Over recent years, hip-joint arthroscopy has become extremely important, particularly in Europe and the USA, and currently has a great deal of potential for growth. While the specific anatomical characteristics of this joint meant that it appeared not very suitable for arthroscopy for many years, techniques and products/systems have been developed in recent years which have significantly expanded the range of indications for hip arthroscopy.
Femoral Acetabular Impingement (FAI) is therefore now one of the most frequent indications. This disease involves changes in shape to the joint partners of the hip joint as a result of the process of movement. The unusual shape of one of the bones in the joint causes the head of the femur to impinge on the acetabular labrum. The condition is known as CAM Impingement (femur) or Pincer Impingement (acetabulum) depending on which of the bones is affected by the anomaly. This leads to an injury of the acetabular labrum which protects the edge of the cartilage.
Other indications are floating arthroliths, initial symptoms from arthrosis of the hip joint, unidentified pain in the hip joint or disease of the synovial membrane (synovia).
When carrying out hip arthroscopy, a distinction is generally drawn between the central compartment (joint region with worn joint surface between femur and acetabulum) and the peripheral compartment (area of the joint involving the neck of the femur, distal to the acetabular labrum). Arthroscopy is carried out on the central compartment with distraction of the affected leg in order to overcome the massive retention force of the capsule.
A telescope with a 70° direction of view is used as standard for hip arthroscopy. The portals are created using cannulated puncture needles and dilation systems. The first stage of access involves the position of the portal being established under X-ray guidance. However, there is a residual risk of injury to the surrounding tissues of this joint and it is therefore particularly important to use an alignment device in the initial stages to create additional portals.
Richard Wolf joined forces with Dr. Wolfgang Mielke from the ARCUS Sports Hospital in Pforzheim to create a "COXARTIS" Instrument Set developed specifically for hip arthroscopy. The easy handling and ergonomic design is ideal for experienced surgeons and for users who are new to the application of hip arthroscopes.
COXARTIS Instrument Set
The Arthrolution trocar sleeves were shaped specially for atraumatic use in the joint for application with a PANOVIEW telescope with a 70° direction of view. Telescopes with a 30° and 45° direction of view can also be used. Cannulated trocars ("pipe") facilitate direct introduction of arthroscopes into the joint using the guide wire.
A new continuous-irrigation trocar sleeve was developed to optimize conditions for visualization within the joint. Continuous irrigation and suction in a harmonized process allow the joint to be irrigated quickly and guarantee an excellent view.
A comprehensive range of hand instruments, such as the new PulseShifter microfractor completes the optimized instrument set.
COXARTIS Alignment Device
The passages to the joint are created under X-ray guidance due to the thick layer of soft tissue surrounding the hip joint.
Starting from the primary telescope portal, the new COXARTIS Alignment Device for Hip Arthroscopy is used to create other work portals safely, quickly and with reduced X-ray exposure for the patient and surgical team. Our COXARTIS Alignment Device makes selecting the portal much easier, particularly for less experienced surgeons who are learning the technique of hip-joint arthroscopy for the first time or who do not carry out regular hip-joint arthroscopies.
The instrument set is complemented by the universal Power Drive ART 1 motor system. This allows powerful shaver handles with a maximum operating speed of 16.000 rpm, power cutters and burrs, and drills and saws to be connected.