Hüfte

Einwegklingen für die Kapsulotomie

Es ist eine breite Palette an Einweg-Messerklingen für arthroskopische Eingriffe an der Hüfte erhältlich. Die CapsuleCut-Klinge, das Bananenmesser, das Hakenmesser und das einziehbare kanülierte Kapsulotomiemesser sind ideal während der Kapsulotomie, um Zugang zu den zentralen und peripheren Kompartimenten zu erhalten.

This animation outlines the steps for safely entering the hip joint using the FlushFit cannula system and SafeCut™ capsulotomy blade.

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A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

Accessing the Hip Joint Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

The soft plastic material of the flush fit, a traumatic cannula system, and the blunt tip of the SafeCut. Capsulotomy blades are designed to reduce the risk of iatrogenic damage during access into the hip joint during hip arthroscopy procedures. Once the hip is distracted, insert a spinal needle and nitinol wire through an anterolateral portal to begin access into the joint. Use an obturator to dilate the capsule before inserting the plastic cannula. Insert the plastic obturator through the cannula by engaging the button, and place it over top of the nitinol wire with a slow, twisting motion. Depress the button behind the laser line and remove the obturator from the joint. Insert the NanoScope and bridge through the cannula to begin viewing the joint. Establish the mid anterior portal using the same steps used for the anterolateral portal to begin preparation for making a capsulotomy. Place the SafeCut blade through the cannula to begin the capsulotomy. The blunt end protects the cartilage from being inadvertently struck. Once the capsulotomy is achieved, replace the cannula through the incision to switch portals. Push behind the laser line to disengage the bridge from the scope and switch it to the mid anterior portal. Insert the blade through the anterolateral portal to complete the rest of the capsulotomy. The blunt tipped SafeCut blades come in straight and curved options with and without a handle, offering unparalleled versatility for safe joint entry.

Zachary Pharr, MD (Nashville, TN), demonstrates safe hip access techniques using the FlushFit Cannula System and SafeCut™ capsulotomy blade.

Animations demonstrating the features and benefits of a specific product.

Animationen, die die Funktionen und Vorteile eines bestimmten Produkts demonstrieren.

Produktdemonstrationen

Animações demonstrando os recursos e benefícios de um produto específico.

Vídeos de demonstração de produtos

Animaciones que demuestran las características y beneficios de un producto específico.

Videos de demostración de productos

Product Demonstrations

Safe Hip Access Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

This is doctor Zach Farr with Tennessee Orthopedic Alliance out of Nashville, Tennessee, presenting the SafeCut Capsulotomy blade, one of the latest advances in safe access regarding hip arthroscopy. As we know, the number of hip arthroscopy procedures being performed has grown immensely in recent decades, providing excellent treatment for our patients who historically did not have great options. However, hip arthroscopy is often described as one of the more difficult procedures in orthopedics. It has a steep learning curve and minor complications have been seen which are primarily related to increased traction time and iatrogenic chondrolabral damage. It is agreed that these iatrogenic injuries can be minimized with surgeon experience, but additionally with continued improvements in instrumentation. The flush fit cannula system, along with the SafeCut capsulotomy blade, are two monumental advances when it comes to safe access. The SafeCut Capsulotomy blade is a four millimeter, one piece construction that combines a blunt tip for cartilage protection, along with a blade that is uniquely designed for cutting through hip capsule tissue. Its working length is hip specific at 220mm, and it comes it comes in both straight and curved options, depending on surgeon preference. In addition, it can be used with or without an ergonomic handle for ease of use. My preference is the non handled version, which can simultaneously be used as a switching stick, eliminating multiple extra steps in traditional capsulotomy creation. Here we are performing hip arthroscopy on a right hip. We've got our anterolateral portal and our mid anterior portal created. Currently we are viewing through the mid anterior portal and looking back at our anterolateral portal. We're now going to start performing our inner portal Capsulotomy. Here we're going to show the new SafeCut Capsulotomy blade. And now we can remove our cannula safely with the blunt tip in the joint that protects the cartilage. And now we are ready to perform our inner portal capsulotomy. We can make this as minimal or as extensive as we'd like. We're going to extend this touch posterolateral. And now back towards our mid anterior portal To start our inner portal Capsulotomy. You'll notice that the blunt tip is protective throughout the Capsulotomy cut here. If you'll take my FlexEFit cannula back and we'll switch now back to the mid anterior portal to complete our inner portal Capsulotomy. Go ahead and take out our SafeCut Capsulotomy blade. We're going to now switch viewing portals to our Anterolateral portal, and we're utilizing the new Pano NanoScope for this. Right now we have it on NanoScope. We can also switch it to a traditional 70 if we'd like, or traditional 30. For this case, we're using the NanoScope version, and so now we're ready to easily finish off our inner portal capsulotomy with minimal steps, which again is decreasing our traction time and helping out with our efficiency. Our blunt tip here is just shown on the femoral head protecting that femoral head. In any kind of oscillation that's required as an extra failsafe there. And we're now finishing off our inner portal, Capsulotomy. If we'd like to take it further. This way we can. And that makes a nice, clean and quick inner portal. Capsulotomy. Now we're starting to get better visualization. We can start moving forward with our hip arthroscopic labrum repair. We have now finished our inner portal Capsulotomy. We've been able to do this both safely and quickly, and we have nice clean edges that we can approximate with our capsule closure at the end of the case. To preserve the native capsule. Here you can see our final arthroscopic labrum repair. We have a three repair construct along with healthy cartilage and good clean leaflets with good edges to be approximated to repair our capsule for hip preservation.

