technique
Summary
Cross-References
References
93 Evaluation of Posterior Hip Pain
Introduction
History
Physical Examination
Imaging
Radiographies
Magnetic Resonance
Injections and Additional Studies
Conclusion
Cross-References
References
94 Surgical Technique: Open Proximal Hamstring Repair
Introduction
Indications for Surgery
Surgical Anatomy
Surgical Technique
Postoperative Rehabilitation
Outcomes
Summary
Cross-References
References
95 Surgical Technique: Endoscopic Partial Hamstring Repair
Introduction
Surgical Technique
Summary
Cross-References
References
96 Surgical Technique: Endoscopic Full Thickness Hamstring Repair
Introduction
Epidemiology
Anatomy and Function
Risk Factors
Diagnosis
History
Physical Exam
Differential Diagnosis
Imaging
Classification
Treatment
Nonoperative Treatment
Open Surgical Repair
Complications of Open Repair
Endoscopic Repair
Author´s Preferred Technique
Postoperative Care
Outcomes of Open Repair
Outcomes of Endoscopic Repair
Discussion
Conclusion
Cross-References
References
97 Surgical Technique: Allograft Augmentation of Chronic Hamstring Repair
Introduction
Patient Evaluation
Imaging
Classification
Relevant Anatomy
Local Bony Anatomy
Semimembranosus
Conjoined Tendon
Sciatic Nerve
Operative Indications
Intraoperative Setup
Surgical Technique
Postoperative Management
Complications
Outcomes
Summary
Cross-References
References
98 Ischiofemoral Impingement
Introduction
Anatomy
Presentation
Patient Evaluation
Nonsurgical Treatment
Operative Treatment
Complications
Outcomes
Summary
Cross-References
References
99 Surgical Technique: Anterior Lesser Trochanteroplasty with Psoas Repair
Introduction
Surgical Technique
Patient Setup
Portal Placement
Lesser Trochanter Resection (Incomplete)
Iliopsoas Tendon Distal Anchor Placement
Lesser Trochanter Resection (Complete)
Iliopsoas Tendon Proximal Anchor Placement
Rehabilitation
Cross-References
References
100 Surgical Technique: Arthroscopic Posterior Lesser Trochanterplasty for Ischiofemoral Impingement
Introduction
Surgical Technique
Positioning
Portal Placement
Identification of Lesser Trochanter
Iliopsoas Fixation
Postoperative Protocol
Outcomes
Limitations
Conclusions
Cross-References
References
101 Treatment Alternatives for Ischiofemoral Impingement
Introduction
Nonsurgical Treatment
Patient Education as Treatment
Correction of Leg Length Inequality
Abductor and Pelvic Muscular Strengthening
Injections and Medications
Surgical Treatment
Endoscopic Lesser Trochanterplasty
Open Lesser Trochanter Resection
Ischioplasty
Distal Transfer of the Lesser Trochanter
Proximal Femoral Osteotomy
Total Hip Arthroplasty
Conclusion
Cross-References
References
102 Deep Gluteal Space with Surgical Technique
Introduction
Deep Gluteal Space Anatomy and Biomechanics
Piriformis Muscle and Related Structures
Obturator Internus Muscle, Pudendal Nerve, and Related Structures
Hamstring Origin and Related Structures
Ischiofemoral Space
Superficial Sensory Innervation: Cluneal Nerves
Sciatic Nerve Anatomy and Biomechanics
Hip-Spine-Pelvis Biomechanics
Deep Gluteal Space Pathologies
Primary Deep Gluteal Syndrome: Extra-Pelvic
Primary Deep Gluteal Syndrome: Intrapelvic
Ischiofemoral Impingement
Hamstring Origin Tear and Hamstring Syndrome
Pudendal Nerve Entrapment
Deep Gluteal Space: Surgical Treatment
Endoscopic Sciatic Nerve Decompression
Rehabilitation
Results
Summary
Cross-References
References
103 Nerve Injuries Around the Hip
Introduction
Epidemiology of Nerve Injury in Hip Arthroscopy
Evaluation of a Nerve Injury
Physical Examination
Electrodiagnosis
Nerve Conduction Studies
Electromyography
Ordering Electrodiagnostic Studies
Interpreting the Electrodiagnostic Study
Clinical Presentations of Nerve Injury Around the Hip
Iliohypogastric Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Ilioinguinal Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Genitofemoral Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Lateral Femoral Cutaneous Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Obturator Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Femoral Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Sciatic Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Superior Gluteal Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Inferior Gluteal Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Pudendal Neuropathy
