hip arthroscopy Archives | Jeremy M. Burnham, MD

Bone & Joint Clinic of Baton Rouge | Sports Medicine


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All Posts Tagged: hip arthroscopy

Hip Arthroscopy with Labral Repair – Postoperative Protocol

*Rehabilitation protocol adapted from Brian Busconi, MD

Bracing, Crutches, and CPM Machine

  • Crutches: 4 weeks
    • After arthroscopic hip surgery to repair a torn labrum, it is important to protect the repair while the labrum is healing. For this reason you will need to use crutches for 4 weeks.
  • Brace: 4-6 weeks
    • A brace is often used to help protect the repaired labrum and hip capsule.
  • Continuous Passive Motion (CPM)

Motion Restrictions

  • Days 0-10: Hip flexion of no more than 90 degrees
  • Weeks 0-3: Limit hip extension to 0 degrees, no internal or external rotation

Medications

  • Pain medications will be prescribed after your hip arthroscopy procedure.
    • It is very important to follow the directions exactly.
    • Your surgeon will work with you ensure optimal pain control.
  • Heterotopic Ossification Prophylaxis: Naproxen 500mg, twice a day, for 4 weeks.
    • Heterotopic ossification, or abnormal bone formation in the soft tissues.
    • It is a rare, but well-known, complication after hip arthroscopy.
    • Naproxen is a non-steroidal anti-inflammatory (NSAID) that helps to prevent heteropic ossification.
    • If Naproxen is prescribed for you, it is very important that this medicine is taken according to the instructions.

Phase 1 (Weeks 0-3)

Goals: Protect Healing Tissues, Reduce Inflammation, Restore Range of Motion

Weeks 0-2

Passive Range of Motion

  • Hip circumduction with hip in 70 degrees of flexion (3 sets for 5 minutes)
  • Flexion to 90 degrees for 20 reps
  • External Rotation in Flexion (70 degrees flexion, 20 reps)
  • Supine Abduction: 25 degrees for 20 reps
  • Side lying piriformis stretch
  • Quadriceps stretch (prone without hip extension)

Strengthening

  • Ankle pumps (progress to Theraband)
  • Isometrics: glutes, quads, abdominals, hip abductors and adductors
  • Gluteal slides (start at postoperative day #2-3, progress to standing by day 10)
  • Short arc quadriceps exercises
  • Side lying hip abduction
  • Bridge

Cardiovascular

  • Stationary bike (starting immediately)
  • Elliptical (with brace, starting at postoperative day #5)
  • Aqua jogging
  • Alter-G at 50% body weight (with brace)

Week 3

Passive Range of Motion

  • Hip Circumduction (with hip in 70 degrees of flexion, 3 sets for 5 minutes)
  • Flexion (to 90 degrees for 20 reps)
  • External Rotation in Flexion (hip flexed at 70 degrees, 20 reps)
  • Supine Abduction (limited to 25 degrees, 20 reps)
  • Side lying Piriformis Stretch
  • Quadriceps Stretch (prone without hip extension)
  • Prone Internal and External Rotation (with knee flexed to 90)

Strengthening

  • Ankle pumps (progress to Theraband)
  • Isometrics: glutes, quads, abdominals, hip abductors and adductors
  • Gluteal slides (start at postoperative day #2-3, progress to standing by day 10)
  • Short arc quadriceps exercises
  • Side lying hip abduction
  • Bridge

Cardiovascular

  • Stationary bike
  • Elliptical
  • Aqua jogging
  • Alter-G at 50% body weight

Phase 2 (Weeks 4-6)

Goals: Protect Repaired Tissue, Prevent Muscular Inhibition, Restore Gait Pattern
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Femoroacetabular Impingement (FAI)

What is FAI?

FAI stands for “femoroacetabular impingement,” or hip impingement for short. FAI occurs when extra bone around the hip bumps up against the labrum and cartilage in the hip joint, resulting in pain and ultimately stiffness and early arthritis.

Symptoms of FAI

FAI can start off with just mild pain in early stages. Most of the pain is felt in the groin area, although it sometimes hurts on the outside or back of the hip. In many cases the pain can progress to severe levels. Untreated FAI can lead to stiffness and early arthritis. Occasionally, labral tears or an inflamed psoas tendon can cause snapping or catching sensations in the hip.

