Skip to main content
SpringerLink
Log in

Complex Hip Reconstruction

  • Chapter
  • First Online:
Operative Hip Arthroscopy

  • 2727 Accesses

Abstract

Arthroscopic management of hip disorders continues to be a rapidly progressing subspecialty within orthopedic sports medicine. Over the past decade, the most common indication for arthroscopic hip surgery has been for diagnostic or debridement procedures. More recently, it has been recognized that hip disorders are a significant cause of disability in active, young adult patients1–6.

Currently, it is common practice at many centers to repair labral tissue, address cartilage injuries, and perform bony osteoplasties. The structural significance of the ligamentum teres and hip capsule to femoroacetabular stability7–10 is also gaining recognition. Early clinical evidence suggests these techniques may result in improved outcomes, as compared to simple debridement procedures11–16.

As knowledge regarding structural deficiencies of the hip increases, innovative reconstructive techniques are beginning to emerge11, 12, 17, 18. These surgical procedures allow difficult hip pathologies to be treated, which may have otherwise gone untreated due to limited surgical alternatives. These techniques include reconstruction of deficient labral tissue, femoroacetabular microfracture, osteochondral transplantation, and capsular or ligamentum teres reconstruction. The early results of these complex reconstructive techniques are encouraging in the properly indicated patient. This chapter provides an overview of the rationale, indications, and surgical technique for these reconstructive procedures of the hip.

Research performed at the Steadman Philippon Research Institute, Vail, CO, USA.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Clohisy JC, Knaus ER, Hunt DM, et al. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467:638–44.

    Article  PubMed  Google Scholar 

  2. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.

    PubMed  Google Scholar 

  3. Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24:540–6.

    Article  PubMed  Google Scholar 

  4. Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007;15:561–70.

    PubMed  Google Scholar 

  5. Philippon MJ, Briggs KK, Yen YM, et al. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91:16–23.

    Article  PubMed  CAS  Google Scholar 

  6. Philippon MJ, Maxwell RB, Johnston TL, et al. Clinical presentation of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007;15:1041–7.

    Article  PubMed  Google Scholar 

  7. Cerezal L, Kassarjian A, Canga A, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics. 2010;30:1637–51.

    Article  PubMed  Google Scholar 

  8. Kashiwagi N, Suzuki S, Seto Y. Arthroscopic treatment for traumatic hip dislocation with avulsion fracture of the ligamentum teres. Arthroscopy. 2001;17:67–9.

    Article  PubMed  CAS  Google Scholar 

  9. Rao J, Zhou YX, Villar RN. Injury to the ligamentum teres. Mechanism, findings, and results of treatment. Clin Sports Med. 2001;20:791–9, vii.

    Article  PubMed  CAS  Google Scholar 

  10. Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg Br. 2009;91:8–15.

    PubMed  CAS  Google Scholar 

  11. Philippon MJ, Briggs KK, Hay CJ, et al. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26:750–6.

    Article  PubMed  Google Scholar 

  12. Philippon MJ, Schroder e Souza BG, Briggs KK. Labrum: resection, repair and reconstruction sports medicine and arthroscopy review. Sports Med Arthrosc. 2010;18:76–82.

    Article  PubMed  Google Scholar 

  13. Sierra RJ, Trousdale RT. Labral reconstruction using the ligamentum teres capitis: report of a new technique. Clin Orthop Relat Res. 2009;467:753–9.

    Article  PubMed  Google Scholar 

  14. Philippon MJ, Schenker ML, Briggs KK, et al. Can microfracture produce repair tissue in acetabular chondral defects? Arthroscopy. 2008;24:46–50.

    Article  PubMed  Google Scholar 

  15. Meyers MH. Resurfacing of the femoral head with fresh osteochondral allografts. Long-term results. Clin Orthop Relat Res. 1985;197:111–4.

    PubMed  Google Scholar 

  16. Evans KN, Providence BC. Case report: fresh-stored osteochondral allograft for treatment of osteochondritis dissecans the femoral head. Clin Orthop Relat Res. 2010;468:613–8.

    Article  PubMed  Google Scholar 

  17. Simpson JM, Field RE, Villar RN. Arthroscopic reconstruction of the ligamentum teres. Arthroscopy. 2011;27:436–41.

    Article  PubMed  Google Scholar 

  18. Crawford K, Philippon MJ, Sekiya JK, et al. Microfracture of the hip in athletes. Clin Sports Med. 2006;25:327–35.

    Article  PubMed  Google Scholar 

  19. Crawford MJ, Dy CJ, Alexander JW, et al. The 2007 Frank Stinchfield Award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.

