Gupta Asheesh, Suarez-Ahedo Carlos, Redmond John M, Gerhardt Michael B, Hanypsiak Bryan, Stake Christine E, Finch Nathan A, Domb Benjamin G
American Hip Institute, Westmont, Illinois, U.S.A.
Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A.
Arthroscopy. 2015 Sep;31(9):1722-7. doi: 10.1016/j.arthro.2015.03.023. Epub 2015 May 14.
To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management.
We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute.
All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure.
Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the end of the procedure. These data may provide surgeons with a set of aggregate trends that may help guide training, clinical practice, and research in the evolving field of hip arthroscopy.
对大量开展髋关节镜手术的外科医生进行调查，了解他们的手术技术、手术类型及术后管理情况。
我们对27位专门从事髋关节镜手术的高年资骨科医生进行了横断面调查，以报告他们在手术操作及术后康复方案方面的偏好和做法。所有参与者在美国髋关节学会的一次会议期间以匿名方式亲自完成了调查。
所有外科医生均在患者仰卧位时进行髋关节镜手术，最初通过术中透视进入髋关节中央腔隙。所有外科医生均进行盂唇修复（100%），大多数医生进行盂唇重建（77.8%）和臀中肌修复（81.5%）。盂唇修复时使用的锚钉类型存在差异。大多数情况下，大多数外科医生进行关节囊闭合（88.9%），在手术结束时注射关节内皮质类固醇或富血小板血浆（59%），并为部分或所有患者开具术后髋关节支具（59%）。康复方案存在相当大的差异。所有外科医生均常规为患者开具预防异位骨化的药物，大多数外科医生（88.9%）开具非甾体类抗炎药3周。40%的受访者将改良Harris髋关节评分作为最重要的疗效指标。
通过对27位高流量中心的髋关节镜外科医生进行调查，发现了一些一致的做法，如术中透视的使用、异位骨化的预防及盂唇修复技术。大多数外科医生进行常规关节囊闭合，除非存在基础疾病妨碍关节囊松解或折叠。调查发现，外科医生在术后康复方案及手术结束时关节内药物注射的使用方面差异较大。这些数据可为外科医生提供一组总体趋势，可能有助于指导髋关节镜这一不断发展领域的培训、临床实践及研究。