Anatomy of the Hip Joint

The hip joint can be thought of as a ball-and-socket joint. The femoral head is the ball, and the acetabulum is the socket. The hip labrum serves as a gasket around the socket to add stability to the hip. Sometimes extra bone grows on either the ball or socket side. This extra bone results in an abnormal shape that not bumps against, or impinges, against other structures in the hip. The result of this can be anywhere from mild pain at first, to a tear of the labrum and damage to the cartilage.

pincer impingement osteoplasty labral repair hip arthroscopy FAI cam impingement

Credit: unknown

When the extra bone occurs around the femoral head (or the ball), it is known as Cam Impingement. When it occurs around the acetabulum (socket) it is known as Pincer Impingement. When it occurs on both areas, it is mixed impingement. Both types of impingement result in similar symptoms, although each causes unique patterns of damage to the cartilage and the labrum.

Diagnosis of Hip Impingement

The diagnosis of FAI is made based off a thorough history and physical examination, and imaging tests consisting of x-rays, MRI, and sometimes ultrasounds. Injections can be used to both treat the pain and to identify the location of the pain. The abnormal bony shape causing FAI can usually be identified on plain x-rays, although sometimes a CT scan is performed to help see the deformity in 3 dimensions. The MRI can help identify tears to the labrum and damage to the cartilage.

pincer impingement osteoplasty labral repair hip arthroscopy FAI cam impingement

MRI showing cam impingement and a tear of the labrum. Credit: Gallo RA, Silvis ML, Stuck D, Mosher TJ, Lynch S, Black KP. Hip Labral Tears Among Asymptomatic Hockey Players Identified on MRI: Two-year Follow-up Study. Poster presentation, American Orthopaedic Society for Sports Medicine, Annual Meeting, Chicago, Illinois, July 10-13, 2013

Treatment of FAI

FAI is treated in many ways. In some cases, nonsurgical methods such as physical therapy or injections are helpful. In other cases, surgery is performed. Most the time, surgery is performed arthroscopically using 2-3 small incisions. An arthroscope (small camera made for the joint) is used to visualize the hip and assist in repairs. If there are labral tears, they are usually repaired back to the bone. The extra bone causing the impingement (either the cam or pincer lesion) is resected back to a more normal shape. Other conditions can be treated during the surgery including snapping of the psoas tendon.

 

More Femoracetabular Impingement Resources

Arthroscopic Treatment of FAI:

