o use a bioabsorbable suture anchor as compared to metal for this repair. The goal of this refixation procedure is for the once torn labrum to scar down the acetabulum and remain there once the suture dissolves.
Partial Psoas Release:
After entering the joint, the psoas tendon is visualized by making a small window in the capsule and then releasing the tight tendon by cutting it. After being cut, the tendon separates and eventually fills in with scar tissue, resting in a lengthened position.
a. Acetabuloplasty (Rim Trimming/Decompression) : Anterior over coverage secondary to a pincer lesion can be treated arthroscopically. This lesion is usually associated with a flattened, degenerative or cystic labrum. Pincer lesions require bony resection which can be performed using a motorized burr. Resection of the rim lesion oftentimes leads to destabilization or requires detachment of the labrum in order to fully visualize the extra bone. Following the rim resection, unstable but healthy residual labral tissue is refixed to the acetabular rim using arthroscopic suture anchoring techniques.
b. Osteochondroplasty (CAM decompression) : With visualization of the Cam lesion, a motorized burr is introduced and the removal of the Cam lesion is performed to recreate a spherical femoral head. A resection of less than 30% of the head neck junction is recommended because this has shown to preserve the load bearing capacity of the femoral neck, thus decreasing the risk of stress fracture. Fluoroscopy is often time used to assist in determining the amount of bone in which to resect.
Iliotibial Band Release:
An ITB release is performed in patients with symptomatic (painful) snaps. This is performed by accessing the lateral space in the hip. Traction is not needed for this portion of the procedure. Once the ITB is visualized, a cut is made to lengthen the tissue.
A trochanteric bursectomy is a simple procedure in which a motorized shaver is placed in the peritrochanteric space (outside of the hip) to debride the inflamed bursal tissue. To access this area of the hip, the same portals that are used to access the inside of the hip joint are used. Traction is not needed for the bursectomy portion of the hip arthroscopy.
Gluteus Medius Repair:
Repair of the Gluteus Medius/Minimus tendon(s) is done in the lateral space, where traction is not needed. In the majority of cases, the procedure is completed arthroscopically, however, the size and/or location of the tear may warrant an open technique to be used. The Tendons are visualized and an anchor(s) is placed into the greater trochanter of the femur while a suture is passed around the tendon. The tendon is then pulled down to its normal anatomic position and tied over the bone. For this procedure, a metal anchor is more commonly used as opposed to a bioabsorbable one. The procedure is very similar to that of a rotator cuff in the shoulder.
Removal of Loose Bodies/Tumors: (include PVNS/Synovial Chondromatosis)
Performing a chondroplasty consists of removing loose fragments of cartilage. This is common in the setting of some arthritis.
The cartilage is taken out of the joint by a motorized shaver or a grasper depending upon the size of the fragments.
Post operative equipment
a. Crutches : The weight bearing status following all hip procedures is 20 lbs foot flat (partial weight bearing). Crutch time is dependant upon the type of surgery, but is usually anywhere from 2-4 weeks. Gluteus medius repairs require 6 weeks of crutches, as does a microfracture procedure.
b. Continuous Passive Motion (CPM) Machine : The CPM machine is used for 4 hours/day for 4 weeks, typically. It is a rental so must be returned. Our office will order the machine and have it delivered to the hospital the day of surgery.
c. Brace : The brace is to be worn for 2 weeks following surgery, mainly to prevent extreme flexion and extension of the hip. It is only to be worn while weight bearing with crutches. Due to the configuration of the brace, it must be worn over clothes. The brace is bought through insurance, ordered by our offic