G

FIGURE 10.35. An 18-year-old man after bony avulsion of the left anterior inferior iliac spine. (A) AP radiograph reveals ossification around the acetabulum (arrow). (B) Three-dimensional CT reconstruction defines the dimensions of the fragment (arrow) creating a mechanical block to internal rotation. (C) Viewing from the anterolateral portal, a full-radius resector is used to develop the margins of the osteophyte (O), which lies anterior to the articular surface of the acetabulum (A). (D) An arthroscopic knife is used to incise the capsule, which is partially contained within the fragment. (E) Hemosta-sis, important for optimal visualization, is maintained with judicious use of the arthroscopic cautery. (F) The anterior capsule (C) has been fully released, and a burr is used to excise the fragment, exposing the anterior column of the pelvis (P). The anterior margin of the acetabulum (A) is at the bottom of the picture, and a portion of the femoral head (F) is in view on the left. (G) The postoperative radiograph reveals the extent of bony resection.

had undergone previous successful capsulorrhaphy of her right shoulder. She had sustained a relatively atraumatic dislocation episode of her right hip 5 years previously that was reduced in an emergency room. Subsequently, she had experienced multiple subluxation/dislocation episodes that she had learned to reduce on her own or with the assistance of a family member. She had developed protective behavior to avoid these episodes but, even with precautions, would intermittently experience symptoms of her hip going out, causing her to fall. On examination, her greatest sense of instability and apprehension was created when translating the femoral head anteriorly with forced abduction and external rotation. Radiography revealed normal joint geometry, and an MRI was unremarkable. Because of persistent symptoms despite adequate precautionary measures, arthroscopy was recommended. A chronic disruption of the liga-mentum teres was identified (Figure 10.36A). The disrupted fibers were debrided and thermal capsulorrha-phy was performed (Figure 10.36B-D). Postoperatively, range of motion was restricted for 8 weeks in a hip spica brace. She responded well with elimination of her pain and episodes of subluxation.

Status Post Total Hip Arthroscopy

Arthroscopy can be performed in the presence of a hip prosthesis. However, the indications are limited.23-26 With a capacious capsule, it may be easy to distract the joint and insert the instruments with the technique as used for a native joint. Normally, distraction should

FIGURE 10.36. A 17-year-old girl with a history of recurrent atraumatic right hip instability. (A) Viewing from the anterolateral portal, a chronic disruption of the ligamentum teres is identified (asterisk). (B) The disrupted fibers are debrided. (C) Viewing posteriorly, thermal shrinkage is begun with the laser introduced from the pos-

FIGURE 10.36. A 17-year-old girl with a history of recurrent atraumatic right hip instability. (A) Viewing from the anterolateral portal, a chronic disruption of the ligamentum teres is identified (asterisk). (B) The disrupted fibers are debrided. (C) Viewing posteriorly, thermal shrinkage is begun with the laser introduced from the pos-

terolateral portal. Note the band created (arrows) indicating a brisk capsular response. (D) Now viewing the peripheral compartment with the traction released and hip flexed, the anterior capsular laxity is most completely addressed with the laser introduced through an ancillary peripheral portal.

FIGURE 10.37. A 38-year-old man with unexplained left hip pain, 21 months following a total hip replacement. (A) AP radiograph reveals a well-positioned press-fit prosthesis with no evidence of loosening. (B) Fluoroscopic view demonstrates the position of the arthro-scope and shaver along the base of the neck, thus avoiding the articular surface of the prosthesis. (C) Debridement of the fibrous tissue exposes the neck of the prosthesis (N) and its junction with the ceramic head (arrow). (D) A dense portion of fibrous tissue (asterisk) was entrapped between the polyethylene liner of the ac-etabulum (A) and the femoral head component (F). Peripheral to this is the reformed capsule (C).

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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