Arthroscopic Anatomy:
The hip joint is divided by the labrum acetabulare in a superficial and a deep compartiment (see figure 1). The superficial part is build by the mucous membrane pockets of the joint, which extend from the outer part of the acetabulum to the intertrocanteric region and with that contain the neck of the femur, the non weight bearing and the non chondroid-covered parts of the head of the femur to the Labrum acetabulare. As landmarks serve particularly the medial over the Collum extending Plica pectineofoveale (see figure 2) and the Zona orbicularis which lies around the neck of the femur. Rarely there are more Plicae ventral and lateral. The deep joint parts lie directly between acetabular and femoral joint area and are apart from the Fossa acetabuli and the Fovea coated with cartilage. The cartilage areas have direct contact with each other, so that the inspection of these parts is only possible by pulling the leg strongly. Only then the horseshoe-formed Facies lunata, the Fossa acetabuli, the Labrum acetabulare, the Lig. capitis femoris and the weight bearing area of the head of the femur can be seen (see figure 3 and 4).
Figure 1:
Figure 2:
Figure 3:
Figure 4:
Technique:
The Hip-arthroscopy is realized on an extension-table lying on the back or the side. In the first part of the operation the superficial part of the joint is inspected without pulling, in the second part the deep compartiment is inspected under traktion with 20-30 kg . Preferentially paratrochanteric, laterale and anterolaterale portals, more infrequently instruments and the arthroscope are introduced over an anterior or posterolaterale portal. Used are besides the standard - 4mm - arthroscope special arthroscopes with overlength, which disposes a separate working-chanal, as well as hand- and motorpowered instruments with overlength.
Indication:
The indication for a Hip-arthroscopy is set in the following cases:
Coxarthrosis: The indication for Hip-arthroscopy in Coxarthrosis should be made especially in patients with recent exacerbation of pain and the clinic suspicion for a intraarticular pathology (incarceration, sudden knifelike pain in the groin, positive impingementtest, apprehensiontest and Trochanter-irritation-test). Prerequisit for the arthroscopie is a radiologic sufficient joint space without bigger Osteophytes.
Hip-dysplasia
Anomalies of the neck of the femur: idiopathic Coxa antetorta, Coxa valga, Coxa vara congenita
Diseases of the joint synovia: inflammable Coxitis, synovial Chondromatosis and pigmented villonodular Synovitis
Removal of free bodies for example in synovial Chondromatosis
Labrum-lesions
Free bodies
Pipkin-Fractures, acetabular dropouts
Purulent Coxitis
Unclear Hip pain
Research:
Hip-arthroscopy is one of the main targets of our experimental and clinic research. In cooperation with the Institut for Anatomy and the Workgroup for Magnetic Resonance Imaging, techniques are optimized, preoperative diagnostic is complemented by new examination procedures like MR-Arthrography, operative proceedings are standardised and new instruments and arthroscopes are tested.
Planning:
To apply for an appointment in our special-consultation-hour tuesdays 12:00 to 14:30, please call 06841-1624520. The duration of the hospitalization period for Hip-arthroscopy, which is in our clinic not performed as outpatient treatment, is ordinarily 3-4 days. Unless cartilage regeneration procedures are necessary, we recomend after a 3-days period without weight bearing a rapid increase in weight bearing. As a rule the patient is after one week able to walk without crutches.
Dr. med. M. Dienst michael_dienst@yahoo.de
PD Dr. med. R. Seil orsei@uniklinik-saarland.de
The hip joint is divided by the labrum acetabulare in a superficial and a deep compartiment (see figure 1). The superficial part is build by the mucous membrane pockets of the joint, which extend from the outer part of the acetabulum to the intertrocanteric region and with that contain the neck of the femur, the non weight bearing and the non chondroid-covered parts of the head of the femur to the Labrum acetabulare. As landmarks serve particularly the medial over the Collum extending Plica pectineofoveale (see figure 2) and the Zona orbicularis which lies around the neck of the femur. Rarely there are more Plicae ventral and lateral. The deep joint parts lie directly between acetabular and femoral joint area and are apart from the Fossa acetabuli and the Fovea coated with cartilage. The cartilage areas have direct contact with each other, so that the inspection of these parts is only possible by pulling the leg strongly. Only then the horseshoe-formed Facies lunata, the Fossa acetabuli, the Labrum acetabulare, the Lig. capitis femoris and the weight bearing area of the head of the femur can be seen (see figure 3 and 4).
Figure 1:
Figure 2:
Figure 3:
Figure 4:
Technique:
The Hip-arthroscopy is realized on an extension-table lying on the back or the side. In the first part of the operation the superficial part of the joint is inspected without pulling, in the second part the deep compartiment is inspected under traktion with 20-30 kg . Preferentially paratrochanteric, laterale and anterolaterale portals, more infrequently instruments and the arthroscope are introduced over an anterior or posterolaterale portal. Used are besides the standard - 4mm - arthroscope special arthroscopes with overlength, which disposes a separate working-chanal, as well as hand- and motorpowered instruments with overlength.
Indication:
The indication for a Hip-arthroscopy is set in the following cases:
Coxarthrosis: The indication for Hip-arthroscopy in Coxarthrosis should be made especially in patients with recent exacerbation of pain and the clinic suspicion for a intraarticular pathology (incarceration, sudden knifelike pain in the groin, positive impingementtest, apprehensiontest and Trochanter-irritation-test). Prerequisit for the arthroscopie is a radiologic sufficient joint space without bigger Osteophytes.
Hip-dysplasia
Anomalies of the neck of the femur: idiopathic Coxa antetorta, Coxa valga, Coxa vara congenita
Diseases of the joint synovia: inflammable Coxitis, synovial Chondromatosis and pigmented villonodular Synovitis
Removal of free bodies for example in synovial Chondromatosis
Labrum-lesions
Free bodies
Pipkin-Fractures, acetabular dropouts
Purulent Coxitis
Unclear Hip pain
Research:
Hip-arthroscopy is one of the main targets of our experimental and clinic research. In cooperation with the Institut for Anatomy and the Workgroup for Magnetic Resonance Imaging, techniques are optimized, preoperative diagnostic is complemented by new examination procedures like MR-Arthrography, operative proceedings are standardised and new instruments and arthroscopes are tested.
Planning:
To apply for an appointment in our special-consultation-hour tuesdays 12:00 to 14:30, please call 06841-1624520. The duration of the hospitalization period for Hip-arthroscopy, which is in our clinic not performed as outpatient treatment, is ordinarily 3-4 days. Unless cartilage regeneration procedures are necessary, we recomend after a 3-days period without weight bearing a rapid increase in weight bearing. As a rule the patient is after one week able to walk without crutches.
Dr. med. M. Dienst michael_dienst@yahoo.de
PD Dr. med. R. Seil orsei@uniklinik-saarland.de
