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Surgery of the Hip
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Daud TS Chou, Jonathan Miles, John Skinner
Any soft tissues overhanging the acetabulum around its circumference, including the labrum, are excised. It is vital to obtain a clear view around the whole acetabulum. The transverse acetabular ligament is identified, lying across the inferior boundary of the acetabulum. Any remaining ligamentum is also excised. Preservation of the transverse acetabular ligament (TAL) is advocated by most surgeons.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The hip is a very stable joint, with stability provided by the ball and socket configuration of the femur and pelvic bones and several thick and strong ligaments (Figure 13). There are three ligaments external to the hip joint: the iliofemoral, ischiofemoral, and pubofemoral ligaments. They are named according to the parts of the hip bone that they are attached to, plus their attachment to the femur. There are two more ligaments at the hip inside the ball and socket of the joint: the ligamentum teres (ligament of the head of the femur) and the transverse acetabular ligament. The ligamentum teres directly attaches the head of the femur to the acetabulum of the hip bone. There is a small pit in the smooth head of the femur, the fovea, where the ligament attaches. Similarly, the other end of the ligament attaches to the centre of the acetabular fossa, where it is surrounded by the smooth lunate surface of the acetabulum. This internal hip joint ligament prevents the head of the femur from rotating too far in any direction within the acetabulum. The transverse acetabular ligament helps to make the socket of the hip joint deeper, along with the acetabular labrum, a rim of fibrocartilage around the edge of the acetabulum. The ligament crosses the acetabular notch, part of the rim not extended by the labrum, making a complete ring of soft tissue. As a result of this extension of the acetabulum, more than half of the femoral head fits within the socket of the hip joint.
Arthroscopic hip preservation surgery
Published in K. Mohan Iyer, Hip Preservation Techniques, 2019
Microscopically, the collagen fibers in the anterior aspect of the labrum are arranged parallel to the labral-chondral junction, but in the posterior aspect, they are aligned perpendicular to the junction. The orientation of the collagen fibers parallel to the labral-chondral junction in the anterior labrum may render it more prone to damage compared to the posterior labrum, where the collagen fibers are directly anchored in the acetabular cartilage. Sensory fibers, mechanoreceptors, and free nerve fibers densely populate the acetabular labrum, capsule, and transverse acetabular ligament, suggesting their potential roles as source of hip pain. It has been found that the anterior zone of the labrum contains the highest relative concentration of sensory fibers.5–7 The acetabular labrum receives its blood supply from radial branches of a periacetabular periosteal vascular ring that traverses the osseolabral junction on its capsular side and continues toward the labrum's free edge.8,9
Arthroscopic versus open, medial approach, surgical reduction for developmental dysplasia of the hip in patients under 18 months of age
Published in Acta Orthopaedica, 2019
Serda Duman, Yalkin Camurcu, Hakan Sofu, Hanifi Ucpunar, Deniz Akbulut, Timur Yildirim
Arthroscopic reduction was performed under general anesthesia with the patient placed in the supine position (Figure 3). An assistant ensured that the hip was maintained in a position of 90° flexion and 40–60° of abduction, and no traction was needed. A medial sub-adductor portal located 1 cm lateral and 1 cm ventral to the ischial tuberosity in the palpable gap between the adductors and the ischiocrural muscles was used to place the 2.7 mm 70° arthroscope intra-articularly under fluoroscopic control (Eberhardt et al. 2015). Arthroscopic evaluation of the hip joint was performed. An anterolateral portal was placed 2 cm distal to the superior iliac spine and 1 cm lateral from a line drawn through the superior iliac spine and the middle of the patella. Radiofrequency ablation and a shaver were used to remove the ligamentum teres and the pulvinar tissue. Arthroscopic scissors were used to incise the transverse acetabular ligament. After intraoperative examination, capsular release with radiofrequency ablation was performed in 5 patients in whom the safe zone was inadequate. Iliopsoas tenotomy was not performed owing to the risks reported by a previous study (Eberhardt et al. 2015). Reduction of the hip joint was then performed, and post-reduction stability was confirmed. Portal incisions were sutured, and a pelvipedal cast was applied in the human position of 100° flexion, < 50° of abduction, and < 10° of internal rotation.