onal block. In this case, general anesthesia will be used.
Spinal vs. Epidural:
In the majority of cases, a spinal block is sufficient as opposed to an epidural. The two blocks differ in the location of the medication into the spine and an epidural is convenient for long cases, where the anesthesiologist can continually dose, according to the time. A spinal block is typically adequate for our procedure as surgical time is rarely over three hours. The anesthesiologist will speak with each patient prior to the procedure to go over the pros and cons. Ultimately, the decision is made by the patient.
One of the most frequently asked questions is, "Will I be awake for the procedure if I use a spinal?" This decision is also made by the patient. Prior to the block, the patient is sedated so they feel very sleepy and unaware of the injection. In most cases, the patient prefers to sleep during the procedure, so after the regional block is completed, additional sedation will be given so the patient can sleep during the surgery. This should also be discussed with the anesthesiologist the day of surgery.
Common Hip Arthoscopy procedures
A synovectomy is performed using radio frequency probes that are able to, with a controlled amount of heat, rid the capsule of inflamed tissue.
Treatment of Labral Tears:
The decision to remove labral tissue is based upon the location, chronicity, and vascularity of the injured fibrocartilage. Attempts are made to preserve as much healthy labral tissue as possible.
a. Labral Debridement : If the quality of the labral tissue is poor (crushed, erythematous, ossified) we perform a debridement of the labrum. This is done by using a rotating shaver in the joint that is able to "shave" the beat up labrum and with the use of a suction, remove the fragments from the joint.
b. Labral Refixation : If the quality of the labral tissue is adequate, an anchor is placed into the bone (acetabular rim). The suture attached to the anchor is then fed around the labral tissue and tied down to the acetabulum. We do 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.