Operative Hip Arthroscopy Second Edition

Operative Hip Arthroscopy

Second Edition

J.W. Thomas Byrd, MD

Assistant Clinical Professor, Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee; Orthopaedic Center, Baptist Medical Plaza, Nashville Sports Medicine and Orthopaedic Center, Nashville, Tennessee

Editor

Operative Hip Arthroscopy

Second Edition

With 581 Illustrations in 814 Parts, 292 in Full Color

Forewords by Lanny L. Johnson, MD, and James R. Andrews, MD

J.W. Thomas Byrd, MD Assistant Clinical Professor

Department of Orthopaedics and Rehabilitation Vanderbilt University School of Medicine Nashville, TN

and

Orthopaedic Center Baptist Medical Plaza

Nashville Sports Medicine and Orthopaedic Center Nashville, TN 37203

USA

First edition © Thieme, New York, Stuttgart

ISBN 0-387-21011-3 Printed on acid-free paper.

© 2005 Springer Science⫹Business Media, Inc.

All rights reserved. This work may not be translated or copied in whole or in part without the writ- ten permission of the publisher (Springer Science⫹Business Media, Inc., 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer soft- ware, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.

While the advice and information in this book are believed to be true and accurate at the date of go- ing to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed in China. (MP/EVB)

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Library of Congress Cataloging-in-Publication Data Byrd, J.W. Thomas (John Wilson Thomas), 1957–

Operative hip arthroscopy / J.W. Thomas Byrd,—2nd ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-387-21011-3 (hc : alk. paper)

1. Hip joint Examination.—2. Arthroscopy. I. Title.

[DNLM: 1. Arthroscopy methods.—2. Hip Joint—surgery. 3. Hip Joint—pathology. WE 860 B995o 2004]

RD772.B97 2004

617.5⬘810597—dc22 2004045358

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T his second edition remains dedicated to my family, Donna, Allison, and Ellen, and to the two finest surgeons that I have known, Ben- jamin Franklin Byrd, Jr., and James Reuben Andrews.

My father, B.F. Byrd, Jr., has dedicated his entire life to fighting cancer, a much more admirable pursuit than anything I will do. He detoured only briefly from this battle to champion another cause, as a highly dec- orated medical officer overseeing the care of wounded from Normandy Beach through the fields of Europe.

Through his lifelong example, he has shown me what

being a physician is all about. As he put it, “a surgeon

is just a regular doctor, with a few special skills.”

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Dr. Andrews taught me the art and the philosophy of sports medicine. He also taught me much about how to treat patients as people and, fortunately, he shared with me a few of his remarkable surgical skills. Per-

haps more importantly, through his example, he in- stilled in me the burning desire to make the most of my abilities.

J.W.T.B.

Foreword to the Second Edition

D r. Byrd’s textbook, Operative Hip Arthroscopy, is a must-have for every physician and surgeon who cares for patients with hip problems. Dr. Byrd is to be complimented for advancing the art and science of medicine with this comprehensive dissertation that not only illustrates what is possible in the diagnosis and treatment of hip pathology, but teaches a procedure that was thought to be impossible in the not too distant past.

This second edition is another major step forward in the application of mini- mally invasive procedures that, until recently, would only have been undertaken with great hesitation because of the magnitude of the surgical exposure. This text includes a comprehensive review of the pertinent anatomy and pathological pro- cesses that are potentially amenable to the ever widening application of arthros- copy. It details the various surgical approaches and specialized instrumentation as well as the critical aspects of the physical examination and postoperative care.

Physicians and surgeons face the challenge of bringing these diagnostic tools and surgical treatments into the real world of everyday practice. This is no easy task, but this text goes a long way in helping to prepare them for this adventure.

It continues the revolution in orthopedic hip surgery that has been advanced by Dr. Byrd and his colleagues. It provides the best opportunity for learning these techniques outside of a personal visit and observation and will undoubtedly en- courage others to join Dr. Byrd in advancing the techniques of arthroscopy of the hip.

Lanny L. Johnson, MD Clinical Professor, Surgery College of Human Medicine Michigan State University East Lansing, Michigan

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Foreword to the First Edition

T he hip is a site of pathology ranging from degenerative disorders to work- and sports-related injuries. The hip is also one of the final frontiers for ar- throscopic intervention.

