Saturday, December 1, 2007

Third Op-Report

Indications: The patient is a 27 year old female with a prior hip arthroscopy with persistent pain, secondary to capsular adhesions, scar tissue and residual cam impingement.

Given her persistent symptoms and lack of improvement with nonoperative measures, she is indicated for a right hip arthroscopy and associated procedures.

After the patient was correctly identified in the holding area, she was brought to the operating room. Spinal anesthesia was then administered and she was placed in a supine position on the traction table and approximately 10 mm of distraction was achieved across the femeroacetabular joint. The right hip was then prepped and draped in a standard, surgical fashion.

A lateral portal was established under fluroscopic guidance and a distal accessory anterolateral portal was established. Arthroscopic examination demonstrated some scar tissue anterior superiorly with areas of softening and mild delamination of the anterior superior rim. There was also some synovitis throughout anteriorly superiorly and posterior superiorly. The cartilage in the femoral head was also in good condition. The acetabular cartilage was also in good condition, with the exception of the softening anterior superiorly. The labrum over the posas was in good condition.

At this point, a wide synovectomy was performed using the Tac-S radiofrequency probe and then the adhesions of the capsule, adjacent to the prior debrided labrum were removed using a beaver blade. the labral capsular junction was then debrided to remove any adhesions and scar tissue of the capsule adjacent to the labrum.

The labral tissue was freed up anterior-superiorly, anterior inferiorly and posterior superiorly, extending posterior -inferiorly. The labral tissue was in excellent condition. There was no evidence of any adhesions of the psoas tendon against the anterior inferior labrum. So no additional surgery was necessary around the psoas tendon.

All the area of the residual inflammation and irritation was anterior-superior, where the scar tissue was most prominent.

After the labral debridement, capsular scar excision and synovectomy in the central compartment, no further pathology was identified there. The traction was released and the hip was brought back into the socket for evaluation of the peripheral compartment.

A T-capsulotomy was made for better visualization at the site of presumed impingement and there was a small cam impingement lesion there that was present with evidence, also of a pincer trough.

At this point, using fluoroscopic guidance and a portal lateral to best evaluate the anterolateral neck, cam decompression was performed using the 5.5 mm high speed bur. this was contoured to the normal concavity of the inferior neck with reestablishment of normal offset.

The decompression of the cam side was extended from approximately seven o'clock anterior inferiorly, up toward the twelve o'clock position. both the lateral retinacular vessels as well as the medial synovial fold and medial___ were clearly identified and preserved throughout the procedure.

At the completion of the cam decompression, all bony debris was evacuated from the joint. Fluoroscopic guidance confirmed good reestablishment of the contour anterolaterally. The hip was dynamically moved to approximately 100 degrees and then internally rotated and no residual bony impingement was present. There was good clearance within the acetabulum, with full flexion and internal rotation.

At the completion of the cam decompression and removal of bony debris, the instruments were removed from the hip joint. The arthroscopy portals were drained of fluid and the arthroscopy portals were closed with 3-0 nylon sutures. A Marcaine cocktail was placed in the joint. The wounds were cleaned and dried. Sterile dressings were applied. The patient was awakened from anesthesia and was brought to the Post Anesthesia Care Unit having tolerated the procedure well.

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