Hip Arthroscopy for Impingement and Labral Repair
The earliest form of treatment for hip impingement was surgical dislocation of the hip. After dislocating the hip, the torn labrum is either removed (debridement or excision) or repaired (repair with bone anchors and suture). Recent studies have shown that repair of the labrum has better results than removing a portion of the labrum. The bony abnormalities are also addressed on the femoral side (Cam) and/or acetabulum (Pincer). If the lesion is a large pincer lesion, often an additional portions of the labrum needs to be taken down, the extra bone removed and the labrum re-fixed to the bone (repair with bone anchors and suture). This form of treatment most effectively addresses all aspects of hip impingement.
Click here to see hip arthroscopy for impingement and labral repair animation
To see animation, click the link above. Click hip, then labral repair of the hip arthroscopy.
Video of Hip Arthroscopy for Impingement and Labral Repair:
Rationale for Hip Arthroscopy
Recent advances in arthroscopy have been made to allow appropriately trained surgeons to address these same abnormalities, but entirely through the arthroscope. Dr. King treats hip impingement and labral tears through the arthroscope alone. The procedure involves removal of the extra bone on the acetabulum, labral repair with bone anchors and suture, and removal of extra bone on the femoral side. Many surgeons who perform hip arthroscopy choose to remove portions of the labrum that are torn with arthroscopy, followed by an open incision to remove the extra bone on the femoral side of the hip joint. It is Dr. King’s belief, and that of others, that preserving and stabilizing the labrum is very important for the health of the hip joint. Removal of portions of the labrum has been shown to improve patient’s symptoms for a short period of time, but that improvement begins to deteriorate with time. Those who have undergone labral repair have lasting improvement in their symptoms.
Acetabular Rim trimming & Preparation
After the labral tear has been identified, the acetabular rim is prepared with a motorized burr to create a bleeding bed of bone to accept the repaired labrum. This is referred to as acetabular rim trimming. Varying amounts of bone a removed during this portion of the procedure depending on the presence and type of impingement. If excessive bone is noted at the acetabular rim (pincer impingement), more bone may be removed.
Anchor Placement & Hip Labral Repair
Currently, hip specific bone anchors are the implants of choice in labral repair. Hip anchors have replaced metal anchors and are loaded with newer generation suture for arthroscopic knot tying. Special drill guides are used and passed through disposable cannula systems that are placed through the arthroscopic portals. The bone is drilled and anchor implanted. Suture from the anchor is wrapped around or penetrated through the labrum at the site of the tear. The suture is then secured based on the type of anchor used.
After acetabular rim trimming and labral repair, the traction on the leg is released. If excessive bone is present at the femoral head neck junction (CAM impingement) this is removed using a motorized burr. Typically, the leg is brought through different motions, termed a dynamic exam, where the areas of impingement are evaluated. Characteristic changes are seen in the cartilage over-lying the regions of excessive bone. After resection is complete, the dynamic exam is repeated to ensure the entire impingement lesion has been removed.
Click here to see additional hip arthroscopy for FAI animation
To see an additional animation, click the link above. Enter the animation window. Click hip, then procedure and the hip arthroscopy for femoral-acetabular impingement tab
Dr. King performs hip arthroscopic procedures at the Des Peres Square Surgery Center in St. Louis, Missouri