ABSTRACT
We conducted a study to assess 30 expert hip arthroscopists' ability to identify common surface landmarks used during hip arthroscopy. Thirty hip arthroscopists independently performed a blinded examination of an awake supine human volunteer for identification of 5 surface landmarks: anterior superior iliac spine (ASIS), tip of greater trochanter (GT), rectus origin (RO), superficial inguinal ring (SIR), and psoas tendon (PT). The examiners applied the labels ASIS, GT, RO, SIR, and PT to the landmarks. An ultrasonographer performed a musculoskeletal ultrasound examination and applied labels as well, and a photographer documented the examiner labels after obtaining overhead and lateral digital images with use of fixed camera mounts. Digital overlay composite images of arthroscopist and ultrasonographer labels were analyzed. Direction and distance of inaccurately placed labels were compared with known values for neurovascular structures previously reported for common arthroscopic portals. Average distance from examiner-applied labels to ultrasonographer-applied labels was 31 mm for ASIS, 24 mm for GT, 26 mm for RO, 19 mm for SIR, and 35 mm for PT. Interobserver variability of examiner-applied labels was recorded as areas of 95% predictive interval: 65 cm2 for ASIS, 16 cm2 for GT, 221 cm2 for RO, 38 cm2 for SIR, and 29 cm2 for PT. Examiner labels demonstrated the highest potential for injury because of anterior portal inaccuracy. Expert hip arthroscopists varied in their ability to accurately and precisely identify common surface landmarks about the hip, using only manual palpation.
Subject(s)
Arthroscopy/standards , Clinical Competence , Hip Joint/surgery , Surgeons , Humans , Ligaments, Articular/surgeryABSTRACT
Osteoarthritis is the most common form of arthritis and can be a major source of disability. Many older patients continue to be active in sports-related activities. Therefore, treating an active patient with osteoarthritis is becoming more common. Physical therapy and weight loss continue to play a central role in the treatment of patients with osteoarthritis. Nonsteroidal anti-inflammatory drugs decrease inflammation and swelling, which makes physical therapy more effective. Intra-articular corticosteroids have been used for the treatment of osteoarthritis. However, no guidelines exist for the administration of corticosteroids and they can be associated with increased risk of tendon rupture and infection. Viscosupplementation has gained popularity in the treatment of osteoarthritis of the knee. Intra-articular injections of hyaluronic acid have been shown to decrease pain and improve functional outcomes.
Subject(s)
Adjuvants, Immunologic/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Hyaluronic Acid/administration & dosage , Osteoarthritis/drug therapy , Adjuvants, Immunologic/pharmacokinetics , Adrenal Cortex Hormones/adverse effects , Adrenal Cortex Hormones/pharmacokinetics , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cyclooxygenase Inhibitors/therapeutic use , Exercise Therapy , Humans , Hyaluronic Acid/pharmacokinetics , Injections, Intra-Articular , Osteoarthritis/therapy , Osteoarthritis, Knee/therapy , Weight LossABSTRACT
Osteoarthritis is the most common form of arthritis, and can be a major source of disability. Many older patients continue to be active in sports-related activities; therefore, the treatment of the active patient with osteoarthritis is becoming more common. Intraarticular corticosteroids have been widely used for the treatment of osteoarthritis. There are no guidelines for the administration of corticosteroids, and they can be associated with increased risk of tendon rupture and infection. Viscosupplementation has gained popularity in the treatment of osteoarthritis of the knee. Intraarticular injections of hyaluronic acid have shown to decrease pain and improve functional outcomes.