Anatomy
Etiology
Clinical Presentation
Diagnosis
Management of a Nerve Injury
Nerve Healing
Symptom Relief
Restoration of Function
Summary
Cross-References
References
Part VI: Hip Instability and Fractures
104 Traumatic Instability: Acute and Delayed Management
Introduction
Mechanism of Injury
Evaluation
History
Physical Exam
Imaging
Treatment
Non-operative Management
Acute Surgical Management
Delayed Surgical Management
Summary
Cross-References
References
105 Surgical Technique: Arthroscopic Reduction and Internal Fixation of Femoral Head and Acetabulum Fractures
Introduction
Femoral Head Fractures
Preoperative Planning
Experience
Game Plan/Contingencies
FAI Considerations
Consent
Equipment
Setup
Traction
Portals
Fluid Pressure
Arthroscopic Reduction
Arthroscopic Internal Fixation
Dynamic Arthroscopic and Fluoroscopic Testing
Postoperative Considerations
Femoral Head Malunions
Acetabular Fractures
Rim Fractures
Anterior Column Fractures
Summary
References
106 Femoral Head Fractures
Introduction
The Normal Hip Joint: An Inherently Stable Articulation
Femoral Head Fractures: Epidemiology and Clinical Evaluation
Classification
Management
Initial Management
Definitive Management
Nonoperative Treatment
Operative Treatment
Surgical Approach: Arthroscopy
Surgical Approach: Open Techniques
Surgical Treatment: Excision Versus ORIF Versus Arthroplasty
Outcomes of Femoral Head Fractures
Summary
Cross-References
References
107 Surgical Technique: Open Hip Dislocation, Open Reduction, and Internal Fixation
Introduction
Vascular Anatomy
Surgical Technique: Digastric (Trochanteric Flip) Osteotomy
Surgical Technique: Modified Smith-Petersen Exposure with Dislocation
Case 1
Case 2
Arthroscopic Reduction Internal Fixation
Summary
Cross-References
References
108 Surgical Technique: Open Reduction and Internal Fixation of Posterior Wall Acetabular Fractures
Introduction
Fracture Morphology
Indications for Surgical Fixation
Treatment
Open Reduction and Internal Fixation of Posterior Acetabular Wall Fractures Surgical Technique
Positioning
Surgical Approach
Reduction and Fixation
Hip Arthroscopy in Posterior Wall Fracture Dislocations
Rehabilitation
Summary
Cross-References
References
109 Atraumatic Instability and Surgical Technique
Introduction
Relevant Anatomy
Relevant Pathophysiology
Diagnosis
Surgical Technique
Indications
Technique
Postoperative Rehabilitation
Clinical Outcomes on Capsular Closure
Summary
Cross-References
References
110 Surgical Technique: Arthroscopic Capsular Plication
Introduction
Indications
Arthroscopic Technique
Interportal and T-Capsulotomy Technique
Capsular Plication
Summary
Cross-References
References
111 Surgical Technique: Arthroscopic Capsular Reconstruction
Introduction
Anatomy
Capsular Pathology and Instability
Clinical Presentation
Imaging
Surgical Technique
Patient Positioning
Portal Placement
Iliotibial Band Allograft Preparation
Arthroscopic Technique - Iliotibial Band Allograft
Postoperative Rehabilitation
Discussion
Summary
Cross-References
References
112 Surgical Technique: Arthroscopic Debridement of the Ligamentum Teres
Introduction
Surgical Technique
Patient Positioning and Anesthesia
Diagnostic Arthroscopy
Femoroacetabular Impingement and Labral Treatment
Ligamentum Teres Assessment
Debridement
Outcomes
Limitations
Conclusion
Cross-References
References
113 Stress Fractures of the Hip and Pelvis
Introduction
Etiology
Risk Factors
Gender Differences and the Female Athlete Triad
Muscle Fatigue
Anatomy
Baseline Fitness and Other Extrinsic Factors
Calcium and Vitamin D
Diagnosis
Imaging
Radiography
Computed Tomography
Bone Scintigraphy
Magnetic Resonance Imaging (MRI)
Stress Fractures of the Hip
Femoral Neck
Stress Fractures of the Pelvis
Sacrum
Pubic Ramus
General Diagnostic and Treatment Guidelines
Summary
References