Knee

application/pdf

A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

Kataloge

Visão geral e abrangente do portfólio de produtos de cada segmento.

Catálogos

Descripción general y completa sobre la cartera de productos de cada segmento. 

Catalogs

Hip Next Generation in Soft-Tissue Repair and Reconstruction

A document containing information about Arthrex products and product lines.

Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

Broschüren

Documento contendo informações sobre produtos e linhas de produtos da Arthrex.

Brochuras

Documento que contiene información sobre los productos y líneas de productos de Arthrex.

Folletos

Brochures

Knotless Hip Capsular Closure Using the LoopLoc™ Knotless Implant and CapsuleStitch™ Suture Passer

Asheesh Bedi, MD, (Ann Arbor, MI) describes a technique for retracting the capsule during arthroscopic cam resections using the new angled open half-pipe cannula.

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Videos - OP-Anleitung

Vídeos — Técnicas cirúrgicas

Videos de técnicas quirúrgicas

Surgical Technique Videos

Capsular Management and Retraction for Cam Resection

So as you can see at this point in the case now, we've shifted our attention to the peripheral compartment just to orient you inside the joint. You can see I've switched the camera to the mid anterior portal. If you rotate your eyes there, you'll appreciate there's our prior labor repair sutures. We're in a cadaver so it doesn't maintain the perfect suction seal and doesn't. And the traction doesn't quite completely return to normal. But if you look now distally here, this is the orientation that you're looking at as you look laterally and posteriorly. Those are the inserting fibers of the gluteus minimus onto the capsule. As I rotate my eyes there anteriorly, you can see those are the inserting fibers of the capsule iris or branches of the iliopsoas muscle. And here you can see this nice intermuscular plane that I always look for, which is kind of the plane that's going to be covering our cam deformity. And if everything makes sense, you can see you can tip your hand up, you can see the labrum and your labor repair sutures there. That's going to be in the area of the greatest cam de-lamination. So it really helps to localize where we want to make our T capsulotomy, if at all, to visualize the Cam lesion. This is our single piece, as you can see CapsuleCut blade. You can bring this in. In my mind, this tends to come in best, as you can see here from your proximal anterolateral portal. And I can use it first to retract and see where is our cam delamination located, where is it beneath. And then once we've decided on the trajectory and the best angle to make our capsular flaps, we can commit right to that location and start to tee our capsule there, right in line with fiber. So as you can see there, we just lay it down. We cut right down along the head neck junction there like that. And I think as you're appreciating this makes two nice equal flaps there, one superior and one anterior flap there that's going to directly overlay our cam lesion. You can see we can start to spread those work a little bit inferiorly there along our capsule. You can also use the Dalla portal to make this cut as well. But it's been my preference to come from the proximal anterolateral portal as most of these Cam lesions, as you can see, tend to sit at this high anterolateral junction. Now do you appreciate there we have these nice flaps that we've preserved. We've cleaned. So these will be nicely there for later repair. And then as you appreciate we can retract this flap and drive up and see our perfusing retinacular vessels right here sitting at the head neck junction. Those are an area of of concern when you're burring and performing your surgery because we need to get up and high, but we also want to protect them. So there's a nice device here. This is a combination of a half pipe retractor I think as you can appreciate it, it's a slotted cannula that we can use to slide down. Can introduce our bur, but then leave it in place and it can actually function for us like a retractor of this capsule. So rather than having the capsule wrap up during our resection we can actually use it there. So here what we'll do is we'll slide it right along the handle of our beaver blade, which has now been lined up in line with our capsulotomy. So there you can see our half pipe cannula is in place. You can slide out the beaver blade. Perfect. So as you can see here, we now have our slotted cannula and retractor in place. There's our two capsular flaps. There's our anterior flap. Here's our supralateral flap. You can see how this nicely can tuck deep to the flap. And I can rotate around and even show you those superior retinacular vessels just peering around the corner there. This can now set here in this position and actually act as a retractor, not only to protect those vessels, but also to allow for introduction of your BR from that trajectory. And now we're in a position to go ahead and slide the BR. So you want to usually have a slightly increased angle. So the BR tip stays right up against. And if you notice that that brings in your your blade nicely and keeps the muscle out of the way. And I want you to see there I've actually taken the capsule retractor and tucked it deep to the flap. And I simply leave that in place. And now you can see that holds that lateral flap open. And I'm now in a good position to br making sure that I'm safe and protecting those retinacular vessels. Once we've introduced that with the half pipe in place, I can now retract the sheath of the BR back. And as you can see, this retractor, half pipe cannula and retractor is protecting me from those superior vessels. This now gives us a great trajectory to work and go ahead and start to perform our cam resection here, working from the anterolateral location. And as you can see here, nicely, proximally, right adjacent to our to our labrum, we can start to set the margin of our physeal scar here.

