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An Arthroscopic Hip Documentation Form
Technical Note
An Arthroscopic Hip Documentation Form Satesh Gokhale, F.R.C.S.(Orth), Munir Khan, M.R.C.S., Jan-Herman Kuiper, Ph.D., James B. Richardson, M.D., F.R.C.S., and Jonathan P. Davies, F.R.C.S.(Orth)
Abstract: Hip arthroscopy is becoming increasingly popular. A simple, precise, and practical means of recording arthroscopic findings will be useful for diagnostic, research, and audit purposes. Basic principles of cartography exist to produce two-dimensional paper representations of our spherical planet. We used the same principles to produce a two-dimensional map of the acetabulum and femoral head. The resulting hip diagram shows the acetabulum as viewed from the side and the femoral head as viewed from above. The ligamentum teres is attached to the medial margin of the head. The head–neck junction and part of the femoral neck is shown at the opposite margin of the ligamentum teres. The hip documentation form is simple, precise, and accurate. We use it to record our findings at hip arthroscopy, which we have used to assist us in our practice. Key Words: Arthroscopy— Cartography—Documentation form—Findings—Hip—Map.
T
he first attempts at hip arthroscopy were described by Burman in 1931.1 Soon afterwards, Takagi reported the use of this procedure.2 Despite lagging behind arthroscopy of other joints in popularity, hip arthroscopy has now become a relatively common procedure with clearly defined diagnostic and therapeutic applications.3-6 At our institution, we regularly carry out autologous chondrocyte grafting techniques for osteochondral lesions in several joints.7,8 As a simple, precise, and practical means of recording our arthroscopic findings in the knee joint for diagnostic, research, and audit purposes, we developed a knee documentation form.9 In extending the use of this technique to the hip, we required a similar docu-
From The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, England. Supported by a grant from The Institute of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, England. Address correspondence and reprint requests to James B. Richardson, M.D., F.R.C.S., Institute of Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, England. E-mail: [email protected] © 2008 by the Arthroscopy Association of North America 0749-8063/08/2407-7404$34.00/0 doi:10.1016/j.arthro.2007.10.009
mentation form to record our arthroscopic findings. Using the principles of stereographic projection and cartographic computer software, we created a twodimensional documentation form of the articular surfaces of the hip which we are now using to complement our practice. INTRODUCTION OF THE TECHNIQUE Anatomy of the Hip Joint The femoral head forms two thirds of a sphere, though only half of the complete sphere can be easily visualized through the arthroscope. The acetabulum is a matching hemisphere with a horseshoe shaped articular surface which gives way inferomedially to the nonarticular fossa ovalis. In most cases, the entire acetabulum can be visualized arthroscopically. The fossa ovalis and fovea of the head provide attachment for the ligamentum teres. The acetabular labrum is attached to the margins of the acetabulum and is completed by the transverse ligament which bridges the periphery of the fossa ovalis. In a study of the human hip, Clarke and Amstutz10 noted that while the head of the femur is not truly spherical, it can be considered circular in the equatorial
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 24, No 7 (July), 2008: pp 839-842
839
840
S. GOKHALE ET AL.
FIGURE 1. An arthroscopic hip documentation form. The documentation form maps the acetabulum from the side view and the femoral head from above. For orientation purposes, it also illustrates the head neck junction, part of the neck, and the ligamentum teres. Extra-articular findings can be recorded in text format.
ARTHROSCOPIC HIP DOCUMENTATION FORM plane. In their study, the average head diameter at the equatorial plane was 48.3 mm (range, 40 to 58 mm).10 The Hip Documentation Form Given that the average diameter of the femoral head is 48.3 mm, and taking the pole of the head as a reference point, we applied a simple geometrical formula (circumference ⫽ ⫻ diameter) to establish that the distance from the pole to any point on the equator of the head was 38 mm. We then applied a basic projection technique of cartography, the equidistant Azimuthal projection, to produce two-dimensional paper representations of the three-dimensional hemisphere.11 We used cartographic computer software (MicroCAM, version 2.02; Geographic Sciences Lab, U.S.A. Military Academy, West Point, NY) to convert the convex surfaces of the head and acetabu-
FIGURE 2. Arthroscopic diagnosis of anterior grade IV osteoarthritis of the hip with associated labral tear. An osteophyte is seen at the head and neck junction.