114 Femoral Neck Fractures: Non-Displaced, Displaced, Non-Union
Introduction
Patient Presentation
Radiographic Evaluation
Classification
Treatment
Internal Fixation Construct Options
Closed or Open Reduction and Internal Fixation in Young Patients
Role of Surgical Timing
Arthroplasty
Outcomes
Outcomes in Young Patients
Outcomes in Elderly Patients
Complications
Medical Complications
Avascular Necrosis
Nonunion and Malunion
Summary
Cross-References
References
115 Surgical Technique: Surgical Fixation of Nondisplaced Femoral Neck Stress Fracture
Introduction
Treatment
Sliding Hip Screw and Dynamic Helical Hip System Surgical Technique
Rehabilitation
Outcomes
Summary
Cross-References
References
116 Surgical Technique: Open Reduction for Displaced Femoral Neck Fractures
Introduction
Femoral Neck Fracture in the Physiologically Young Patient
Fracture Pattern: Classification and Characteristics
Treatment
Open vs Closed Reduction and the Role of Capsulotomy
Timing of Surgery
Implant Choice and Fixation Strategy
Sliding Hip Screw and Anti-Rotation Screw Surgical Technique
Rehabilitation
Outcomes
Summary
Cross-References
References
117 Surgical Technique: Valgus Intertrochanteric Osteotomy for Femoral Neck Nonunion
Introduction
Preoperative Evaluation
Imaging
Physical Examination
Preoperative Planning Case Example
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Outcomes
Conclusion
Cross-References
References
118 Surgical Technique: Arthroscopic Removal of Loose or Foreign Body
Introduction
Surgical Technique
The Gunshot
The Posterior Wall or Femoral Head Fragment After a Hip Dislocation
The Broken Guidewire
Synovial Chondromatosis
Summary
References
Part VII: Avascular Necrosis
119 Osteonecrosis of the Femoral Head: Overview
Introduction
Background
Etiology
Presentation
Imaging
Staging
Treatment Options
Pre-collapse ON
Nonoperative Modalities
Statins
Anticoagulation
Bisphosphonates
Operative Modalities
Core Decompression
Autologous Bone Marrows Concentrate Injection
Operative Modalities After Collapse
Vascularized Fibula Grafts
Osteotomies
Rotational Transtrochanteric Osteotomy
Angular Intertrochanteric Osteotomy
Osteochondral Allograft Transplantation
Joint Arthroplasty
Hemiarthroplasty
Hip Resurfacing
Total Hip Arthroplasty
Summary
Cross-References
References
120 Surgical Technique: Arthroscopic Core Decompression
Introduction
Etiology
Pathophysiology
Clinical Presentation
History and Physical Examination
Imaging Studies
Management Options
Arthroscopic-Assisted Core Decompression: Surgical Technique
Patient Positioning and Surgical Setup
Landmarks
Portals
Diagnostic Arthroscopy
Fluoroscopic Confirmation of the Lesion
Core Decompression
Guide Pin Placement
Introduction of Reamer
Introduction of 30 Curved Curette
Insertion of Syringe into Socket
Closure
Postoperative Course
Summary
Cross-References
References
121 Surgical Technique: Arthroscopic Core Decompression with Iliac Crest Bone Graft
Introduction
Etiology
Pathophysiology
Clinical Presentation
History and Physical Examination
Imaging Studies
Management Options
Arthroscopic Core Decompression with Iliac Crest Bone Graft: Surgical Technique
Patient Positioning, Surgical Setup, Iliac Crest Cancellous Autograft Harvest
Landmarks
Portals
Diagnostic Arthroscopy
Fluoroscopic Confirmation of the Lesion
Core Decompression
Guide Pin Placement
Introduction of Reamer
Introduction of 30 Curved Curette
Insertion of Syringe into Socket
Closure
Postoperative Course
Summary
References
122 Surgical Technique: Free Vascularized Fibular Graft for Avascular Necrosis
Introduction
Presentation and Imaging
Management
Patient Population
Surgical Approach and Technique
Summary
Cross-References
References
123 Surgical Technique: Bone Graft for Avascular Necrosis of the Hip
Introduction
Clinical Exam, Imaging, and Staging
Treatment
Surgical Technique
Summary
Cross-References
References
124 Surgical Technique: Curved Intertrochanteric Varus Osteotomy for Avascular Necrosis
Introduction
History of Femoral Varus Osteotomy
Principles of Curved Intertrochanteric Varus Osteotomy
Indications for CVO
Preoperative Planning