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Hip

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Publications

Peer-Reviewed Publications
  1. Burnham JM, Bradley JP. (2018) MRI Findings Are Only One Part of the Equation in National Football League Athletes: Shoulder Instability in Contact Athletes. Arthroscopy. doi: 10.1016/j.arthro.2017.07/026. PMID: 29304983.
  2. Unger RZ, Burnham JM, Gammon L, Malempati CS, Jacobs CA, Makhni EC. (2018) The Responsiveness of Patient-Reported Outcome Tools in Shoulder Surgery is Dependent of the Underlying Pathological Condition. Am J Sports Med. doi: 10.1177/0363546517749213. PMID: 29323925.
  3. Shin J, Burnham JM, Pauyo T, Moreau C. (2017). Refractory Pain Following Hip Arthroscopy: Evaluation and Management. Accepted, Journal of Hip Preservation Surgery, March 2017. Manuscript No. JHPS-2017-021.
  4. Pfeiffer TR, Burnham JM, Hughes J, Kanakamedala AC, Herbst E, Popchak A, Irrgang J, Debski RE, Musahl V. (2017). A Tomahawk Shaped Femur is a Risk Factor for Anterior Cruciate Ligament Injury. Accepted, JBJS, June 2017.
  5. Burnham JM, Wright V. (2017) Update on ACL Rupture and Treatment in the Female Athlete. Orthopaedic Clinics of North America, March 2017. doi: 10.1016/j.csm.2017.05.004. PMID: 28886823.
  6. Pfeiffer TR, Kanakamedala AC, Herbst E, Nagai K, Murphy C, Burnham JM, Popchak A, Debski RE, Musahl V. (2017). Female Gender Predicts Greater Rotatory Knee Laxity in Collegiate Athletes. KSSTA. doi: 10.1007/s00167-017-4684-6. PMID: 28823037.
  7. Musahl V, Herbst E, Burnham JM, Fu FH. (2017) A Review of the Anterolateral Complex and Anterolateral Ligament of the Knee. Accepted, July 2017, Journal of the American Academy of Orthopaedic Surgeons. Manuscript No. JAAOS-D-16-00758.
  8. McQuerry JL, Burnham JM, Ireland ML, Wright RD. (2017) Delayed Presentation of Thigh Compartment Syndrome in a Previously Undiagnosed Factor VII Deficient High School Football Athlete. Accepted, JBJS Case Connector, July 2017.
  9. Burnham JM, Fu FH. The importance of individualized, anatomic anterior cruciate ligament (ACL) reconstruction. Annals of Joint, July 2017. doi: 10.21037/aoj.2017.07.07
  10. Wilson BR, Roberson K, Burnham JM, Yonz MC, Ireland ML, Noehren B. (2017) Relationship Between Hip Strength and the Y-Balance Test Composite Score. Journal of Sport Rehabilitation, July 2017. doi: 10.1123/jsr.2016-0187 PMID: 28714790.
  11. Jacobs CA, Burnham JM, Jochimsen KN, Hunt ER, Malempati CS, Molina D, Hamilton DA, Abt JP, Lattermann C, Duncan ST. (2017) Preoperative Symptoms in Femoroacetabular Impingement Patients Are More Related to Mental Health Scores than the Severity of Labral Tear or Chondral Lesion. Accepted, Journal of Arthroplasty, June 2017. doi: 10.1016/j.arth.2017.06.053 PMID: 28739309.
  12. Burnham JM, Makhni EC, Meta F, Lizzio V, Bozic K. (2017) Technology Assessment and Cost-Effectiveness in Orthopaedics: How to Measure Outcomes and Deliver Value in a Constantly Changing Healthcare Environment. Current Reviews in Musculoskeletal Medicine. doi: 10.1007/s12178-017-9407-6. PMID: 28421386.
  13. Burnham JM, Pfeiffer T, Shin J, Herbst E, Fu FH. (2017) Bony Morphologic Factors Affecting Injury Risk, Rotatory Stability, Functional Outcomes, and Re-tear Rate after ACL Reconstruction. Annals of Joint, June 2017.
  14. Herbst E, Albers M, Burnham JM, Fu FH, Musahl V. (2017) Anatomy of the Anterolateral Complex of the Knee. Accepted, Orthopaedic Journal of Sports Medicine, July 2017.
  15. Massey P, Perry KJ, Berken D, James J, Nelson BG, Burnham JM, Hollister A. (2017) Delayed Diagnosis of Pediatric Osseous Blastomycosis of the Hand: A Brief Report. Hand & Microsurgery. doi: 10.5455/handmicrosurg/262225.
  16. Burnham JM, Malempati C, Carpiaux A, Ireland ML, Johnson DL. (2017) Anatomic Femoral and Tibial Tunnel Placement During Anterior Cruciate Ligament Reconstruction: Anteromedial Portal All-Inside and Outside-In Techniques. Arthroscopy Techniques, March 2017. doi: 10.1016/j.eats.2016.09.035. PMID: 28580242.
