A recent study was published regarding the risk of sciatic nerve traction injury in the Journal of Bone and
Risk of Sciatic Nerve Traction Injury During Hip Arthroscopy—Is It the Amount or Duration?: An Intraoperative Nerve Monitoring Study sixty-one years]), thirty-five (58%) had intraoperative nerve dysfunction and four (7%) sustained a clinical nerve injury. The average maximum traction weight (and standard deviation) for patients who did and those who did not have nerve dysfunction or injury was 38.1 ± 7.8 kg (range, 22.7 to 56.7 kg) and 32.9 ± 7.9 kg (range, 22.7 to 45.4 kg), respectively. The odds of a nerve event increased 4% with every 0.45-kg (1-lb) increase in the traction amount (age/sex-adjusted; p = 0.043; odds ratio, 1.04; 95% confidence interval, 1.01 to 1.08). The average total traction time for patients who did and those who did not have nerve dysfunction was 95.9 ± 41.9 minutes (range, forty-two to 240 minutes) and 82.3 ± 35.4 minutes (range, thirty-eight to 160 minutes), respectively, and an increase in traction time did not increase the odds of a nerve event (p = 0.201). Age and sex were not significant risk factors.
Using intraoperative nerve monitoring we prospectively studied the prevalence, pattern, and predisposing factors for sciatic nerve traction injury during hip arthroscopy.
Of sixty patients (thirty-one female and twenty-nine male, with a mean age of thirty-seven years [range, sixteen to
sixty-one years]), thirty-five (58%) had intraoperative nerve dysfunction and four (7%) sustained a clinical nerve injury. The average maximum traction weight (and standard deviation) for patients who did and those who did not have nerve dysfunction or injury was 38.1 ± 7.8 kg (range, 22.7 to 56.7 kg) and 32.9 ± 7.9 kg (range, 22.7 to 45.4 kg), respectively. The odds of a nerve event increased 4% with every 0.45-kg (1-lb) increase in the traction amount (age/sex-adjusted; p = 0.043; odds ratio, 1.04; 95% confidence interval, 1.01 to 1.08). The average total traction time for patients who did and those who did not have nerve dysfunction was 95.9 ± 41.9 minutes (range, forty-two to 240 minutes) and 82.3 ± 35.4 minutes (range, thirty-eight to 160 minutes), respectively, and an increase in traction time did not increase the odds of a nerve event (p = 0.201). Age and sex were not significant risk factors.
Read the study here: jbjs.org/article.aspx?articleid=1375179
To find more information about Hip Arthroscopy, see our website at www.HipArthroscopyDoctor.com
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patient/physician relationship for medical care. If you need medical care or medical attention, please schedule an appointment with your physician in person, or go to an Emergency Room.
Atlanta has many excellent physical therapists. Unfortunately, not many are intimately familiar with rehabilitating patients after arthroscopic hip surgery. The same may be true in your area. Sometimes conventional ‘on land’ rehab can be troublesome or painful for patients. We will therefore send patients to rehab to include some aquatic based exercises. The buoyancy of water can be effective in taking pressure off the joints in the lower
extremities and help with restoring neuromuscular control and balance.
We do not recommend submersion of the hip underwater until at least two weeks after surgery. The portal/punctures need to be clearly closed. The depth of the water plays a significant role in terms of how much resistance / force is placed across the hip. Knee deep water is more challenging in many ways than chest deep water. Consult with your therapist or doctor if you are interested in the benefits of aquatic rehab. It’s not for everyone, but can be done safely and effectively.
If you are not a swimmer, you can wear a life vest and do it under supervision in shallow water, and hold on the edge of the pool. If you are like me, you don’t like cold water then summer time can be a great time to be in the pool and work on your hip!
Aquatics can utilize underwater treadmills, aqua joggers, and leg floatation
buoys, among many other fun things!
Pain after surgery is
not uncommon. In many patients, the pain level is very low in the initial period after surgery because:
1. Pain medication masks the pain
2. Reduced activity lessens the pain
3. Inflammation in the joint (synovitis) was cleaned out
Once the patient gets going with more intense activity or rehabilitation therapy, the pain often increases, albeit temporarily. This is common and may not necessarily be a problem.
Check with your physician to understand the expectations for your particular condition. Often patient’s will experience an occasional twinge, click, pop, ‘twang’, snap or thud at some point(s) in their recovery, and it doesn’t necessarily mean something has gone wrong. Such symptoms are often short lived and not associated with prolonged or sustained pain. Anchors popping loose or the hip popping out of socket are things some patients worry about, but we have not seen that. It can be a concern however, and it’s important to communicate with your surgeon if you or your therapists have any concerns about your healing process.