    PubMed  Google Scholar 

  20. Ferguson SJ, Bryant JT, Ganz R, et al. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–8.

    Article  PubMed  CAS  Google Scholar 

  21. Ferguson SJ, Bryant JT, Ganz R, et al. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–60.

    Article  PubMed  CAS  Google Scholar 

  22. Ferguson SJ, Bryant JT, Ganz R, et al. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon). 2000;15:463–8.

    Article  CAS  Google Scholar 

  23. Espinosa N, Beck M, Rothenfluh DA, et al. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2 Pt.1): 36–53.

    Article  PubMed  Google Scholar 

  24. Byrd JW, Jones KS. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. Arthroscopy. 2009;25:365–8.

    Article  PubMed  Google Scholar 

  25. Trueta J. The normal vascular anatomy of the human femoral head during growth. J Bone Joint Surg Br. 1957;39:358–94.

    PubMed  Google Scholar 

  26. Kapandji IA. The physiology of the ligamentum teres. In: Kapandji IA, editor. The physiology of the joints, vol. 2. 2nd ed. New York: Churchill Livingstone; 1978.

    Google Scholar 

  27. Wenger D, Miyanji F, Mahar A, et al. The mechanical properties of the ligamentum teres: a pilot study to assess its potential for improving stability in children’s hip surgery. J Pediatr Orthop. 2007;27:408–10.

    Article  PubMed  Google Scholar 

  28. Sampatchalit S, Barbosa D, Gentili A, et al. Degenerative changes in the ligamentum teres of the hip: cadaveric study with magnetic resonance arthrography, anatomical inspection, and histologic examination. J Comput Assist Tomogr. 2009;33:927–33.

    Article  PubMed  Google Scholar 

  29. Wenger DR, Mubarak SJ, Henderson PC, et al. Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: surgical technique and early clinical results. J Child Orthop. 2008;2:177–85.

    Article  PubMed  Google Scholar 

  30. Byrd JW, Jones KS. Traumatic rupture of the ligamentum teres as a source of hip pain. Arthroscopy. 2004;20:385–91.

    Article  PubMed  Google Scholar 

  31. Hewitt J, Guilak F, Glisson R, et al. Regional material properties of the human hip joint capsule ligaments. J Orthop Res. 2001;19: 359–64.

    Article  PubMed  CAS  Google Scholar 

  32. Hewitt JD, Glisson RR, Guilak F, et al. The mechanical properties of the human hip capsule ligaments. J Arthroplasty. 2002;17: 82–9.

    Article  PubMed  Google Scholar 

  33. Philippon MJ. The role of arthroscopic thermal capsulorrhaphy in the hip. Clin Sports Med. 2001;20:817–29.

    Article  PubMed  CAS  Google Scholar 

  34. Bellabarba C, Sheinkop MB, Kuo KN. Idiopathic hip instability. An unrecognized cause of coxa saltans in the adult. Clin Orthop Relat Res. 1998;355:261–71.

    Article  PubMed  Google Scholar 

  35. Philippon MJ, Zehms CT, Briggs KK, et al. Hip instability in the athlete. Oper Tech Sports Med. 2007;15:189–94.

    Article  Google Scholar 

Download references

Acknowledgements

No financial support in the form of grants, equipment, or other items was received in relation to the completion of this work.

Vail Valley Medical Center IRB approval (PRO# 2002–03) was received for completion of this manuscript.

Author information

Authors and Affiliations

  1. Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23708, USA

    Trevor R. Gaskill M.D.

  2. Steadman Philippon Research Institute, The Steadman Clinic, Vail, CO, USA

    Trevor R. Gaskill M.D.

  3. Department of Hip Arthroscopy, Steadman Philippon Research Institute and Steadman Clinic, 181 West Meadow Dr. Suite 1000, Vail, CO, 81657, USA

    Marc J. Philippon M.D.

Authors
  1. Trevor R. Gaskill M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc J. Philippon M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marc J. Philippon M.D. .

Editor information

Editors and Affiliations

  1. Orthopaedic Center, Baptist Medical Plaza I, Nashville Sports Medicine and, Church Street 2011, Nashville, 37203, Tennessee, USA

    J.W. Thomas Byrd

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Gaskill, T.R., Philippon, M.J. (2013). Complex Hip Reconstruction. In: Byrd, J. (eds) Operative Hip Arthroscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7925-4_30

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-7925-4_30

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-7924-7

  • Online ISBN: 978-1-4419-7925-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation