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Capsulotomy offers increased exposure, accuracy with advanced hip arthroscopy
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Capsulotomy in conjunction with hip arthroscopy is indicated in treating degenerative arthritis cases, for femoroacetabular impingement or when large loose bodies need removing from the joint, among other indications, according to an orthopedic surgeon from San Francisco.
“There are pros and cons to it. The pros outweigh the cons,” Thomas G. Sampson, MD, said during a presentation on achieving ideal exposure for hip arthroscopy through extensive capsulotomy.
Capsulotomy improves the mobility of arthroscopic instruments and helps gain greater access to key areas of the hip, particularly the peripheral compartment, Sampson said. “It’s a little more time consuming; maybe a little more extravasation, but it is not a problem,” he said.
While Sampson noted during the 2010 meeting of the Arthroscopy Association of North America that some of his colleagues oppose doing a capsulotomy with arthroscopic hip procedures, he said it should not be controversial in these cases, since it serves the same purpose as open procedures for the same indications.
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Image: Sampson TG |
Since the 1990s, surgeons have used capsulotomy effectively in hip arthroscopy for various reasons and its use has expanded dramatically as the complexity of hip arthroscopy has advanced, he said.
“Indications for extensive capsulotomy are when you really need to do a lot more in the peripheral compartment and when you are going to do advanced techniques [such as] removal of large loose bodies, as well the FAI [femoroacetabular impingement] work that we are performing these days,” he said.
He showed a pincer impingement case demonstrating the extent of the delamination and damage to full-thickness cartilage in the peripheral compartment, which was more readily viewed following capsulotomy.
Having a good understanding of the bony and ligamentous anatomy of the posterior and anterior hip capsule is critical to executing the technique well, Sampson said. It involves first making an arthroscopic capsular incision along the neck of the femur and extending it over the labrum and then along the acetabular rim. To expose the area from the base of the femoral neck to the supra acetabular ilium, he uses a radiofrequency probe, based on his abstract.
In showing images of performing capsulotomy transversely, Sampson said that technique is often needed for patients with hip dysplasia. Longitudinally- oriented capsulotomy, however, facilitates procedures like labral grafting since the capsule is lifted up and over the labrum and held close to the rim in the process. “In this way, you can really get good visualization of your whole head-neck junction, all the damage …,” he noted.
Among the nearly 1,000 consecutive hip arthroscopies he has completed with capsulotomy since 1999, Sampson reported three fractures and one subluxation for a complication rate of 0.46% and attributed that, in part, to using capsulotomy in a variety of cases and pathologies to improve exposure of the hip joint.
“It allows for complex procedures and access is more efficient with reproducibility. Also it is safe and effective,” he said. – by Susan M. Rapp
Reference:
- Sampson TG. Extensive capsulotomy for ideal exposure and treatment in hip arthroscopy. Paper SS-33. Presented at the 2010 Annual Meeting of the Arthroscopy Association of North America. May 20-23, 2010. Hollywood, Fla.
- Thomas G. Sampson, MD, can be reached at Post Street Orthopaedics and Sports Medicine, 2299 Post St., Suite 107, San Francisco, CA 94115-3443; 415-345-9400; e-mail: tgsampsonmd@yahoo.com.
- Disclosure: Sampson receives travel expenses, honoraria from Stryker and Smith & Nephew and royalties from Smith & Nephew.
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