Joseph C. McCarthy

Acetabular and Labral Pathology

Summary The cadaveric data show that labral lesions are extremely common, present in 93% of specimens.

The Future of Hip Arthroscopy

Over the past 30 years, indications for hip arthroscopy have grown remarkably to nearly 30 procedures, each of these vetted in this textbook. Minimally invasive arthroscopic procedures are one of the fastest growing areas of orthopedics, witnessed by the exponentially increasing numbers of publications in the literature as well as the founding of organizations such as ISHA (The International Society of Hip Arthroscopy). And yet the rapid advancements in this area have served to highlight significant limitations in our knowledge of the hip joint. These limitations serve to spawn further investigation of the hip itself, and continuing efforts to address pathologic conditions in and around this complex joint.

Arthroscopy Following Total Hip Replacement

Despite outstanding results in the majority of patients total hip replacement may be associated with a number of unplanned outcomes. Some of these are visible radiographically, such as a trochanteric wire or titanium bead within the joint or a screw backing out. However some painful conditions are not readily diagnosable by imaging. These conditions may include dense scar from an anterior hip approach tethering the iliopsoas muscle. Trunnion metallosis, when early, may also not be visualized. It is for all of the above reasons that arthroscopy, for patients with unremitting pain post-arthroplasty is valuable. It can directly visualize the joint articulation and bearing surfaces. It can identify and treat arthrofibrosis and tethering scar. It can facilitate loose body or hardware removal. It may also help, because the joint can be moved, demonstrate dynamic pathologic soft-tissue conditions. Since the procedure is performed as an outpatient it reduces surgical risk and cost.

History of Hip Arthroscopy in the USA

Anatomic constraints greatly contributed to the difficulty with arthroscopic hip access. Burman from New York, in 1931, did publish his experience on achieving intra-articular visualization in cadavers, but only in the peripheral compartment. In North America, clinical experience began in the early 1980s, following Glick and McCarthy’s development of dedicated hip distractors. Johnson, in a similar time frame, published his technique utilizing a fracture table in the supine position. Both portal access and hip-specific instrumentation have evolved significantly as procedural indications and complexity have expanded. Cartilage and labral imaging were greatly facilitated by Palmer and McCarthy’s publication on the use of gadolinium-enhanced arthro MRI scanning and oblique views. Potter’s pioneering work, at Hospital for Special Surgery, with multiplanar, thin-slice, high-resolution non-contrast MRI advanced understanding of both joint and soft-tissue pathology. Dgemric, initiated at Boston Children’s Hospital, furthered our understanding of early stages of cartilage wear. All of these developments, in concert with the work of international colleagues, have facilitated procedural advancements in the central and peripheral hip compartments and now to the extra-articular tissues.