Arthroscopic findings of the hip in new onset hip pain in adolescents with previous Legg-Calve-Perthes disease

Nine adolescent patients with new onset hip pain and previous Legg-Calve-Perthes disease (LCPD) were evaluated by hip arthroscopy. Eight of the nine patients had previous hip surgery for their LCPD and a pain-free interval averaging over 5 years. Hip arthroscopy was performed in the supine position on a fracture table using a distention distraction technique. Eight of the nine hips had intra-articular abnormalities including; four tears of the ligamentum teres, three femoral head osteochondritis dissecans, two labral tears, two hips with significant synovitis and three hips with other femoral head abnormalities. Seven of the eight hips improved following their arthroscopic treatment and the patients returned to their before-pain activities including sports. Three patients have required subsequent surgery. The abnormal mechanics from residual femoral head deformity may increase the risk of developing a variety of painful lesions. Hip arthroscopy is a safe way to evaluate and treat these intra-articular abnormalities.     

Arthroscopic anatomy of the hip

The arthroscopic anatomy of the hip has been studied using a number of portals. Both distraction and positioning are necessary to allow insertion of instruments, and to allow exposure of the important anatomical structures. The internal anatomy of the hip joint is described in detail based on the arthroscopic view from the different portals. This study helps orient those interested in arthroscopy of the hip.     

弹响髋的关节镜下手术治疗

[目的] 探讨军事训练致外侧型弹响髋的特点及关节镜治疗方法与疗效。[方法] 收治14例18髋军事训练引起的外侧型弹响髋，采用关节镜下髂胫束松解，术后早期功能锻炼。[结果] 疗效优11髋，良5髋，优良率94．1％，有效率100％，未出现感染、血肿、神经损伤等并发症。[结论] 关节镜下髂胫束松解术治疗弹响髋，只要重视围手术期处理，术后疗效满意，可取代传统切开术。     

Arthroscopic shaver-assisted total hip arthroplasty revision

A case report of a 54-year-old man who underwent a revision arthroplasty 13 years after his original hip replacement is presented. The patient presented to the clinic with a 2-month history of hip pain. Severe pelvic osteolytic lesions were seen on radiographs. The revision procedure consisted of debridment of the osteolytic lesions and bone grafting. An arthroscopic shaver was used to remove the osteolytic lesions proximal to the acetabular cup. Excellent debridment was obtained. Cortical bone allograft was the used to fill the void areas behind the cup. The patient did well postoperatively with no recurrence of osteolysis as seen on radiographs obtained 7 months after surgery. This report presents a successful case of pelvic osteolytic debridment with the use of an arthroscopic shaver.     

Arthroscopic surgery of the hip joint

Hip arthroscopic examination of 196 joints was performed in 104 patients treated during the past 4 years. Of these, 11 joints were treated by arthroscopic surgery. We have developed a technique using a two-directional approach that facilitates a global view of joint areas and allows simpler performance of surgical procedures. Removal of loose bodies, joint debridement in osteoarthritis, and synovectomy in rheumatoid arthritis are good indications for arthroscopic surgery of the hip joint. Short-term follow-up was satisfactory, and a reduction of pain was obtained in all patients. Although the joint space of the hip is narrower and the operative technique is more difficult to perform than in the knee, we believe that arthroscopic surgery of the hip is a suitable method in selected cases.     

Arthroscopic reduction of the dislocated hip in infants

We present our early experience of arthroscopic reduction of the dislocated hip in very young infants with developmental dysplasia of the hip (DDH). Eight dislocated hips, which had failed attempts at closed reduction, were treated by arthroscopy of the hip in five children with a mean age of 5.8 months (4 to 7). A two-portal technique was used, with a medial sub-adductor portal for a 2.7 mm cannulated system with a 70° arthroscope and an anterolateral portal for the instruments. Following evaluation of the key intra-articular structures, the hypertrophic ligamentum teres and acetabular pulvinar were resected, and a limited release of the capsule was performed prior to reduction of the hip. All hips were reduced by a single arthroscopic procedure, the reduction being confirmed on MRI scan. None of the hips had an inverted labrum. The greatest obstacle to reduction was a constriction of the capsule. At a mean follow-up of 13.2 months (9 to 24), all eight hips remained stable. Three developed avascular necrosis. The mean acetabular index decreased from 35.5° (30° to 40°) pre-operatively to 23.3° (17° to 28°). This study demonstrates that arthroscopic reduction is feasible using two standardised portals. Longer follow-up studies are necessary to evaluate the functional results.     

