AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Defining the Team Approach to Hip Preservation_ Collaborative Surgical Specialization Pearls and Pitfalls-J.W. Thomas Byrd, MD

Defining the Team Approach to Hip Preservation_ Collaborative Surgical Specialization Pearls and Pitfalls-J.W. Thomas Byrd, MD

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This presentation by Dr. J.W. Thomas Byrd at the 2019 AANA/ISHA conference focuses on the team-based surgical approach to hip preservation, emphasizing collaboration between arthroscopic and open surgical techniques. Key aspects include effective coordination of schedules for office visits, operating room time, and follow-up care to optimize patient outcomes.<br /><br />A critical decision in combined procedures is determining who requires hip arthroscopy alongside periacetabular osteotomy (PAO), a choice typically made by the PAO surgeon. The arthroscopic portion has unique features: addressing cam deformities can be done openly but easily modified based on acetabular reorientation; mild pincer lesions may be addressed arthroscopically; subspine decompression might be necessary; and labral hypertrophy is often present.<br /><br />The surgical team must decide whether to perform arthroscopy and PAO simultaneously or in staged procedures. Staged approaches simplify technical challenges associated with combined surgery and require careful management of adhesives, drapes, and dressings. When done in the same setting—often inpatient—organization is crucial to reduce complications like fluid extravasation. Strategies include lowering pump pressure while monitoring blood pressure, delaying capsulotomy, and typically avoiding working in the peripheral compartment.<br /><br />Overall, this collaborative, specialized team approach requires meticulous planning and intraoperative techniques to navigate the pearls and pitfalls of combining arthroscopic and open hip preservation procedures, aiming for improved surgical outcomes and patient recovery.

Keywords

hip preservation

arthroscopic surgery

periacetabular osteotomy

PAO surgeon

cam deformity

pincer lesion

subspine decompression

labral hypertrophy

combined surgical procedures

surgical team coordination