Curved Intertrochanteric Varus Osteotomy: Surgical Technique
Patient´s Position
Skin Incision and Exposure of Planned Osteotomy Line
Setting of Crescentic Osteotomy Guide
Intertrochanteric Osteotomy
Rotation of Fragment and Osteotomy Fixation
Closure
Postoperative Management
Results of Curved Intertrochanteric Varus Osteotomy
Shortening Length of Lower Limb and Progression of Femoral Head Collapse
Mid- to Long-term Clinical Results
Pearls and Pitfalls
Case Example
Summary
Cross-References
References
125 Surgical Technique: Trapdoor Procedure for Avascular Necrosis
Introduction
Clinical Presentation and Imaging Studies
Indications for Surgery
Surgical Technique
Postoperative Management
Outcomes
Summary
Cross-References
References
126 Surgical Technique: Subchondroplasty for Acetabular Cysts
Introduction
Pathology
Technique
Patient Positioning
Portal Placement and Intra-Articular Assessment
Subchondroplasty
Subchondroplasty Technique Pearls
Rehabilitation
Discussion
Cross-References
References
Part VIII: Hip Cartilage Restoration
127 Hip Cartilage Restoration: Overview
Introduction
Prevalence and Etiology of Cartilage Lesions in the Hip
Diagnosis
Surgical Interventions and Decision-Making Algorithm
Clinical Outcomes
Surgical Technique (CPG)
Arthroscopic Approach
Open Approach
Cross-References
References
128 Surgical Technique: Arthroscopic Microfracture of Acetabular Articular Cartilage Lesions
Introduction
Further Descriptions of Mechanism of Injury: FAI
Necessity of Microfracture Technique
Indications
Microfracture Concept and Brief Description of Procedure
Initial Descriptions of Hip Microfracture (Open and Arthroscopic Procedures)
Results
Surgical Technique
Rehabilitation
Summary
Cross-References
References
129 Surgical Technique: Microfracture and Fibrin Glue for Cartilage Delamination
Introduction
Fibrin
Surgical Uses
Uses in Trauma and Orthopaedics
Use in Hip Arthroscopy
Technique
Results in the Literature
The Future
Summary
References
130 Surgical Technique: Microfracture Adjuvants in Hip Cartilage Restoration
Introduction
Microfracture Adjuvants Promoting Chondrogenesis
Microfracture Adjuvants Transplanting Chondrocytes
Indications
Patient Evaluation and Preoperative Planning
Surgical Technique
PRP-Infused Micronized Cartilage Allograft Augmentation
Mononuclear Concentrate in a PRP Matrix
Autologous Matrix-Induced Chondrogenesis
Chitosan-Based Polymer Scaffold (BST-CarGel)
Autologous Matrix-Enhanced Chondral Transplantation
Particulated Juvenile Allograft Cartilage
Postoperative Care
Outcomes
Summary
Cross-References
References
131 Surgical Technique: DeNovo
Introduction
Surgical Technique
Outcomes
Cross-References
References
132 Surgical Technique: ProChondrix
Introduction
Surgical Technique
Patient Positioning and Anesthesia
Diagnostic Arthroscopy
Preparation of the Acetabular Defect
Measurement
Graft Preparation
Graft Insertion
Graft Fixation
Modifications to Rehabilitation
Outcomes
Limitations
Conclusions
Summary
Cross-References
References
133 Stem Cell Therapy for Hip Injuries: Clinical Applications
Introduction
Mononuclear Concentrate in a Platelet-Rich Plasma Matrix
Surgical Technique
Results
Expanded Mesenchymal Stem Cells (MSCs) in Hip Focal Cartilage Defects
Surgical Technique
Results
Expanded Mesenchymal Stem Cell in Hip Osteoarthritis
Surgical Technique
Results
Expanded Mesenchymal Stem Cells Seeded in a Collagen Membrane
Expanded Mesenchymal Stem Cells in Hip Tendinopathy
Surgical Technique
Results
Expanded Mesenchymal Stem Cells in Femoral Head Osteonecrosis
Surgical Technique
Results
Summary
Cross-References
References
134 Surgical Technique: Bone Marrow Aspirate Concentrate
Introduction
Basic Science
Clinical Applications
Technical Considerations
Authors Preferred Surgical Technique
Preparation of PRP/PPP Mixture
Bone Marrow Aspiration and Autologous Concentrated Bone Marrow Production
Autologous Concentrated Bone Marrow Application
Summary
Cross-References
References
135 Surgical Technique: Osteochondral Autograft Transfer and Osteochondral Allograft Transplant for Preservation of the Femora...
