Arthroscopic hip surgery

AORN Journal,  Dec, 2005  by Rochelle A. Shugars,  Robert C. More

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The article "Arthroscopic hip surgery" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Dec 31, 2008.

Complete the examination answer sheet and learner evaluation found on pages 1021-1022 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on arthroscopic hip surgery, nurses will be able to

1. explain how hip anatomy affects pathological changes,

2. describe how range of motion examinations are used to make a diagnosis of specific hip diseases,

3. discuss preoperative preparation of the patient undergoing arthroscopic hip surgery, and

4. identify intraoperative care provided to ensure the safety of the patient undergoing hip surgery.

The ability to look into a joint with a small optical instrument through a limited incision to diagnose and possibly treat a joint problem (ie, arthroscopy) has been possible for many decades. The most accessible joint for arthroscopic procedures is the knee, and knee arthroscopy became popular and widely available in the 1970s. (1) The shoulder was next, with many procedures developed and refined in the 1980s. (1) By the late 1980s and early 1990s, other joints such as the elbow, wrist, and ankle routinely were treated arthroscopically. (1)

The hip has been the final frontier for arthroscopic treatment of the major joints in the body. Although the first hip arthroscopic procedure was performed in 1931, only in the last five years has hip arthroscopy been performed routinely, with specific indications and better defined techniques. (1) Hip arthroscopy developed later than arthroscopic treatment of other joints because

* the hip is a deep ball and socket joint, and it is difficult to see around the curve of the femoral head;

* the hip has strong ligaments that resist distraction, making it a difficult joint to enter; and

* the closely surrounding neurovascular structures make access more challenging.

This article explores the advances in instrumentation and techniques that have been decisive in making hip arthroscopy a more routine surgical procedure. The surgical team, however, needs to be well-versed in the nuances of hip arthroscopy to ensure that the procedure is safe and effective.

ANATOMY

The hip is a ball and socket joint (Figure 1). The ball is the femoral head, which forms three-fourths of a sphere. The socket is the acetabulum, which is not a true hemisphere, but rather forms a horseshoe-shaped joint surface with a depression in the middle called the fossa. The transverse acetabular ligament connects the bony portions to complete the rim of the socket. The ligamentum teres arises from the confluence of the acetabular fossa, and the transverse ligament then inserts into a small depression in the femoral head. This structure provides the head with blood flow early in development, but it is not essential for blood flow in adults. The ligamentum teres does appear to provide some stability for the hip, especially in the flexed/abducted/externally rotated position or with hyperabduction. The anterior rim of the acetabulum has a small depression called the psoas notch; the iliopsoas muscle tendon is located extracapsularly in this area. The iliopsoas attaches to the lesser trochanter of the femur and functions as the primary flexor of the hip. A series of ligaments connects the acetabulum to the femoral neck; collectively, this structure is called the hip capsule. (2)

[FIGURE 1 OMITTED]

The labrum is a fibrocartilaginous structure located around the bony acetabular rim, blending with the capsule. It increases the surface area of the socket, thereby increasing hip stability and decreasing stress on the acetabular articular cartilage. Like the meniscus of the knee, there is blood flow only at the peripheral capsular attachment with poor healing potential in the avascular portion. (2)

If the pelvis were viewed from the front with a flat object lying on the acetabular rim, the relationship of the pelvis to the plane of this object would be called the acetabular version. The term anteversion means the plane faces toward the person examining the object; retroversion means the plane faces away. A normal acetabulum is 20-degrees to 30-degrees anteverted; however, wide variation exists. The term acetabular dysplasia means that the acetabulum does not develop into a normal deep socket; the socket is shallower. (2)