Revival of Shelf Acetabuloplasty by Shiro Hirose

Author:Shiro Hirose
Language: eng
Format: epub, pdf
Publisher: Springer Singapore, Singapore

Osteoarthritis (Tönnis grades II and III)

Coxa valga (femoral neck shaft angle >140°)

5.5 Surgical Technique

Patients were placed in a modified supine position on a traction table under general and epidural anesthesia. Anterolateral, mid-anterior, and proximal mid-anterior portals (ALP, MAP, and PMAP) were utilized. At this point, the modified MAP [10] is slightly lateral to the classic MAP to avoid lateral femoral cutaneous nerve palsy.

Interportal capsulotomy was performed using an arthroscopic knife (Becton Dickinson, Brentwood, TN) and radiofrequency probe between ALP and MAP (ArthroCare, Smith & Nephew, Andover, MA). Intra-articular pathologies including acetabular chondrolabral damage and femoral head chondral damage were assessed. If cartilage damage classified as ICRS grade III or IV was significant and defect size <3 cm2, microfracture was performed.

Second, unstable labral tears were addressed with suture anchors after the acetabular rim was freshened with the use of a motorized round burr until a bleeding bed was visible to facilitate labral healing but avoiding formal rim resection. If a prominent anterior inferior iliac spine (AIIS) type II or III was present, subspine decompression was performed using a motorized round burr if applicable. Labral repair was performed using bioabsorbable suture anchors (OsteoRaptor, Smith & Nephew, Andover, MA or Gryphon BR, Depuy Mitek Sports, Raynham, MA) in the manner of pierced suture repair with knots tied on the capsular side of the labrum [11] (Fig. 5.2b). Traction was released to confirm successful restoration of a labral fluid seal.

Fig. 5.2Endoscopic shelf acetabuloplasty. (a) Supine arthroscopic view from the anterolateral portal (ALP) showing an anterior-superior labral tear. (b) Midsubstance labral repair was visualized from the ALP. (c) Peripheral compartment view from the MAP without traction, showing cam deformity at femoral head-neck junction and (d) femoral osteoplasty. (e, f) Arthroscopic view from the ALP showing shoelace capsular plication using Ultratape passed via the mid-anterior portal (MAP) and the proximal mid-anterior portal (PMAP). (g, h) Two 2.4 mm guide wires were introduced through the MAP under fluoroscopy. (i) Osteotome was utilized to make the shelf slot along with 2.4 mm guide wires. (j) Free bone graft harvested from ipsilateral iliac crest, with two parallel 1.5 mm Kirschner wires. (k) The free bone autograft was inserted into the slot through the guide wires with press-fit fixation. (l) Another graft was placed above shelf graft and fixed with Superfixorb cannulated screw and washer

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