Arthroscopic treatment of a symptomatic hip plica

Synovial plicae are detected most readily by diagnostic arthroscopy. As arthroscopic techniques are applied more frequently to various joints, it should be expected that the diagnosis of plica syndrome will become more common. The authors present a case of symptomatic plica in the hip of a competitive runner, who was treated with arthroscopic resection.     

Arthroscopic findings in the initial stages of hip osteoarthritis

Standard radiographic projections have poor diagnostic ability in detecting early degenerative changes of the hip. Comparison of arthroscopic and radiographic findings is the best method to assess the accuracy of conventional radiography. This study reviewed the records and radiographs of 234 hip arthroscopies. One hundred eighty-six of the patients had normal preoperative radiographs; of these, 60 (32.2%) had evidence of osteoarthritis at arthroscopy. The extent and location of the chondral damage were studied, and both of these parameters were correlated to the radiographic appearance of osteoarthritis. Hips with normal radiographs but arthroscopic osteoarthritis were found to have less damage compared with the radiographically osteoarthritic hip. Hips with normal radiographs also were more likely to have only one side (60%) of the joint damaged, either the acetabulum or femoral head. Conversely, when osteoarthritis was evident radiographically, both sides of the joint were usually involved (75.7%). These patients are often young (average age: 36 years), and women are more likely to be affected than men (71% versus 29%).     

Arthroscopic treatment of septic arthritis of the hip

Arthroscopic debridement and drainage was done in 10 patients with septic arthritis of the hip. Staphylococcus aureus was the most commonly identified organism. All patients were placed in the supine position on a fracture table and three arthroscopic portals were used during the procedure. No major complication related to the arthroscopy of the hip resulted. The average followup was 4 years 11 months. All patients had excellent results.     

髋关节滑膜软骨瘤病的关节镜下治疗

[目的]探讨关节镜治疗髋关节滑膜软骨瘤病的方法和疗效,初步提出髋关节滑膜软骨瘤病的镜下分型。[方法]自2001年3月～2008年5月本院收治髋关节滑膜软骨瘤病患者21例,其中男15例,女6例;手术时年龄17～49岁,平均32.4岁;左侧9例,右侧12例。采用关节镜技术取出游离体并行滑膜切除术。病变位于外周间室者术中放松牵引进行手术,对于髋臼窝病变,需要借助弧形刨削刀和可折弯射频。[结果]所有患者术后症状缓解,MRI显示关节积液减少或消失,随访时间11个月～8年,平均45个月,Harris评分由术前的56.2分增加至随访时92分,疗效优良率85.7%。随访期内未见复发。[结论]髋关节镜治疗原发性髋关节滑膜软骨瘤创伤小、术后功能恢复快、效果满意。髋关节滑膜软骨瘤病的镜下分型可以指导手术操作并避免遗漏病变。     

Arthroscopic management of chondromatosis of the hip joint

In selected cases, we present the arthroscopic surgery of the hip joint as an alternative to the conventional arthrotomy. It is distinguished by less surgery, minimal invasive exploration, and slight traumatization. Also, it comprises a short morbidity, and thereby, the method reduces the costs. If the operation succeeds, the patient and the surgeon are both enthusiastic.     

