debmorrison
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Can anyone take a stab at this one?? I am looking toward 29862 for the scope with debridement and maybe 27071 for bone excision....???
PREOPERATIVE DIAGNOSIS: Right hip capsulitis with possible labral tearing and camera pincer impingement
POSTOPERATIVE DIAGNOSIS: Camera pincer impingement right hip with articular surface delamination, degenerative labral tearing and early osteoarthritis
OPERATION: Right hip arthroscopy with debridement of labrum and articular cartilage with conversion to open lateral incision with an acetabuloplasty, labral repair and femoral neck osteoplasty
SURGEON: ANESTHESIA: General
INDICATIONS: Patient has continued to have pain and got about two days of relief with a Cortisone shot. He has been unable to gain his motion back. He has some referred lateral pain as well. Both his MRI and x-rays were not significant for arthritis. He did have some cam pincer changes.
PROCEDURE: The patient was taken to the operating room. We had discussed arthroscopic versus possible opening if his capsule was tight and he was having difficulty being able to get into the bony procedure. He was then placed in the lateral position after a time out was performed. He had a sterile prep and drape in the usual fashion. Smith and Nephew lateral positioner was performed and the foot well padded. I checked the range of motion of the hip which was limited with extension and internal rotation.
He had an anterolateral portal made after localization with the needle and an ??????? wire was then placed with dilating up for placement of the anterolateral cannula. An anterior portal was then made but I had to actually pull back and do a capsulotomy because of how tight he was and I was having difficulty getting in from his anterior capsule being somewhat adherent.
After a period I could put a needle in but I was having trouble dilating up and thus a shaver was then brought in and used to clean up the labrum and the articular cartilage as particularly anteriorly but even posteriorly he had some delamination at the edge of the articular margin and the labrum. I cleaned up a little bit of the fovea and the ligament of teres was not torn. Inferiorly he was unremarkable. I thus converted him to an open procedure.
He had a lateral incision made which was extended down and retractors placed. A T-shaped capsular incision was made. I peeled off the labrum to be able to do an acetabuloplasty and take off some of the pincer mechanism. Traction was taken off to allow for the femoral neck after I had repaired the labrum of which a portion of it was not reparable. I could repair it up to about the 11 to 11:30 position from anteriorly but he had a little bit from the 10 to the 11:30 position where his labrum was torn enough. He did have some speckling of the articular cartilage more towards the lateral aspect. He was noted to have some capsulitis and some synovium sitting particularly over the area of the femoral neck that I had to remove in order to allow for excision of the bone. The labrum had been repaired with an Arthrex Bio stay tack anchor that was passed around the labrum and tied as a simple stitch with the knot up on the acetabulum. A C-arm intensifier was used for the arthroscopic part of the procedure.
The capsule was then repaired with #0 Vicryl followed by #2-0 Vicryl for the subcutaneous tissue and running subcuticular stitch. #3-0 Prolene was used to close the skin. The arthroscopic portals were also closed. A sterile dressing was then applied after infiltration of Marcaine. He tolerated the procedure well and will get started on a protocol with crutches and some simple range of motion exercises and actually get him to riding a bike with the well leg for peddling or possibly a hip CPM machine. I will talk to our trainers to discuss options.
Thanks sooo much!!!
debbie
PREOPERATIVE DIAGNOSIS: Right hip capsulitis with possible labral tearing and camera pincer impingement
POSTOPERATIVE DIAGNOSIS: Camera pincer impingement right hip with articular surface delamination, degenerative labral tearing and early osteoarthritis
OPERATION: Right hip arthroscopy with debridement of labrum and articular cartilage with conversion to open lateral incision with an acetabuloplasty, labral repair and femoral neck osteoplasty
SURGEON: ANESTHESIA: General
INDICATIONS: Patient has continued to have pain and got about two days of relief with a Cortisone shot. He has been unable to gain his motion back. He has some referred lateral pain as well. Both his MRI and x-rays were not significant for arthritis. He did have some cam pincer changes.
PROCEDURE: The patient was taken to the operating room. We had discussed arthroscopic versus possible opening if his capsule was tight and he was having difficulty being able to get into the bony procedure. He was then placed in the lateral position after a time out was performed. He had a sterile prep and drape in the usual fashion. Smith and Nephew lateral positioner was performed and the foot well padded. I checked the range of motion of the hip which was limited with extension and internal rotation.
He had an anterolateral portal made after localization with the needle and an ??????? wire was then placed with dilating up for placement of the anterolateral cannula. An anterior portal was then made but I had to actually pull back and do a capsulotomy because of how tight he was and I was having difficulty getting in from his anterior capsule being somewhat adherent.
After a period I could put a needle in but I was having trouble dilating up and thus a shaver was then brought in and used to clean up the labrum and the articular cartilage as particularly anteriorly but even posteriorly he had some delamination at the edge of the articular margin and the labrum. I cleaned up a little bit of the fovea and the ligament of teres was not torn. Inferiorly he was unremarkable. I thus converted him to an open procedure.
He had a lateral incision made which was extended down and retractors placed. A T-shaped capsular incision was made. I peeled off the labrum to be able to do an acetabuloplasty and take off some of the pincer mechanism. Traction was taken off to allow for the femoral neck after I had repaired the labrum of which a portion of it was not reparable. I could repair it up to about the 11 to 11:30 position from anteriorly but he had a little bit from the 10 to the 11:30 position where his labrum was torn enough. He did have some speckling of the articular cartilage more towards the lateral aspect. He was noted to have some capsulitis and some synovium sitting particularly over the area of the femoral neck that I had to remove in order to allow for excision of the bone. The labrum had been repaired with an Arthrex Bio stay tack anchor that was passed around the labrum and tied as a simple stitch with the knot up on the acetabulum. A C-arm intensifier was used for the arthroscopic part of the procedure.
The capsule was then repaired with #0 Vicryl followed by #2-0 Vicryl for the subcutaneous tissue and running subcuticular stitch. #3-0 Prolene was used to close the skin. The arthroscopic portals were also closed. A sterile dressing was then applied after infiltration of Marcaine. He tolerated the procedure well and will get started on a protocol with crutches and some simple range of motion exercises and actually get him to riding a bike with the well leg for peddling or possibly a hip CPM machine. I will talk to our trainers to discuss options.
Thanks sooo much!!!
debbie