CapsuleCut™ Blades

Imaging and Resection

Overview of Hip Joint Access Featuring the Synergy Extended Length Hip Arthroscope System

We'll begin today with a demonstration of the landmarks around the hip as we approach access to the hip. Here we've marked the anterior superior iliac spine, or ASIS. We've drawn a line inferiorly from the axis, and we'll avoid going medial to that line with any of our portals in order to protect the femoral neurovascular bundle. Here we've marked the greater trochanter. We'll take care during the procedure not to use the greater trochanter as a landmark, because the greater trochanter can move. So if we have more or less distraction, the greater trochanter may move inferiorly or superiorly. If we have more or less femoral anteversion or more or less internal or external rotation of the hip, the greater trochanter will move anteriorly or posteriorly. So we don't want to use the greater trochanter as a landmark. It's more something to avoid. We want to use the ASIS and the pelvis as our landmark, because ultimately what we're approaching is the acetabulum, and we want to maintain a consistent angle of approach toward the acetabulum. Posteriorly, the sciatic nerve is back in this range, so as long as we're anterior to the. Posterior edge of the greater trochanter, we should be well away from the sciatic nerve. So first we'll begin with an anterolateral portal. And the way that we locate our anterolateral portal. Is by first laying the spinal needle across the expected trajectory. We'll take an x ray here. And that gives us an idea of where we want to be from superior to inferior. Now, as far as anterior to posterior, we want to be somewhere along this line. We will not use the greater trochanter as our landmark. We'll imagine where would be in line with the 12:00 position on the acetabulum. That's where we want to be. We want to be approaching the 12:00 or perhaps 1230 o'clock position on the acetabulum. We're going to get a shot with the spinal needle meeting the most inferior part of the Gram. So that'll be here. We'll turn the bevel so that we pass the labrum. So the flat part of the bevel is toward the labrum. We'll pass through the capsule like this. And then we flip the bevel like this so that now we can use the bevel to pass the femoral head. And here you see it's passed the femoral head without digging into the femoral head. So we want to be as inferiorly as possible in the air ArthroFX gram while not hitting the actual femoral head. Here we insert the guidewire through the spinal needle. We'll take the spinal needle out, and then we'll use over the guidewire technique to insert our cannula. This is a 4 or 5 cannula. And this is generally the first cannula that we'll enter the joint with. So you can you want to avoid plunging with this cannula. And you can do that by using your finger your index finger on the skin. Or you can use a golf grip where you use two hands like so. And use this to avoid plunging, so you stop yourself from plunging. We'll see the cannula coming toward the joint. We'll lever like this away from the femoral head so that we avoid hitting the femoral head. And then we avoid our plunge using our golf grip or using our index finger. Now we're in the joint and we'll place our scope. Through the candle. So there's our scope. Now I generally start my approach dry. And what we want to visualize here is the triangle between the femoral head on the right and the labrum on the left. And this anterior triangle is going to be our insertion site for our second portal. My second portal is going to be an anterior portal. So we want to be a little bit lateral to this line, which we drop down from the ASIS. So we'll come to about here and we'll pick a spot essentially parallel with our anterolateral portal. And I want to pick a spot where my spinal needle and my scope are going to converge at about a 30 degree angle. That's about the the spot that I want to pick. So you shouldn't define a particular distance between these two portals, because the distance may vary depending on the size or shape of the patient. But what can remain consistent is this angle of convergence between the spinal needle and the scope. So we'll then insert the spinal needle into the joint. And we want to come in through this anterior triangle here. And we want to come in at a point where we leave a little bit of a cuff of capsule on the acetabular side, which we can then use later to repair the capsule. So we pass our guidewire again through our spinal needle. And then we'll now pass the blue or 5.0mm scope sheath over the guidewire. This comes into the joint. Again, I'm watching the cannula come in and I can use my index finger to prevent plunges. So my index finger is right up against the patient. I lever away from the femoral head. I make sure I don't scuff the femoral head on the way in. And now my cannula is in. And now we have an outflow. So we can now run the pump and we have an outflow. So we'll be able to flush out the joint. Scope sheaths have been smoothed on the end. So they're less likely to scuff the femoral head. And that's important. But of course we should still take care to avoid bumping them into the femoral head on the way in and out. So now we'll pass a banana blade or any type of blade you choose through this, Us through this scope sheath and into the joint. And I'm going to use this blade for my capsulotomy. Now, I like to do this through the anterior portal, not through a more distal portal, but through the anterior portal, because this gives me an angle where the blade is essentially perpendicular to the fibers of the capsule. And you can see this in the arthroscopic picture. If you come from a more distal portal, the blade will be cutting obliquely across the fibers of the capsule, which makes it harder to repair afterward. So we're going to use this beaver blade to to perform an inter portal capsulotomy. And we want to take care to see the tip of the blade at all times so that we don't cut the femoral head. Take a lot of care to see the tip of the blade so you don't cut the femoral