Unique anatomic considerations challenge the hip arthroscopist and have slowed the advancement of hip arthroscopy. The dense soft tissue encasing the joint, the relatively noncompliant capsule, and the ball-and-socket architecture constrain both access and maneuverability of instrumentation.

The evolution of hip arthroscopy has followed a different course from other joints. In the knee, for example, standard practice for recognized pathology evolved from open technique to less invasive arthroscopic procedures. Conversely, in the hip, standard practice evolved from no treatment at all because of the failure to recognize the existence of these lesions. Arthroscopic assessment defined the pres- ence of symptomatic hip pathology amenable to something other than a total hip replacement, which is the major surgical procedure for patients with hip disease.

Rarely has arthrotomy been an accepted practice for elusive sources of hip pathology. However, arthroscopy for certain causes of hip pain offers an alterna- tive where previously the only option was living within the constraints of the symptoms.

There are several merits to hip arthroscopy. First, arthroscopic assessment has identified previously unrecognized disorders. Second, arthroscopy is a less inva- sive alternative to arthrotomy for certain pathologies. Third, for such elusive causes of hip pain as labral or chondral injuries, arthroscopy offers a definitive treatment where none existed before. Fourth, it has a role as a staging procedure for osteotomy candidates and patients with avascular necrosis. Finally, arthros- copy may have a role as a palliative and temporizing procedure for select patients with degenerative hip disease.

The authors have prepared a comprehensive text covering all facets of hip ar- throscopy. I believe the reader will find this work informative and helpful in the care of patients and in the understanding of the principles of arthroscopic surgery of the hip. I congratulate the authors on their excellent work and wish the reader the success in the challenging and rewarding endeavor of hip arthroscopy.

James R. Andrews, MD Medical Director American Sports Medicine Institute

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Preface

T he fundamental principles for effectively performing hip arthroscopy re- main unchanged from the first edition of this text. These include proper patient selection, attention to patient positioning for the procedure, care- ful orientation to the anatomy, meticulous technique in portal placement and in- strumentation of the joint, and thoughtful guidance through the postoperative recovery.

However, the indications continue to expand and the available interventional technology is growing at an accelerated rate. This second edition attempts to cap- ture these state-of-the art advancements and provides outcomes data now avail- able with many of these methods.

Our knowledge of the normal arthroscopic anatomy is more complete. Inter- pretation of pathological anatomy is much improved, and we are now beginning to understand the pathomechanics involved in the development of many of these conditions. We have met with success in reducing the symptoms associated with a variety of painful conditions, improving the quality of life for many patients.

However, it is through better understanding of the pathomechanics and patho- physiology that we can now start to influence the natural history and progression of many of these pathological states.

There are unique challenges to hip arthroscopy that should discourage the ca- sual consideration of this procedure without clear indication and purpose. The dos and don’ts are clearly emphasized in this text. If you prepare to embark on a case of arthroscopic surgery of the hip, be sure of your indications, be versed in the technique, but read about the complications twice. As my father’s chief, Bar- ney Brooks, MD, Chief of Surgery Vanderbilt University, 1925–1952, was quoted as saying to one of his residents “Son, you don’t have to learn about all the com- plications for yourself; you can read about a few of them.”

The title Operative Hip Arthroscopy reflects a de-emphasis on the role of sim- ply diagnostic procedures. In the chapter, Physical Examination, the diagnosis of intraarticular hip lesions may still be elusive. Arthroscopy may be considered without clear knowledge of the nature of the pathology, but usually with at least a good degree of predictability that there is something that can be addressed. If in doubt, most hip problems amenable to arthroscopy declare themselves over time.

In many respects, the distinction between diagnostic arthroscopy and opera- tive arthroscopy is analogous to what Lewis Grizzard, the colorful journalist from Atlanta, said about the difference between naked and nekkid. “Naked means you ain’t got no clothes on, and nekkid means you ain’t got no clothes on and you’re up to something.” In this respect, with arthroscopy, we prefer to go “nekkid.”

