AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Radiology Interpretation in Hip Preservation Surgery-Tania Ferguson, MD MAS

Radiology Interpretation in Hip Preservation Surgery-Tania Ferguson, MD MAS

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This document discusses revision hip preservation surgery, particularly focusing on multiply operated hips in young patients (notably 22-24 years old) with persistent pain and dysfunction after previous procedures such as periacetabular osteotomy (PAO), hip arthroscopy, and labral surgeries. Key considerations include optimizing osseous architecture, correcting dysplasia, femoral alignment, impingement, and torsion. The complexity of revision surgery lies in addressing multiple anatomical and pathological issues: chondral surface damage, labral pathology (refixation or reconstruction), capsular problems, soft tissue and muscular envelope integrity, neural elements (notably lateral femoral cutaneous nerve neurectomy), and scar tissue management.<br /><br />The capsule is emphasized as a significant pain generator, with interventions such as capsulectomy, capsular decompression, and capsular reconstruction (using alloderm matrix) being critical for symptom relief. Surgical techniques include exposing and dynamically assessing the capsule and muscles during surgery, evaluated via the Heuter approach, along with arthroscopic labral debridement, rim resection, and labral reconstruction often using lateral meniscus grafts.<br /><br />Other addressed pain sources and functional impairments include iliopsoas adhesions and incompetence, ectopic bone formation, and issues involving the rectus femoris and abductor muscles. Neural pain components are addressed by selective neurectomy of the lateral femoral cutaneous nerve. Dynamic intraoperative assessment of femoral head and capsular function plays a central role in ensuring optimization.<br /><br />The overall surgical strategy combines open and arthroscopic approaches tailored to previous operative history and current pathology, aiming to restore hip mechanics, relieve pain, and preserve joint function in young, active patients with complex revision needs.

Keywords

revision hip preservation surgery

multiply operated hips

young patients

periacetabular osteotomy (PAO)

hip arthroscopy

labral surgery

capsular reconstruction

lateral femoral cutaneous nerve neurectomy

iliopsoas adhesions

dynamic intraoperative assessment