head. Now notice I'm coming. I'm cutting from bottom right to top left because I'm going parallel to the labrum, so I'm not cutting directly toward myself. I'm cutting this way, using the blade as a rudder to cut parallel to the labrum. And that's important as well, because we want to leave a consistent cuff of tissue on the acetabular side. For later capsular repair. Here we go. We can now demonstrate that we'll switch the candles. So I'll turn off the flow. I'll switch portals using the bridging system and put the scope in the anterior portal and look posteriorly. And I'll take that blade. And now we'll pass the blade through. This. And now we can complete our capsulotomy here. And again we've checked that the portal did not go through the labrum and we did not scuff the femoral head, and we keep the beaver blade in view throughout. So we'll complete our capsulotomy now. Cutting anteriorly again parallel to the labrum, not necessarily directly toward us. Rather I'm going parallel to the labrum. That's that's important because that's how we preserve a good cuff. Of a uniform thickness along the acetabular side for the later capsular repair. So now I can switch back using the bridging system. We can use half pipes to pass instruments. One thing I would note is that when you use half pipes, it's important that the half pipe converge toward the switching stick or instrument that it's going along. So you want the half pipe to converge like this. You do not want them running in parallel like this, because if you run them in parallel and it catches a little soft tissue, then it will diverge. So you want it converging. You want the tip running along the switching stick or instrument. So it's converging at all times. So when you go in with the half pipe you come out with the switching stick. When you come in with the switching stick you come out with the half pipe always converging. And same with any other instrument. So we're here converging toward the switching stick as we come in and switching stick out. And then we'll put a probe in sharp part of any instrument, always toward the half pipe converging as we come down and half pipe out. And now we'll go through a diagnostic arthroscopy. So we'll begin with the ligamentum teres. This is obviously a cadaver. So we see the ligamentum teres is quite badly torn. We can evaluate the acetabular fossa. Look at the foveal cartilage here. You see. Femoral head defect in the superomedial. Posterior superior medial femoral head posterior to the fovea. We can look for notch osteophytes like this one around the acetabular fossa and for synovitis in the acetabular fossa. So we begin again at 6:00 at the ligamentum teres below the ligamentum teres you see the transverse acetabular ligament. Then we go anterior inferiorly. So this is 5:00, 4:00. At 3:00 you see the psoas. You. So this is the psoas notch. And this is a good marker directly anteriorly to this is where the iliopsoas runs. So if you do an iliopsoas fractional lengthening at the level of the joint line, it's right on the other side of that capsule. You don't necessarily need to cut through the capsule. You can go up and over the capsule. But this you gives you a good localizer of where it is. A note if you do ISO's lengthening at the level of the joint line, it's often bifid at the level of the joint line. So look for a second or third slip of the tendon. So 3:00 2:00. 1:00. 12:00. And then as you move more posteriorly. 11:00, 10:00, 9:00, 8:00, 7:00. And right back to 6:00. Right back to the ligamentum teres. A couple of interesting views to work with. This is an intra-articular view, of course, of the labrum. And from here you can probe the anterior labrum and the peripheral cartilage of the acetabulum, which are some of the most commonly worked on areas in hip arthroscopy. It's also useful to use a use a bird's eye view where you come from superior from the capsular side, and you can see the capsular side of the labrum from this view. So at this point, I'll point out a distal anterolateral accessory portal, which will be approximately in this region. So I want this to be converging now from distal to proximal at a 30 degree angle to my to my scope. And this will be quite a bit more lateral than the anterior portal was. So through this portal, I'll have a nice trajectory for placement of anchors most of the way around the acetabulum. I can use a I can use a switching stick to enter the joint here. Through the this anterolateral portal, we can see the capsule here. We see the the labrum here. This is the anterior labrum. Lateral labrum. 12:00 here. This is the rectus femoris up above the capsule. The indirect head of the rectus femoris here, traveling above the capsule. I'm now retracting it. These fibers with my probes. So that's indirect. Head of the rectus femoris. And this is capsule. So I'll preserve this cuff of capsule throughout for later repair. And you can see how laterally at 12:00 the capsule almost fuzes with what's left of the indirect head of the rectus femoris. So we'll preserve that as well for later repair. I'll also demonstrate the bird's eye view here, viewing from above the labrum. If you retract the capsule up, you can. You can view the capsular side of the labrum. So nice view of the capsular side. Very useful view. And we'll use this view often to develop the plane between the capsule and the labrum for an acetabular plasty before doing a labral repair. So now we're going to create a posterolateral portal. And this will be parallel with our anterolateral and our anterior portals. And this portal will allow us to access the more posterior parts of the acetabular rim working down here. Okay. So the the posterior portal is parallel to about the 10:00 position on the posterior lateral acetabulum. Usually this coincides with the posterior lateral corner of the trochanter. Approximately. But as before, I do not use the trochanter as my reference point for locating the landmark. I think of where is it going to arrive on the acetabulum. So I'm targeting the acetabulum with this portal, not targeting the greater trochanter.

