Preliminary Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum
Postoperative Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum
Name of Operation: Revision right hip arthroscopy, labral tear debridement, synovectomy, debridement of ligamentum teres, and capsular shift procedure with revision decompression cam and rim side.
Indications: The patient suffered from persistent right hip pain 2 years status post a prior hip arthroscopy after she had been in a forced external position after she had a baby. She had a stretch of the anterior capsule with persistent pain, re-tear of the labrum, and also tearing of the ligamentum teres. She had failed non-operative measures and given the persistent pain and lack of improvement, she was indicated for right hip arthroscopy and associated procedures.
Procedure: After the patient was correctly identified in the holding area, she was brought into the operating room. Spinal epidural anesthesia was administered. She was placed in the supine position on the traction table and approximately 10mm of distraction were achieved across the acetabular joint. The right hip was then prepped and draped in the standard surgical fashion.
A lateral portal was established under fluroscopic guidance using the Seldinger technique. Then a mid anterior and additional anterior lateral accessory portal were both established. Arthroscopic examination demonstrated a labral tear anteriorly with evidence of a defect in the anterior capsule. There was some residual mild bone spurring bone spurring on the acetabular rim as well as mild superior lateral cam impingement lesion. Residual remaining aspects of the decompression were in good condition. There was synovitis adjacent to the capsular rent, and there was synovitis in the fat pad in addition to a partial tear of the ligamentum teres.
At this point the labrum was debrided of non viable tissue. The capsule was elevated off the residual rim impingement and then a rim decompression was performed. The ligamentum teres was then debrided of non viable tissue and a fat pad debridement was performed. The cartilage on the femoral head was in excellent condition as was the remaining aspect of acetabulum.
The scope was then placed in the peripheral compartment where a T capsulotomy was performed for good visualization of the superior lateral aspect of the cam lesion. There was some extension of the cam superior laterally. Cam decompression was completed up in the superior lateral 11 to 1 o'clock position with good visualization and protection of the retinacular vessels during this period of time. There was some irritation and erythema around the labrum in this position consistent with the residual impingement. At the completion of the residual cam decompression, no further impingement was present.
The T capsulotomy was then shifted for solid clossure of the anterior capsule. The medial limb was brought lateral with 5 sutures passed side to side using ideal suture passer and a bird beak penetrator with good secure fixation of the capsular repair. at the completion of the capsular repair, no residual defect was present. the head was well contained with the socket. At this point no further pathology was identified.
The instruments were removed from the hip joint. It was 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, dried, sterile dressings were applied, and the patient was awakened from anesthesia and brought to the PACU having tolerated the procedure well.