The flexion-adduction test: an early sign of hip disease

This report introduces the flexion-adduction test as an additional diagnostic technique for hip pathology in children and young adults. Losses of flexion-adduction, internal rotation, abduction and total flexion arc are all individually assessed in patients with confirmed hip pathology. The findings suggest that the "flexion-adduction" test is a simple, but sensitive, clinical procedure to detect the early signs of hip disease in older children and young adults. Although abduction and internal rotation are reportedly the most commonly restricted movements in frequent hip pathologies such as irritable hip, Legg-Calve-Perthes disease and slipped epiphysis, we believe that the loss of flexion-adduction is often the first affected range of movement. A statistical analysis of 87 cases from 1994 to 1997 is presented wherein the clinical loss of flexion-adduction provided the initial suggestion of underlying hip pathology, and concludes that the loss of internal rotation, abduction and flexion arc are not statistically reliable tests for clinically diagnosing pathology individually. Often, despite a positive flexion-adduction test, the other ranges of movements remained unaffected or minimally affected in children and young adults with varying hip diseases, later confirmed through subsequent physical examinations or investigations. A thorough explanation of the flexion-adduction test is provided.     

Arthroscopic treatment of early glenohumeral arthritis

Background

The articular cartilage of the shoulder is not endowed with intrinsic repair abilities, so the detection of chondral lesions during arthroscopy may indicate that additional articular procedures are needed. The aim of the current study was to evaluate the benefits of arthroscopy in patients with early shoulder arthritis, and to assess which clinical and radiological features are correlated with better arthroscopic outcomes.

Materials and methods

Out of a total of 2,707 shoulders, 61 arthroscopies were performed on patients aged 30–55 years suffering from a painful early arthritic shoulder. We performed a retrospective study of 47 of those 61 patients with osteoarthritis at Samilson–Prieto stage I or II. SST and Constant score were used as outcome measures. Arthroscopic circumferential capsulotomy was performed to release the soft tissues and increase the joint space. Glenoid chondral lesions were caregorized according to location (anterior, posterior, centered) and size (small, large, total) and treated with microfractures; in the last 11 patients, we placed a engineered hyaluronic acid membrane, Hyalograft^® C, on the surface of the glenoid. Postoperative care included mobilization the day after surgery, with the arm protected in a sling for two weeks. Follow-up examinations were performed at 3, 6, 12, and 24 months after surgery. The clinical and radiographic data collected were compared with those obtained at the last examination.

Results

The mean Constant score increased from 43.8 points to 79.1, and the mean SST score increased from 4.9 points to 9.4 points. Clinical outcomes improved significantly in 44 patients (93.6 %). The three patients (6.4 %) with the lowest scores showed progression of arthritis. Age, gender, glenohumeral distance, and presence of engineered hyaluronic acid membrane were not related to clinical scores. Recovery of range of motion as well as small and centered cartilage lesions were statistically associated with improved outcome.

Conclusion

The main finding was that soft tissue procedures (including capsulotomy and synovectomy) associated with glenoid microfractures are only suitable for patients with early arthritis and preserved humeral head shape, particularly in cases with small and centered glenoid cartilage lesions.     

Arthroscopic findings of Kienbock's disease

PurposeKienböck's disease affects the lunate bone, and osteoarthritis changes progress as the disease advances; however, relatively few studies have reported the arthroscopic findings of Kienböck's disease, and these reports have been in small populations. The purpose of this study was to review arthroscopic findings in a larger population than studied in previous reports.MethodsWe retrospectively reviewed 57 patients who underwent radial osteotomy for Kienböck's disease after arthroscopy of both the radiocarpal and midcarpal joints. All arthroscopic findings were classified as follows in terms of the location of osteoarthritic changes: lunate fossa of the radius, proximal/distal surface of the lunate bone, and capitate head. Radiological stages were classified according to the modified Lichtman's classification system.ResultsAll but two patients had cartilage lesions in the proximal lunate cartilage. Older patients had significantly more cartilage lesions, but radiological stage showed no correlation with the number of cartilage lesions.ConclusionsThis study demonstrated that the proximal lunate bone was affected in most cases of Kienböck's disease and that older patients had more cartilage lesions.