Discoloration of part of the operated leg after hip arthroscopy is not a very uncommon finding. Discoloration is a non-specific finding meaning that there are several reasons why it could occur. Before you read further, if you have discoloration of your leg, make sure you let your doctor know immediately. One of the causes could be a blood clot and that can be an emergency. They could also signify infection. You need to discuss it with your physician.
That said, color changes in the legs after hip arthroscopy
can depend upon several factors: your skin complexion, your activity level, how much you are up and down with crutches, your blood pressure, the room temperature around you, other medical conditions like peripheral vascular disease, varicose veins, diabetes, heart conditions, etc, etc. Many times, a subtle color change (hue of purple or pink or red) are simply due to the increased blood-flow in the operated leg, or the increased fluid after the arthroscopic procedure has pumped water into your thigh. Wearing compression stockings and getting on a bike (if ok with your doctor) can help circulate bloodflow). The discoloration will often be more prominent soon after you stand up or if you have been up on your feet for a while, especially in the shower. This can relate the effects of gravity and often gets better over time. Once your gait and walking get more normalized, these color changes resolve and you get back to ‘the old you.’
In general, color changes are not alarming and resolve on their own. Because there are some rare conditions that could result in
a problem, you should always check your condition with your physician and monitor it with their guidance.
Apparently the Current Procedures and Terminology (CPT) guidelines are going to be updated at some point to include
CPT codes for hip arthroscopy, and replace the previously unlisted codes (29999):
The proposed new codes
CPT 29914 Hip arthroscopy, osteoplasty femur (CAM impingement)
CPT 29915 Hip arthroscopy, osteoplasty acetabulum (PINCER impingement)
CPT 29916 Hip arthroscopy, labral repair
This could have a significant impact on insurance coverage for patients who are in need of hip arthroscopy surgery.
By Craig Custance
The Atlanta Journal-Constitution
Macon — It may be enough to satisfy state lawmakers, but some medical experts hope the Georgia High School Association’s new heat policy is only the first step.
The GHSA executive committee on Monday unanimously approved a statewide policy regulating athletic practices in hot weather. While the rule requires all schools to have a written policy for conducting practices during times of extreme heat and humidity, the schools will set their own policies. It also requires schools to have a scientifically approved instrument that measures heat and humidity at all practices.
The association will request that the state board of education adopt the proposal as a state rule.
The policy comes nearly one month after the death of Rockdale County football player Tyler Davis, who died of heatstroke Aug. 1. He collapsed the day before during a voluntary football practice.
Association executive director Ralph Swearngin said Davis’ death pushed forward the dialogue to establish statewide rules.
“We wanted to come up with a position that was strengthening our position, but still keeping our position, which is to educate how to make those calls [on when to practice],” Swearngin said. “But we want to make sure they have a structure so there is a consistent process for making those decisions, even if circumstances are different.”
Georgia legislators, who had questioned the GHSA about its lack of rules regarding practicing in heat, called the policy a good first step.
“Certainly having that policy is a good one; implementing it is where the rubber meets the road,” said Rep. Chuck Martin (R-Alpharetta), who spoke Monday morning at the executive committee on behalf of the GHSA legislative overview committee.
Sen. John Wiles (R-Marietta), who joined Martin in Macon for the meeting, said he’s pleased the GHSA is taking action. He also said he plans to check with medical experts to see if the policy is strong enough.
Some experts said they would like to see statewide standards, and they wonder how the policies will be enforced.
Dr. Stephanie Martin, co-surgical director of the Children’s Healthcare of Atlanta Sports Medicine Program, said she hopes the policy
will be monitored and improved. Martin said she has dealt with a number of heat-related cases this summer and that Georgia has been fortunate to have had only one death.
“I’m proud of Georgia for establishing this, but they need to go the next step.” Martin said. “Set guidelines. Maybe you have it graduated, which would take into consideration the southern counties. Maybe their cancellation [standard] is set a little bit higher.”
A recent Atlanta Journal-Constitution survey of metro Atlanta schools showed that 91 of 123 schools were using some sort of device at practice to measure heat and humidity.
Cobb County became the first metro Atlanta school system to implement a heat policy, using measurements from a digital psychrometer to determine when it was safe to practice. The policy, which started in 2000, came after the death of Wheeler High School football player Marcus Ellison, who collapsed during a preseason workout in 1999. Schools in Gwinnett, Atlanta Public Schools and Clayton have been given psychrometers, which measure heat and humidity, and training on how to use the device.
When Davis died, Rockdale County did not have a heat policy in place or a heat-measuring device at practice. The county later put in a policy prohibiting teams from practicing when temperatures reached 95 degrees.
Dr. Jon Hyman of the Atlanta Sports Medicine and Orthopedic Center said other factors need to be considered besides temperature and humidity. He said coaches need to measure the athlete’s body mass in order to plan a safe practice for each athlete.