Introduction
Indications
Patient Evaluation and Preoperative Planning
Surgical Technique
OAT and Mosaicplasty
OCA
Postoperative Care
Outcomes
Summary
References
136 Labral Deficiency
Introduction
Labral Function
Etiology
Hip Stability Labral Deficiency
Dysplasia
Cartilage Effects of Labral Deficiency
Treatment Alternatives
Nonoperative Management
Arthroscopic Labrum Augmentation
Arthroscopic Labrum Reconstruction
Outcomes
Summary
Cross-References
References
137 Surgical Technique: Arthroscopic Rectus Autograft
Introduction
Indications
Technique
Results
Summary
Cross-References
References
138 Surgical Technique: Arthroscopic Segmental Labral Augmentation Using Iliotibial Band Autograft or Allograft
Introduction
Anatomy
Structure of the Labrum
Function of the Labrum
Clinical Presentation
Imaging Evaluation
Surgical Technique
Patient Positioning
Portal Placement
Diagnostic Arthroscopy
Graft Harvest and Preparation
Arthroscopic Technique
Postoperative Rehabilitation
Discussion
Summary
Cross-References
References
139 Surgical Technique: Arthroscopic Segmental Labral Reconstruction Using Tibialis Anterior Allograft
Introduction
Surgical Technique
Patient Positioning and Anesthesia
Diagnostic Arthroscopy
Acetabuloplasty
Femoroplasty
Labral Reconstruction
Suture Management
Measurement Technique
Graft Preparation
Graft Insertion
Outcomes
Limitations
Conclusion
Cross-References
References
140 Surgical Technique: Arthroscopic 270 Degree Labral Reconstruction Using Iliotibial Band Allograft
Introduction
Arthroscopic 270 Degree Labral Reconstruction
Operative Technique
Rehabilitation
Outcomes
Conclusion
Cross-References
References
141 Surgical Technique: Open Hip HS Allograft
Introduction
Surgical Technique
Summary
References
Part IX: Oncologic Conditions
142 Osteoid Osteoma and Surgical Technique
Introduction
Classic Presentation of Osteoid Osteoma
Histology
Multicentricity/Multifocality
Classification of Osteoid Osteoma
Intra-Articular Osteoid Osteoma (IAOO)
Clinical Presentation of OO Around the Hip
Imaging Osteoid Osteoma
Radiographs
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Radionuclide Studies
Positron Emission Tomography (PET)
Ultrasound
Treatment Options for Osteoid Osteoma
Nonoperative
Open Surgical Excision
Complications of Open Surgical Excision
Percutaneous Excision
Complications of Percutaneous Excision
Percutaneous Radiofrequency Ablation (RFA)
Complications of RFA
Arthroscopic Excision
Complications of Arthroscopic Excision
Recurrence of Osteoid Osteoma
Lesion Accessibility with Hip Arthroscopy Instrumentation
The Presence of Additional Pathology Which Could Be Addressed with Hip Arthroscopy
Arthroscopic Excision of Intra-Articular Osteoid Osteoma of the Hip: Surgical Technique
Positioning and Diagnostic Arthroscopy
Peripheral Compartment Work and Excision of Osteoid Osteoma
Postoperative Care
Summary
Cross-References
References
143 Surgical Technique: Excision of Heterotopic Ossification
Introduction
Etiology of Heterotopic Ossification (HO)
Risk Factors
Imaging and Labs
Classification
Prophylaxis
Surgical Technique
Outcomes
Conclusion
Cross-References
References
144 Synovial Disorders of the Hip
Introduction
Synovial Chondromatosis
Pathophysiology
Clinical Features and Diagnosis
Treatment and Outcomes
Tenosynovial Giant Cell Tumor (Pigmented Villonodular Synovitis)
Pathophysiology
Clinical Features and Diagnosis
Treatment and Outcomes
Summary
Cross-References
References
145 Surgical Technique: Arthroscopic Treatment of Pigmented Villonodular Synovitis
Introduction
Evaluation and Imaging
Surgical Considerations
Surgical Technique for Arthroscopic Synovectomy
Outcomes of Arthroscopic Synovectomy
Summary
Cross-References
References
146 Surgical Technique: Arthroscopic Treatment of Synovial Chondromatosis
Introduction
Technical Pearls
Position and Joint Distraction
The Hip Joint
Central Compartment
Peripheral Compartment
The Difficult Loose Body Removal
Conclusion
Summary
References
Index