841
lum into planar circular diagrams, with a cm-scale to help orientation (Fig 1). We then incorporated this “hip documentation form” into a pro forma which we now use in our practice (Fig 2). We made the hip documentation form generic, and have found it to be user-friendly. While recording findings, anterior or posterior on the femoral head and acetabulum should be marked according to the side of the operated hip. DISCUSSION Arthroscopy of the hip has become an increasingly popular procedure in recent years, and now plays an important role in both the diagnosis and treatment of many hip pathologies.5,12 At our institution, we have been performing autologous cartilage grafting for osteochondral defects within the knee for several years,
842
S. GOKHALE ET AL.
with encouraging results.7,8 In extending the application of this technique to lesions within the hip joint, we have found the described hip documentation form to be of great value (Fig 2). Furthermore, the accurate documentation and representation of areas of pathology have been of use in planning of femoral and acetabular osteotomies, and in autologous chondrocyte implantation for the treatment of chondral defects. If a more complete record of a hip arthroscopy is required, we recommend a digital video recording. The paper map is easier to manage, however, and can usefully have annotations added. We plan to continue to use the hip documentation form and pro forma described, and hope that it may prove to be of help to hip surgeons elsewhere. REFERENCES 1. Burman MS. Arthroscopy or the direct visualization of joints: An experimental cadaver study. 1931. Clin Orthop Relat Res 2001;390:5-9. 2. Takagi K. The arthroscope: The second report. J Orthop Sci 1939;14:441-466. 3. Beaule PE, Clohisy JC, Schoenecker P, Kim YJ, Millis M,
4. 5. 6. 7.
8.
9. 10.
11. 12.
Trousdale RT. Hip arthroscopy: An emerging gold standard. Arthroscopy 2007;23:682. Baber YF, Robinson AH, Villar RN. Is diagnostic arthroscopy of the hip worthwhile? A prospective review of 328 adults investigated for hip pain. J Bone Joint Surg Br 1999;81:600-603. Blankenbaker DG, De Smet AA, Keene JS, Fine JP. Classification and localization of acetabular labral tears. Skeletal Radiol 2007;36:391-397. Awan N, Murray P. Role of hip arthroscopy in the diagnosis and treatment of hip joint pathology. Arthroscopy 2006;22: 215-218. Richardson JB, Caterson B, Evans EH, Ashton BA, Roberts S. Repair of human articular cartilage after implantation of autologous chondrocytes. J Bone Joint Surg Br 1999;81:10641068. Roberts S, McCall IW, Darby AJ, et al. Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology. Arthritis Res Ther 2003;5:R60-R73. Talkhani IS, Richardson JB. Knee diagram for the documentation of arthroscopic findings of the knee— cadaveric study. Knee 1999;6:95-101. Clarke IC, Amstutz HC. Human hip joint geometry and hemiarthroplasty selection. In: The hip, proceedings of the third open scientific meeting of Hip Society. St. Louis: CV Mosby Co, 1975;63-89. Robinson AH, Sale DS, Morrison JL, Muehrchke PC. Elements of cartography. Ed 5. New York: John Wiley and Sons, 1984. Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: Surgical technique and review of the literature. Arthroscopy 2005;21:1496-1504.
An Arthroscopic Hip Documentation Form Satesh Gokhale, F.R.C.S.(Orth), Munir Khan, M.R.C.S., Jan-Herman Kuiper, Ph.D., James B. Richardson, M.D., F.R.C.S., and Jonathan P. Davies, F.R.C.S.(Orth)
Abstract: Hip arthroscopy is becoming increasingly popular. A simple, precise, and practical means of recording arthroscopic findings will be useful for diagnostic, research, and audit purposes. Basic principles of cartography exist to produce two-dimensional paper representations of our spherical planet. We used the same principles to produce a two-dimensional map of the acetabulum and femoral head. The resulting hip diagram shows the acetabulum as viewed from the side and the femoral head as viewed from above. The ligamentum teres is attached to the medial margin of the head. The head–neck junction and part of the femoral neck is shown at the opposite margin of the ligamentum teres. The hip documentation form is simple, precise, and accurate. We use it to record our findings at hip arthroscopy, which we have used to assist us in our practice. Key Words: Arthroscopy— Cartography—Documentation form—Findings—Hip—Map.
T
he first attempts at hip arthroscopy were described by Burman in 1931.1 Soon afterwards, Takagi reported the use of this procedure.2 Despite lagging behind arthroscopy of other joints in popularity, hip arthroscopy has now become a relatively common procedure with clearly defined diagnostic and therapeutic applications.3-6 At our institution, we regularly carry out autologous chondrocyte grafting techniques for osteochondral lesions in several joints.7,8 As a simple, precise, and practical means of recording our arthroscopic findings in the knee joint for diagnostic, research, and audit purposes, we developed a knee documentation form.9 In extending the use of this technique to the hip, we required a similar docu-
From The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, England. Supported by a grant from The Institute of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, England. Address correspondence and reprint requests to James B. Richardson, M.D., F.R.C.S., Institute of Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, SY10 7AG, England. E-mail: [email protected] © 2008 by the Arthroscopy Association of North America 0749-8063/08/2407-7404$34.00/0 doi:10.1016/j.arthro.2007.10.009
mentation form to record our arthroscopic findings. Using the principles of stereographic projection and cartographic computer software, we created a twodimensional documentation form of the articular surfaces of the hip which we are now using to complement our practice. INTRODUCTION OF THE TECHNIQUE Anatomy of the Hip Joint The femoral head forms two thirds of a sphere, though only half of the complete sphere can be easily visualized through the arthroscope. The acetabulum is a matching hemisphere with a horseshoe shaped articular surface which gives way inferomedially to the nonarticular fossa ovalis. In most cases, the entire acetabulum can be visualized arthroscopically. The fossa ovalis and fovea of the head provide attachment for the ligamentum teres. The acetabular labrum is attached to the margins of the acetabulum and is completed by the transverse ligament which bridges the periphery of the fossa ovalis. In a study of the human hip, Clarke and Amstutz10 noted that while the head of the femur is not truly spherical, it can be considered circular in the equatorial
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 24, No 7 (July), 2008: pp 839-842
