Impinging Osteophytes

Osteophytes, or bone fragments, can impinge on the joint, causing pain. These can often be excised arthro-scopically. Excision of osteophytes or fragments caused by previous trauma are the most likely to result in successful patient satisfaction.66 This procedure may necessitate an extracapsular as well as ex-traarticular dissection. Principles for effectively and safely performing this procedure are as follows.

1. Thorough knowledge of the normal anatomy is necessary to accurately assess anatomy altered by trauma.

2. Constant orientation to the extraarticular anatomy is important, especially the neurovascular structures, relative to the area of dissection.

3. When dissecting outside the capsule, keep the soft tissue debridement directly on bone and avoid straying into the surrounding soft tissues. Remember that "bone is home."

4. Optimal visualization is best achieved with a high-flow fluid management system. Blood and debris hinder visualization in the absence of adequate flow. A high-flow system is necessary to achieve adequate flow without having to use excessive pressure. Increased pressure results in inordinate fluid extravasation; this cannot be modulated well with a gravity-flow system alone.

5. Maintain hemostasis: hypotensive anesthesia (systolic BP < 100 mm Hg); add epinephrine to the fluid; and employ an electrocautery device.

FIGURE 2.18. A 19-year-old woman with a 7-year history of worsening right hip pain. (A) AP radiograph reveals findings of synovial chondromatosis characterized by numerous loose bodies. (B, C) CT scan further substantiates the presence of loose bodies within the joint and within the peripheral compartment. (D) Intraarticular

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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