Naoki Nakano

Accuracy of navigated cam resection in femoroacetabular impingement: A randomised controlled trial

The main cause for revision hip arthroscopy surgery is incomplete bony resection of femoroacetabular impingement (FAI). This study aimed to compare the cam resection accuracy via the conventional hip arthroscopy technique with the navigation technique.

Historical review of arthroscopic surgery of the hip

Background & purposeIncreasing our appreciation of the historical foundations of hip arthroscopy offers greater insight and understanding of the field’s current and future applications. This article offers a broad history of the progress of hip arthroscopy.MethodsHip arthroscopy’s development from the early technologies of endoscopy to the present day is described through a review of the available literature.ResultsEndoscopic science begins with the Lichtleiter, developed by Phillip Bozzini (1779–1809) in 1806, but endoscopes were not applied to joints until 1912, as presented by Severin Nordentoft (1866–1922). The work of Kenji Takagi (1888–1963), especially, was instrumental in the arthroscope’s development, allowing Michael Burman (1901–75) to perform the first recorded hip arthroscopy, detailed in a 1931 paper after extensive cadaveric research. Although World War II stalled further development, a renewed application of fibre optics following post-war innovations in glass manufacture heralded the modern arthroscope’s invention. During the 1970s hip arthroscopy was first mobilized for diagnosis and exploration, leading to its later adoption for therapeutic surgical interventions. Modern hip arthroscopy has been facilitated by international research into optimum distraction, portals of entry, positioning of patients, and the technology of arthroscopic instruments. In 2008, the International Society for Hip Arthroscopy (ISHA) was founded to represent this international expert community.ConclusionsTechnology, communication and evidence-based medicine have jointly facilitated the development of this young but promising corner of Orthopaedics.

Medial synovial fold cyst in the hip leading to pectineofoveal impingement.

Abstract Pectineofoveal impingement is a relatively rare condition, which can cause hip or groin pain along with mechanical symptoms of clicking in the young adult. We present the case of a 13-year-old girl who was referred to us with left hip pain, which had been affecting her for over six months along with mechanical symptoms of clicking. Following appropriate clinical examination and investigations the patient underwent arthroscopic surgery of her hip. At arthroscopy, a cyst was identified on the medial synovial fold, which was abutting against the zona orbicularis leading to pectineofoveal impingement. The cyst was decompressed and the synovial fold excised arthroscopically. Following arthroscopic intervention, the patient did extremely well and remains asymptomatic at the last follow-up (7 months following the procedure). The case highlights the importance of the medial synovial fold pathology as an important cause for pain and mechanical symptoms in the young adult hip.

Management guidelines for metal-on-metal hip resurfacing arthroplasty: A strategy on followup

Despite the initial promise of metal-on-metal (MoM) implants as the ideal bearing surface for hip replacements and resurfacings, high short term failure rates due to an adverse reaction to metal debris (ARMD) have led to a dramatic reduction in the number of MoM implants used in the modern era. With over one million patients worldwide having undergone hip operations utilizing a MoM bearing surface, the long term outcomes for such patients remains unknown, and there is much debate as to the most effective management of these patients. Although several regulatory bodies have released guidelines on the management of patients with MoM hips, these recommendations remain open to interpretation, and the most effective management for these patients remains unclear. The aim of this review is to compare the current guidelines for managing patients with MoM hips and also to discuss established ARMD risk factors, evidence regarding the optimum management for patients with MoM hips, and the indications for revision surgery. Furthermore, although specialized laboratory tests and imaging can be used to facilitate clinical decision making, over-reliance on any single tool should be avoided in the decision making process, and surgeons should carefully consider all findings when determining the most appropriate course of action.

Femoroacetabular impingement: the past, current controversies and future perspectives.

Femoroacetabular impingement (FAI) is a clinical syndrome in which morphological abnormalities of the femoral head and/or the acetabulum result in an abnormal contact between the femur and acetabulum during normal hip motion, leading to cartilage and/or labral damage and hip pain. It is subdivided into two distinct morphologies: the cam-type wherein there is a reduction in the femoral head–neck offset or the pincer type wherein there is focal or global over-coverage of the acetabulum. There is also mixed-type FAI in which both camand pincer-type deformities are seen in the same hip. FAI has gained significant importance in the recent past and the main reason for this is because it has been considered a precursor to osteoarthritis (OA) especially in cam-type impingement, but there is still no conclusive evidence about pincer-type impingement leading to OA [1]. In the United States, the rate of FAI surgery increased sevenfold among newly trained orthopedic surgeons between 2006 and 2010, and this is projected to increase even further [2]. The number of FAI-related publications increased fivefold between 2005 and 2010, showing a recent boom in FAI-related research [3]. Despite the large increase in the number of hip arthroscopies performed on patients with FAI, the optimal diagnostic approach and ideal treatment of FAI remains controversial.

