Hip Impingement: Removal of Bony Lesion From the Hip Socket

Hip Impingement: Removal of Bony Lesion From the Hip Socket

This surgical demonstration shows the removal of a bony pincer lesion on the rim of the hip socket that can cause hip impingement. The extra bony growth on the socket side can pinch the ball of the hip with specific movements, causing pain and damage to the labrum and surface cartilage inside the joint. Shaving down this extra bone can help improve the symptoms caused by this pinching. Here, we are looking at a right hip inside the joint. The patient is lying on their back with their feet this way and their head this way.

Here is the femoral head, also called the ball, and the acetabulum, commonly known as the socket. A layer of smooth surface cartilage covers both the ball and the socket, and this ring of spongy cartilage that goes around the rim of the socket is the labrum. In order to shave down the extra bone on the socket, the surgeon must first get under a layer of capsule, which is this tissue here. The capsule is thick tissue that surrounds the joint. This is done by using a radiofrequency device, which helps peel the capsule tissue off the bone.

Once the capsule tissue is lifted away from the labrum, a burr instrument is brought into the joint. This is what the surgeon uses to shave down the bone. You can see the end of the burr has a ball tip with angled edges. When the surgeon spins the ball one way, against the grain so to speak, it removes the bone faster. When it is spun the other, way with the grain, the bone can be smoothed out more gently.

Only half of the burr is exposed. The other half is shielded by the metal shaft of the instrument. This is used to help protect the surrounding soft tissue from being wound up in the burr. The surgeon will change the angle of the camera to make sure nothing is missed. Since this procedure is typically done together with a hip labral repair, removing this extra bone also creates a smooth surface for the suture anchors that will be used to fix the labrum.

Once the surgeon has removed enough bone, they would continue on to the labral repair.