  17. Kline P, Burnham JM, Yonz MC, Johnson DL, Ireland ML, Noehren B. (2017) Hip External Rotation Strength Predicts Hop Performance After Anterior Cruciate Ligament Reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, April 2017. April 2017. doi: 10.1007/s00167-017-4534-6. PMID: 28378137.
  18. Burnham JM, Albers M, Herbst E, Fu FH. (2017) Individualized, Anatomic Anterior Cruciate Ligament (ACL) Reconstruction. World Clinics in Orthopedics, Accepted
  19. Arner JW, Herbst E, Burnham JM, Rahnemai-Azar AA, Soni A, Naendrup J, Popchak A, Fu FH, Musahl V. (2017) MRI Can Accurately Detect Meniscal Ramp Lesions of the Knee. Knee Surgery, Sports Traumatology, Arthroscopy, doi: 10.1007/s00167-017-4523-9. PMID: 28343325.
  20. Herbst E, Albers M, Burnham JM, Shaikh HS, Naendrup J, Fu FH, Musahl V. (2017) The Anterolateral Complex of the Knee: A Pictorial Essay. Knee Surgery, Sports Traumatology, Arthroscopy, doi: 10.1007/s00167-017-4449-2. PMID: 28233023.
  21. Musahl V, Getgood A, Neyret P, Claes S, Burnham JM, Batailler C, Sonnerty-Cottet B, Williams A, Amis A, Zaffagnini S, Karlsson, J. (2017) Contributions of the Anterolateral Complex (ALC) and the Anterolateral Ligament (ALL) to Rotatory Knee Stability in the Setting of ACL Injury: A Roundtable Discussion. Accepted, Knee Surgery, Sports Traumatology, Arthroscopy, April 2017. doi: 10.1007/s00167-017-4436-7. PMID: 28286916.
  22. Herbst E, Burnham JM, Albers M, Musahl V, Fu FH. (2017) Layer-by-Layer Anatomy of the Anterolateral Complex of the Knee. Operative Techniques in Orthopaedics, doi: 10.1053/j.oto.2017.02.002.
  23.  Rahnemai-Azar AA, Zlotnicki J, Burnham JM, Guenther D, Soni A, Debski RE, Musahl V. (2017) Secondary Stabilizers of the ACL Deficient Knee. Operative Techniques in Orthopaedic Surgery, doi: 10.1053/j.oto.2017.02.005.
  24. Burnham JM, Herbst E, Pauyo T, Johnson DL, Fu FH, Musahl V. (2016) Technical Considerations in Revision ACL Surgery. Accepted, Operative Techniques in Orthopaedics, October 2016. http://dx.doi.org/10.1053/j.oto.2017.01.012.
  25. Jacobs CA, Burnham JM, Malempati C, Makhni EC, Swart E, Johnson DL. (2016). Allograft Augmentation of Hamstring Autografts for Young Patients Undergoing ACL Reconstruction: Clinical and Cost-Effectiveness Analyses. American Journal of Sports Medicine. Doi: 10.1177/0363546516676079. PMID: 28298052.
  26. Burnham JM, Herbst E, Albers M, Pauyo T, Fu FH. (2016) The Anterolateral Complex of the Knee: A Comprehensive Review of Its Structure and Function. Journal of Clinical Orthopaedics, October 2016. doi: 10.13107/jcorth.2454-5473.141.
  27. Goldberg J, Burnham JM, Dhawan V. (2016) Subcutaneous Ulnar Nerve Transposition Using Osborne's Ligament as a Ligamentodermal or Ligamentofascial Sling. Accepted, American Journal of Orthopedics. Manuscript No. AMJORTHOP-D-15-00220.
  28. Burnham JM, Yonz MC, Robertson K, McKinley R, Wilson BR, Johnson DL, Ireland ML, Noehren B. (2016) Correlation of Hip and Trunk Dysfunction with Single Leg Step-Down Performance. PTIS doi: 10.1016/j.ptsp.2016.05.007 PMID: 27592407
  29. Burnham JM, Kim D, Kamineni S. (2016) Midshaft Clavicle Fractures: A Critical Review. Orthopedics 39(5). PMID: 27220117.
  30. Burnham JM, Howard J, Lattermann CL. (2015) Medial Patellofemoral Ligament Reconstruction with Concomitant Tibial Tubercle Transfer: A Systematic Review of Outcomes and Complications. Arthroscopy. doi: 10.1016/j.arthro.2015.11.039. PMID: 26882966.
  31. Duncan ST, Khazzam MS, Burnham JM, Spindler KP, Dunn WR, Wright RW. (2015). Sensitivity of Standing Radiographs to Detect Knee Arthritis: A Systematic Review of Level I Studies. Arthroscopy, 31(2),321-328. doi: 10.1016/j.arthro.2014.08.023. PMID: 25312767.