Arthroscopic excision of heterotopic ossification in the rectus femoris muscle causing extra-articular anterior hip impingement

Subspine impingement is an extra-articular hip impingement syndrome that usually occurs when there is abnormal contact between an enlarged or malorientated anterior inferior iliac spine (AIIS) and the distal anterior femoral neck in straight flexion of the hip. We present the case of a 13-year-old boy with a history of left groin pain and loss of range of movement of the hip for over six months following an avulsion fracture of the AIIS during a game of rugby. He was diagnosed with subspine impingement secondary to a large lesion of heterotopic ossification in the rectus femoris; this was dissected and extracted from the muscle in toto arthroscopically. This case highlights the importance of heterotopic ossification after injury as an important cause for subspine impingement in the young adult hip. This is the first report and describes subspine impingement secondary to a large lesion of heterotopic ossification.

Is restricted hip movement a risk factor for anterior cruciate ligament injury

Restricted hip movement along with femoroacetabular impingement (FAI) has been reported to be an important risk factor in anterior cruciate ligament (ACL) injury. We performed a literature review assessing the evidence that FAI, or restricted hip movement, contributes to the likelihood of sustaining an ACL injury to provide an evidence-based and comprehensive update on the relationship between these pathologies. Studies were divided into three categories: clinical studies, radiological studies and cadaveric studies. Clinical studies primarily assessed the limitations to hip movement in patients with ACL injury, and numerous studies of this kind have demonstrated a relationship between restricted movement and ACL injury. Radiological studies have been able to demonstrate a higher number of bony hip abnormalities in patients with ACL injury. However, due to variable results within these studies, it is unclear which kinds of bony abnormality are specifically associated with an increased risk of ACL injury. Cadaveric studies have demonstrated that peak ACL relative strain was inversely related to the range of internal rotation of the femur, thus providing a potential mechanism for this relationship. In conclusion, clinical and radiological studies have established a correlation between restricted hip and ACL injury, but have been unable to demonstrate an increased risk of future ACL injury in individuals with restricted hip movement. Future prospective cohort studies are necessary to confirm this. Additionally, these findings highlight the need for a thorough clinical assessment of the hip when assessing patients with an ACL injury.

Review: Current concepts in computer-assisted hip arthroscopy

In the last 15 years, hip arthroscopy has become increasingly popular in addressing femoroacetabular impingement (FAI) because of its minimally invasive approach. However, assessing the adequacy of bone resection when correcting FAI can be difficult because visualisation and spatial awareness of the joint are poor. Recent advances in technology in the field of computer‐assisted surgery and navigation and robotic surgery in orthopaedics as a resource for preoperative planning and intraoperative assistance have been widely reported. This technology is expected to upgrade surgical planning and operative techniques, decrease human error and improve patient outcomes by precisely defining the divergent anatomy and kinematics of the hip joint. This review attempts to bring the reader up‐to‐date with the current developments in the field of computer assisted hip arthroscopy, and discusses our experience with pre‐operative planning, navigation and robotics and also provides a platform for future research in this arena.

Pseudoaneurysm of a branch of the femoral circumflex artery as a complication of revision arthroscopic release of the iliopsoas tendon

Treatment of painful internal snapping hip via arthroscopic release of the iliopsoas tendon is becoming the preferred option over open techniques because of the benefits of minimal dissection and fewer complications. However, complications do occur with arthroscopic techniques as well. We present the case of a 33-year-old woman who presented with painful internal snapping of her right hip and underwent arthroscopic release of the iliopsoas tendon. Following the procedure she continued to complain of pain in her groin and was therefore investigated further with a magnetic resonance imaging (MRI) which revealed a swelling near the femoral circumflex vessels. A computed tomography (CT) angiogram revealed a 15 mm pseudoaneurysm of the femoral circumflex artery, which was successfully treated by selective catheterisation and embolisation. Hip arthroscopists should be sufficiently familiar with the vascular anatomy around the hip and keep this complication in mind when releasing the iliopsoas tendon arthroscopically especially in revision cases with adhesions.