J.W. Thomas Byrd, MD

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Contents

Foreword to the Second Edition by Lanny L. Johnson . . . vii

Foreword to the First Edition by James R. Andrews . . . ix

Preface . . . xi

Contributors . . . xv

1 Overview and History of Hip Arthroscopy . . . 1

J.W. Thomas Byrd 2 Indications and Contraindications . . . 6

J.W. Thomas Byrd 3 Physical Examination . . . 36

J.W. Thomas Byrd 4 Adult Hip Imaging . . . 51

Roy E. Erb 5 Extraarticular Sources of Hip Pain . . . 70

Steve A. Mora, Bert R. Mandelbaum, Levente J. Szalai, Nicholas D. Potter, Archit Naik, Jeff Ryan, and William C. Meyers 6 Gross Anatomy . . . 100

J.W. Thomas Byrd 7 Portal Anatomy . . . 110

J.W. Thomas Byrd 8 Arthroscopic Anatomy of the Hip . . . 117

Richard N. Villar and Nicola Santori 9 The Lateral Approach . . . 129

Thomas G. Sampson 10 The Supine Approach . . . 145

J.W. Thomas Byrd 11 Hip Arthroscopy Without Traction . . . 170

Michael Dienst 12 Arthroscopic Iliopsoas Release for Coxa Saltans Interna (Snapping Hip Syndrome) . . . 189

Thomas G. Sampson 13 Hip Arthroscopy in Athletes . . . 195

J.W. Thomas Byrd 14 Hip Arthroscopy in Adolescence and Childhood . . . 204

Keith R. Berend and Thomas Parker Vail

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15 Unique Populations: Dysplasia and the Elderly . . . 220 J.W. Thomas Byrd

16 Complications Associated with Hip Arthroscopy . . . 229 J.W. Thomas Byrd

17 Rehabilitation . . . 236 T. Kevin Robinson and Karen M. Griffin

18 Clinical Nursing Care . . . 252 Kay S. Jones

Index . . . 267

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Contributors

Keith R. Berend, MD

Chief Resident, Division of Orthopedics, Duke University Medical Center, Durham, NC 27713, USA

J.W. Thomas Byrd, MD

Assistant Clinical Professor, Department of Orthopaedics and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN; Orthopaedic Center, Baptist Medical Plaza, Nashville Sports Medicine and Orthopaedic Center, Nashville, TN 37203, USA

Michael Dienst, MD

Assistant Professor, Department of Orthopedic Surgery, University Hospital, 66421 Homburg/Saar, Germany

Roy E. Erb, MD

Western Colorado Radiology Associates, Grand Junction, CO 81501, USA Karen M. Griffin, PT, ATC

Physical Therapist/Athletic Trainer, STAR Physical Therapy, Nashville, TN 37115, USA

Kay S. Jones, MSN, RN

Clinical Nurse Specialist, Nashville Sports Medicine and Orthopaedic Center, Nashville, TN 37203, USA

Bert R. Mandelbaum, MD

Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, CA 90404, USA

William C. Meyers, MD

Professor and Chairman, Department of Surgery, Assistant Dean,

Interdisciplinary Studies, Drexel University College of Medicine, Philadelphia, PA 19102, USA

Steve A. Mora, MD

Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, CA 90404, USA

Archit Naik

Medical Student, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA 19102, USA

Nicholas D. Potter, DPT, ATC

Physical Therapist, Department of Orthopaedics, Duke University Medical Center, Durham, NC 27710, USA

T. Kevin Robinson, PT, DSc OCS

Associate Professor, School of Physical Therapy, Belmont University; Physical Therapist, STAR Physical Therapy, Nashville, TN 37115, USA

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Jeff Ryan, PT

Physical Therapist, Department of Orthopedics, Drexel University College of Medicine, Philadelphia, PA 19102, USA

Thomas G. Sampson, MD

Associate Clinical Professor, Department of Orthopaedic Surgery, University of California, San Francisco, CA, Orthopaedic Surgeon, San Francisco, CA 94109, USA

Nicola Santori, MD, PhD

Centro Diagnostico, 00154 Rome, Italy Levente J. Szalai, MD

Resident, Department of Surgery, Drexel University College of Medicine, Philadelphia, PA 19102, USA

Thomas Parker Vail, MD

Associate Professor, Director of Adult Reconstructive Surgery, Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA

Richard N. Villar, MS, FRCS

Cambridge Hip and Knee Unit, BUPA Cambridge Lea Hospital, Impington, Cambridge CB4 4EL, UK

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