  32. Burnham JM, Broussard M, Milbrandt TA. (2014). Bilateral Pulmonary Embolism in an Adolescent with Sickle Cell Disease and a Recent Total Hip Arthroplasty. The Iowa Orthopaedic Journal, 34, 107-110. PMID: 25328468.
  33. Burnham J, Hollister A, Rush D, Avallone T, Shi R, Jordan J. (2011). Technique for and an Anatomic Guide to Forearm Tendon Repair. Techniques in Hand & Upper Extremity Surgery, 15(2), 125-132. doi: 10.1097/BTH.0b013e318201ba07. PMID: 21606787.
  34. Cardenas RJ, Javalkar V, Ezer H,Burnham J, Nanda A. (2011). Occipital Interhemispheric Transtentorial Approach to the Superior Cerebellum. J Clin Neurosci, 18(1), 128-130. doi: 10.1016/j.jocn.2010.04.053. PMID: 20947356.
Books & Book Chapters
  1. Burnham JM, Murr K, & Kamineni S. (2016). Arthroscopy of the Elbow: The Basics. In G. S. Kulkami (Ed.), Textbook of Orthopaedics and Trauma (3rd ed., Vol. 3, pp. 2008-2014): Jaypee Brothers
News, Media, & Non-Peer Reviewed Publications
  1. Burnham JM, Frank R. Sports Medicine Research at the 2016 Annual Meeting: Part 2 – Upper Extremity and Return-to-Play. AAOS Now. May, 2016.
  1. Burnham JM, Frank R. Sports Medicine Research at the 2016 Annual Meeting: Part 1 – Basic Science, Lower Extremity, and Cost-Effectiveness. AAOS Now. April, 2016.
  1. Burnham JM. The AAOS Resident Assembly: A Look Back on the Inaugural Year. AAOS Now. April, 2016.
  1. Erickson B, Burnham JM. Effect of Work Hour Restrictions on Orthopaedic Residency. AAOS Now. January, 2016.
  1. Harwood JL, Burnham JM. Leadership in Orthopaedics: A Personal Journey. AAOS Now. September, 2015
  1. Burnham JM, Harwood JH. Wearable Technology: Implications for Orthopaedic Surgery. AAOS Now. August, 2015.
  1. Erickson B, Burnham JM, Harwood JL, Frank R. What are the Essential Reads for Orthopaedic Residents? A Call for a National Orthopaedic Surgery Reading List. AAOS Now. August, 2015.
  1. Midley, Connie. Daily Exercise Improves Overall Health. Vim & Vigor. December, 2015.
  1. Burnham, JM. Importance of Core Strength in Overall Health. Lexington Herald-Leader. October 26, 2014.
Submitted Publications
  1. Jacobs CA, Burnham JM, Malempati C, Makhni EC, Swart E, Johnson DL. (2016). Allograft Augmentation of Hamstring Autografts for Young Patients Undergoing ACL Reconstruction: Clinical and Cost-Effectiveness Analyses. Submitted, American Journal of Sports Medicine, May 2016.
  1. Wilson BR, Roberson K, Burnham JM, Yonz MC, Ireland ML, Noehren B. (2016) Relationship Between Hip Strength and the Y-Balance Test Composite Score. Submitted, International Journal of Sports Medicine, May 2016. Manuscript No. IJSM-05-2016-5634-ob.
  1. McQuerry JL, Burnham JM, Ireland ML, Wright RD. (2016) Delayed Presentation of Thigh Compartment Syndrome in a Previously Undiagnosed Factor VII Deficient High School Football Athlete. Submitted, JBJS Case Connector, May 2016.
  1. Burnham JM, Willis CB, Ireland ML. (2016) Can Femoral Tunnel Reaming Method in ACL Reconstruction Be Determined from Plain Radiographs Alone? Submitted, KSSTA, March 2016. Manuscript No. KSST-D-16-00393.
  1. Goldberg J, Burnham JM, Dhawan V. (2016) Subcutaneous Ulnar Nerve Transposition Using Osborne's Ligament as a Ligamentodermal or Ligamentofascial Sling. Revisions Submitted, American Journal of Orthopedics, January 2016. Manuscript No. AMJORTHOP-D-15-00220.
  1. Eads R, Burnham JM, Hennig, P, Ireland ML. (2016) Candidal Septic Arthritis Masquerading as a Twisting Injury of the Knee. Submitted, Iowa Orthopaedic Journal, January 2016.
  1. James J, Massey P, Heaton JM, Berken D, Burnham JM, Hollister AM. (2015) Blastomycosis Osteomyelitis of a Pediatric Hand: Case Report and Literature Review. Submitted, Clinical Orthopaedics and Related Research, June 2015.
  1. Yonz MC, Burnham JM, Noehren B, Ireland ML. (2015) Relationship Between Trunk, Hip, and Knee Extension Strength to Hop Test Performance. Submitted, Medical Science in Sports and Exercise, June 2015.
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