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CURRENT CONCEPTS

Hip Arthroscopy: Current Advances Similarly, the same authors demonstrated that the

and Scientific Evidence
labrum was the primary hip stabilizer to distraction
forces at small displacements, which may explain

hip microinstability with loss of labral function.
Clinically, the importance of labral preservation

was emphasized in several studies. Dippman et
al. showed that improvements in pain and function
after labral repair was most significant from 3 to 6

months postoperatively. In a systematic review,
Ayeni et al. demonstrated better clinical outcomes

with labral repair compared to labral debridement.
In a retrospective review of early hip arthroscopy

procedures with labral d́bridement, Krych et al.
reported only modest outcomes with a 45% failure

rate. In cases where the labrum has been excised
or is not repairable, a systematic review by Ayeni et
al. demonstrated that labral reconstruction can have

short-term improvement in patient pain and function.

As surgeons we strive to improve outcomes in our
patients. A Scandinavian expert group described

the development of a hip registry with its baseline 03
data, which will provide for future scientific work. In

The correct diagnosis of hip pathology remains addition, it is important to use valid, reliable, and
responsive instruments to objectively assess patient
challenging. This is highlighted by a survey study
that showed the majority of surgeons were unsure outcome. Levy et al. highlight multimodal analgesia
of evidence supporting the best clinical test for as a safe and effective method of providing a high

FAI. Ayeni et al. showed that maximal squat test satisfaction rate of patients undergoing outpatient
had only limited diagnostic ability, and may not be hip arthroscopy. Intra-operatively, Sa and colleagues
demonstrated that the alpha angle is a good
clinically helpful to distinguish whether CAM-type
FAI is symptomatic in a patient. A radiographic clue predictor of outcome and represents a simple,
reproducible and inexpensive guide that can be
reported by Ji and colleagues may be herniation
pits on the femoral head-neck junction, as the used. Postoperatively, comprehensive rehabilitation
is a key component to successful outcome in
prevalence was higher in symptomatic patients
with pincer-type FAI. In some cases, diagnostic hip any of these procedures. In failure of primary hip
arthroscopy, the results of revision hip arthroscopy
injections are routinely used in these challenging
cases to differentiate pain sources. However, at medium-term follow-up reported by Aprato et al.
Ayeni et al. report that pain relief from a local demonstrated that outcomes can improve, but may

anesthetic injection may not be a good predictor not be as successful as in primary hip arthroscopy.
of arthroscopic management of FAI, but no pain

relief from this injection predicts a high likelihood
of a negative result from surgery. For therapeutic

purposes, Krych et al. report that cortisone injection
had only limited value as the average pain relief

duration was only 10 days. However, hyaluronic
acid demonstrated more optimistic results in a

prospective trial of twenty patients with decreased
pain scores and improved function at 12 months.

The acetabular labrum is theorized to have the roles
of intra-articular fluid pressurization and hip stability.

In a cadaveric model, Philippon et al. found that
partial labral resection decreased intra-articular fluid

pressurization, and labral repair (better with through
suture techniques over looped suture techniques)

or labral reconstruction was able to restore
pressurizations to the intact state.

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32 ISAKOS NEWSLETTER 2014: Volume II