Tuesday, January 1, 2013
Op report #6 (open surgical dislocation)
The patient suffered from persistent right hip pain, sense of instability. She failed non-operative measures and had clinical, radiographic and diagnostic studies consistent w given pathology. Given the persistent pain, she was indicated for a revision allograft labral reconstruction, capsular repair and revision arthroplasty. Spinal epidural anesthesia was administered. She was placed in the lateral decubitus position. Right leg was prepped and draped in standard surgical fashion. A lateral portal was made down to the iliotibial band. A modified Gibson approach was performed and the gluteus Maximus was retracted posteriorly. The trochanteric flip osteotomy was then performed with a 15mm trochanteric wedge. The minimums was dissected off the anterior capsule and dissected anteriorly. A T- capaulotomy was then performed allowing for good visualization of the labrum. Hip was dislocated after ligamentum teres was cut. Labral reconstruction from prior semitendinosis allograft appeared to be well incorporated but was not providing a suction seal, probably due to the thin tissue quality. As a result, augmentation of the labral allograft reconstruction was performed. The edge of the acetabular rim was prepared and a total of six 1.4 mm anchors were placed and labral allograft reconstruction was performed with good anatomic restoration of the labrum. Dynamic arthroscopy was performed and demonstrated no evidence of any impingement in any direction at all. There was no subluxation of the joint. The iliopsoas was very tight so some additional bony decompression was performed with a psoas across the front of the femoral head to minimize any underlying pain that may have been related to the iliopsoas. Subsequent to this, the capsule was repaired anatomically and tightened to improve capsular stability as well. Trochanteric osteotomy was then prepared with three 3.5mm screws and the wound was copiously irrigated. Then the wound was closed in layered with 0 vicryl to close the fascia, 2-0 vicryl followed by running monocotyledons suture and steri strips. No drain was necessary as there was no bleeding. 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 without complications.