He also wonders how the GHSA’s new policy will be enforced.
“Leaving it to each school to make their own policy is fine, as long as there is enforcement and adequate resources to initiate that policy,” he said. “A policy is just words.”
By Michael Buteau
June 18, 2008 15:49 EDT
Tiger Woods will have reconstructive surgery on his left knee and miss the rest of the golf season, ending a campaign that peaked with a playoff victory in the U.S. Open two days ago.
The date of the surgery to repair a ruptured anterior cruciate ligament and the length of his rehabilitation weren’t known, according to a statement on his Web site. Woods tore the ligament while running in the weeks after the 2007 British Open, the statement said, and doctors assured him there “will be no long-term” effects.
Woods also sustained a “double stress fracture” in the tibia, the bigger bone, of his lower left leg while rehabilitating from knee surgery performed on April 15. Together, the injuries will deprive golf of its biggest star just as it reaches the height of the season.
“Now, it is clear that the right thing to do is to listen to my doctors, follow through with this surgery, and focus my attention on rehabilitating my knee,” Woods said.
Woods, the world’s No. 1-ranked golfer, won the U.S. Open in a 19-hole playoff over Rocco Mediate. During the five-plus rounds, Woods often grimaced and doubled over in pain from his left leg.
“It’s really awful,” Mediate said in a telephone interview with the Golf Channel. “Everyone saw his knee was not right, but nobody really knew the extent of it.”
The latest knee surgery, the fourth of Woods’s career, will force him to miss golf’s two remaining major tournaments — the British Open next month and the PGA Championship in August, where he is the reigning champion. He’ll also miss the Ryder Cup matches in September against Europe.
Dr. Jon Hyman, an orthopedic surgeon and sports medicine expert in Atlanta, said Woods may need up to six months to fully recover.
“He’ll need to rehabilitate his muscles around the knee,” Hyman, who isn’t involved in Woods’s care, said in a telephone interview. “The reconstructive surgery itself is fairly straightforward. It can be done oftentimes in under an hour, but the recovery involves muscular reconditioning and muscular training. That can take many months.”
Woods has won 14 major titles, four short of Jack Nicklaus’s record. He has won at least one major title each of the last four years, and television ratings jump when he is in contention. General Electric Co.’s NBC network said big-city ratings were up 90 percent for the playoff against Mediate, compared with the last previous Open playoff in 2001, which pitted Retief Goosen against Mark Brooks.
“His injury or his inability to play for the rest of the year is going to affect the ratings for sure,” said Neal Pilson, a former head of CBS Sports and now a New York-based broadcasting consultant. “But in terms of the structure of the sport, I don’t think it will have a long-term material impact because he’s eventually going to stop playing.”
PGA Tour players said they simply want Woods to get completely healthy.
“If it takes two years to get healthy, I hope he takes two years off,” Joe Ogilvie said in a telephone interview while preparing for this week’s Travelers Championship in Connecticut. “If he keeps pushing it, his long-term future is in jeopardy. I think it’s positive that he’s taking his time and getting this taken care of.”
Shortly after the Open tournament ended at Torrey Pines Golf Course near San Diego, Woods said he had ignored the advice of doctors when he decided to compete. He refused to cite his injury as an excuse for bad shots and would only say “maybe” when asked if he had further injured himself by competing.
The stress fractures were discovered shortly before the Memorial Tournament, two weeks before the U.S. Open, Woods said. The injury had “a huge impact on the timing for my return,” he said.
“I was determined, though, to do everything and anything in my power to play in the U.S. Open at Torrey Pines, which is a course that is close to where I grew up and holds many special memories for me,” Woods said in the statement today. “Although I will miss the rest of the 2008 season, I’m thrilled with the fact that last week was such a special tournament.”
Woods’s coach, Hank Haney, said the golfer was suffering through a “tremendous” amount of pain during the week.
`FOCUS ON GOLF’
“I know much was made of my knee throughout the last week, and it was important to me that I disclose my condition publicly at an appropriate time,” Woods said. “I wanted to be very respectful of the USGA (U.S. Golf Association) and their incredibly hard work, and make sure the focus was on the U.S. Open.”
A day after the tournament ended, Goosen, a two-time U.S. Open champion, doubted the seriousness of Woods’s injury.
“Nobody knows if he was just showing off or if he was injured, and I believe if he was really injured he would not have played,” Goosen said in an interview with German TV before the start of the BMW International Open in Munich.
Asked if he thought Woods was faking his injury, Goosen said: “I think so. I think so. You see when he made the putts and he went down on his knees shouting, `Yeah,’ his knee wasn’t sore.”
Goosen later said he was “being light-hearted.”
With Woods out, Ladbrokes Plc, the world’s largest publicly traded gambling company, said it would refund all wagers placed on Woods to win the British Open or PGA Championship.