CapsuleCut Blade, 4 mm, Detachable

CapsuleCut Blade, 4 mm, Detachable, Curved

CapsuleCut-Klinge, abnehmbar, gebogen, 4 mm

CapsuleCut Blade , Detachable, Curved 4 mm

CapsuleCut, cuchilla, extraíble, curvada, 4 mm

SafeCut Capsulotomy Blade w/Handle, Straight

SafeCut Capsulotomy Blade, gerade, mit Handgrif

SafeCut Capsulotomy Blade w/Handle, Curved&nbsp;

SafeCut Capsulotomy Blade, gebogen, mit Handgrif

SafeCut Capsulotomy Blade w/o Handle, Straight

SafeCut Capsulotomy Blade, gerade, ohne Handgriff

SafeCut Capsulotomy Blade w/o Handle, Curved

SafeCut Capsulotomy Blade, gebogen, ohne Handgriff

SafeCut Capsulotomy Blade, Detachable, Curved

Handgriff zum Einbringen von Wechselstäben

Einwegklingen für die Kapsulotomie

Educational Resources and Products

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Overview of Hip Joint Access Featuring the Synergy Extended Length Hip Arthroscope System

Safe Hip Access Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

Accessing the Hip Joint Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

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Broschüren (2)

Knotless Hip Capsular Closure Using the LoopLoc™ Knotless Implant and CapsuleStitch™ Suture Passer

CapsuleCut™ Blades

Kataloge (1)

Hip Next Generation in Soft-Tissue Repair and Reconstruction

Operationstechnik-Animationen (1)

Accessing the Hip Joint Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

Produktdemonstrationen (2)

Safe Hip Access Using the FlushFit Cannula System and SafeCut™ Capsulotomy Blade

Overview of Hip Joint Access Featuring the Synergy Extended Length Hip Arthroscope System

Videos - OP-Anleitung (1)

Capsular Management and Retraction for Cam Resection

CapsuleCut™ Blades (11)

AR-6527-02

AR-6527-02C

AR-6527-03

AR-6527-03C

AR-6527-06

AR-6527-06C

AR-6527-07

AR-6527-07C

AR-3027

AR-6527-07N-1

AR-6527-07N

Disposable Knife Blades (2)

AR-6527-05

AR-6527-19