839
840
S. GOKHALE ET AL.
FIGURE 1. An arthroscopic hip documentation form. The documentation form maps the acetabulum from the side view and the femoral head from above. For orientation purposes, it also illustrates the head neck junction, part of the neck, and the ligamentum teres. Extra-articular findings can be recorded in text format.
ARTHROSCOPIC HIP DOCUMENTATION FORM plane. In their study, the average head diameter at the equatorial plane was 48.3 mm (range, 40 to 58 mm).10 The Hip Documentation Form Given that the average diameter of the femoral head is 48.3 mm, and taking the pole of the head as a reference point, we applied a simple geometrical formula (circumference ⫽ ⫻ diameter) to establish that the distance from the pole to any point on the equator of the head was 38 mm. We then applied a basic projection technique of cartography, the equidistant Azimuthal projection, to produce two-dimensional paper representations of the three-dimensional hemisphere.11 We used cartographic computer software (MicroCAM, version 2.02; Geographic Sciences Lab, U.S.A. Military Academy, West Point, NY) to convert the convex surfaces of the head and acetabu-
FIGURE 2. Arthroscopic diagnosis of anterior grade IV osteoarthritis of the hip with associated labral tear. An osteophyte is seen at the head and neck junction.
841
lum into planar circular diagrams, with a cm-scale to help orientation (Fig 1). We then incorporated this “hip documentation form” into a pro forma which we now use in our practice (Fig 2). We made the hip documentation form generic, and have found it to be user-friendly. While recording findings, anterior or posterior on the femoral head and acetabulum should be marked according to the side of the operated hip. DISCUSSION Arthroscopy of the hip has become an increasingly popular procedure in recent years, and now plays an important role in both the diagnosis and treatment of many hip pathologies.5,12 At our institution, we have been performing autologous cartilage grafting for osteochondral defects within the knee for several years,
842
S. GOKHALE ET AL.
with encouraging results.7,8 In extending the application of this technique to lesions within the hip joint, we have found the described hip documentation form to be of great value (Fig 2). Furthermore, the accurate documentation and representation of areas of pathology have been of use in planning of femoral and acetabular osteotomies, and in autologous chondrocyte implantation for the treatment of chondral defects. If a more complete record of a hip arthroscopy is required, we recommend a digital video recording. The paper map is easier to manage, however, and can usefully have annotations added. We plan to continue to use the hip documentation form and pro forma described, and hope that it may prove to be of help to hip surgeons elsewhere. REFERENCES 1. Burman MS. Arthroscopy or the direct visualization of joints: An experimental cadaver study. 1931. Clin Orthop Relat Res 2001;390:5-9. 2. Takagi K. The arthroscope: The second report. J Orthop Sci 1939;14:441-466. 3. Beaule PE, Clohisy JC, Schoenecker P, Kim YJ, Millis M,
4. 5. 6. 7.
8.
9. 10.
11. 12.
Trousdale RT. Hip arthroscopy: An emerging gold standard. Arthroscopy 2007;23:682. Baber YF, Robinson AH, Villar RN. Is diagnostic arthroscopy of the hip worthwhile? A prospective review of 328 adults investigated for hip pain. J Bone Joint Surg Br 1999;81:600-603. Blankenbaker DG, De Smet AA, Keene JS, Fine JP. Classification and localization of acetabular labral tears. Skeletal Radiol 2007;36:391-397. Awan N, Murray P. Role of hip arthroscopy in the diagnosis and treatment of hip joint pathology. Arthroscopy 2006;22: 215-218. Richardson JB, Caterson B, Evans EH, Ashton BA, Roberts S. Repair of human articular cartilage after implantation of autologous chondrocytes. J Bone Joint Surg Br 1999;81:10641068. Roberts S, McCall IW, Darby AJ, et al. Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology. Arthritis Res Ther 2003;5:R60-R73. Talkhani IS, Richardson JB. Knee diagram for the documentation of arthroscopic findings of the knee— cadaveric study. Knee 1999;6:95-101. Clarke IC, Amstutz HC. Human hip joint geometry and hemiarthroplasty selection. In: The hip, proceedings of the third open scientific meeting of Hip Society. St. Louis: CV Mosby Co, 1975;63-89. Robinson AH, Sale DS, Morrison JL, Muehrchke PC. Elements of cartography. Ed 5. New York: John Wiley and Sons, 1984. Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: Surgical technique and review of the literature. Arthroscopy 2005;21:1496-1504.