Research Papers

Dr. Snibbe is involved in multiple research projects focused on hip arthroscopy and hip replacement surgery. His interests include:

  • Clinical outcomes after hip arthroscopy
  • Treatment options for different types of impingement
  • Biomechanics of the hip and pelvis before and after arthroscopic hip impingement surgery
  • The use of platelet-rich plasma during hip arthroscopy
  • Outcomes after minimally invasive hip replacement

Femoroacetabular Impingement in Professional Ice Hockey Players

Femoroacetabular impingement of the hip joint has been identified as a major cause for hip pain in athletes. Surgical open decompression of the hip has historically been proposed as the first treatment of choice. Functional outcomes in athletes after this procedure are unknown.

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Arthroscopic Management of Femoroacetabular Impingement

Morphological and spatial abnormalities of the proximal femur and acetabulum have been recently recognized as causes of femoroacetabular impingement. During joint motion in hips with femoroacetabular impingement, abnormal bony contact occurs, and soft tissue structures (chondral and labral) often fail. Femoroacetabular impingement has been reported to be a contributor to early-onset joint degeneration. Ganz et al have described good midterm success with an open surgical dislocation approach to reconstruct normal joint clearance. The purpose of this report is to discuss relevant literature and describe an arthroscopic approach to treat femoroacetabular impingement. This approach has particular relevance in high-demand patients, particularly in athletes seeking to return to high-level sport.

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Revision Hip Arthroscopy

Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy. Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy.

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Hip Injuries and Labral Tears in the National Football League

Injuries to the hip account for approximately 10% of all injuries in football, but definitive diagnosis is often challenging. Although these injuries are often uncomplicated contusions or strains, intra-articular lesions are increasingly found to be sources of hip pain.

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Sports and Recreation Activity of Patients With Femoroacetabular Impingement Before and After Arthroscopic Osteoplasty

Hip arthroscopy represents a new and minimally invasive method of treating patients with femoroacetabular impingement (FAI). However, participation in popular sports after this procedure has not yet been analyzed. Arthroscopic treatment of FAI increases the level of popular sports activities, and this level of activity correlates with the clinical outcome in terms of pain and function.

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Hip Arthroscopy in Athletes

Arthroscopy has defined numerous elusive causes of disabling hip pain. In the past, athletes were resigned to living within the constraints of their symptoms, often relinquishing their competitive athletic careers. The most common lesions include labral pathology, articular damage, and disruption of the ligamentum teres. Careful clinical assessment is reliable at determining the existence of hip joint pathology, although variable in determining its nature. Arthroscopy is effective at addressing numerous lesions, often allowing successful resumption of the athlete’s competitive career. This article details the assessment of hip joint problems in the athlete with numerous illustrative examples highlighting various forms of pathology that can be addressed.

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Hip Arthroscopy for Labral Tears

Arthroscopy of the hip joint is a relatively new diagnostic and therapeutic option for labral tears. More data are needed to characterize the utility and effectiveness of hip arthroscopy and identify patient-related factors that might predict functional outcome.

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Correlation of Short Form–36 and Disability Status With Outcomes of Arthroscopic Acetabular Labral Debridement

Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form–36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported. Short Form–36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores.

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Safe Angle for Suture Anchor Insertion During Acetabular Labral Repair

The purpose of this study was to define a safe angle for suture anchor insertion during acetabular labral repair that will facilitate anchor placement within bone and prevent penetration into the hip joint. Nine acetabuli were harvested. Anatomic measurements were performed at the anterosuperior quadrant. Electronic calipers were used to measure acetabular bone. “Safe angle” measurements were obtained with suture anchor drills and a protractor. Comparisons between groups were calculated with a 1-way analysis of variance. The Tukey post-hoc analysis was completed for all significant analysis of variance results.

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Prospective Analysis of Hip Arthroscopy With 2-Year Follow-up

Numerous indications, but little outcome data, have been reported for hip arthroscopy. The purpose of this prospective study is to report the 2-year results of hip arthroscopy performed on a consecutive series of patients for a variety of disorders.

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Arthroscopic Labral Repair in the Hip: Surgical Technique and Review of the Literature

Hip pain can be caused by multiple pathologies. Injuries to the acetabular labrum are the most common pathologic findings identified at the time of hip arthroscopy. Five causes of labral tears have been identified; these include trauma, femoroacetabular impingement, capsular laxity, dysplasia, and degeneration. Studies have shown the function and the importance of the labrum. To restore function of the labrum, new surgical techniques, such as suture anchor repair, have been described. The goal of arthroscopic treatment of a torn labrum is to relieve pain by eliminating the unstable flap tear that causes hip discomfort. The goals of these treatments are to maintain the function of the hip joint and decrease the development of premature arthrosis.

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JBJS Hip Arthroscopy McCarthy 2005

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JBJS Hip dislocation Sekiya

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JBJS Labral Tears Beaule

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JBJS Labral Tears Clohisy 2006

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Hip Arthroscopy in the Athletic Patient: Current Techniques and Spectrum of Disease

Over the last decade, the management of hip injuries has evolved substantially due to the advancement of techniques in arthroscopy and diagnostic tools such as magnetic resonance imaging. Arthroscopy of the hip remains a challenge due to the osseous and soft-tissue constraints of the hip. Currently, various hip lesions, including labral tears, loose bodies, femoroacetabular impingement, coxa saltans (snapping hip syndrome), ligamentum teres injuries, and capsular laxity, can be successfully treated arthroscopically. As continued improvements are made in surgical techniques and in specifically designed instrumentation for the hip, the indications for arthroscopy will continue to increase and arthroscopy of the hip will become a standard procedure performed by an increasing number of orthopaedic surgeons.

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JBJS Symposium Young Hip 2008

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JBJS Young Adult Impingment Leunig

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Repair of the Adult Acetabular Labrum

Although hip arthroscopy is a new technique, indications for its use are rapidly expanding. With better utilization and understanding of both radiologic assessment of hip pathology and clinical examination, specific intra-articular derangement is being identified. Longitudinal, peripheral, and intrasubstance anterior hip labral tears can be repaired using anterior paratrochanteric and anterior portals with standard hip arthroscopy equipment. Repair of the torn labrum may help re-establish the anatomic function of the labrum, thereby preventing biomechanical compromise through surgical debridement, which may lead to degenerative changes associated with osteoarthritis. Although long-term results are still unknown, results of short-term follow-up are positive.

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Acute Iatrogenic Dislocation Following Hip Impingement Arthroscopic Surgery

This is the first case report of an iatrogenic anterior hip dislocation after arthroscopic surgery for femoroacetabular impingement with over 1 year of follow-up. This case report describes the clinical course of a patient with symptomatic cam-pincer femoroacetabular impingement. She underwent arthroscopic rim trimming, labral debridement after a failed attempt at labral refixation from suture cut-through, and femoral head-neck resection osteoplasty. The procedure involved supranormal hip distraction for extraction of an iatrogenic loose body (detached metallic radiofrequency probe tip). The patient had an anterior hip dislocation in the recovery room. Immediate closed reduction under general anesthesia and bracing were performed but failed despite the ability to obtain a concentric but grossly unstable reduction. After 3 failed attempts, a mini-open capsulorrhaphy was performed that successfully restored stability. Her postoperative management and outcome are presented. All of the major static stabilizers of the hip (osseous, labral, and capsuloligamentous) were surgically altered, and a multifactorial causation is proposed. Lessons learned are discussed in hopes of minimizing the occurrence of this rare but dramatic complication.

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How Accurately Can the Acetabular Rim Be Trimmed in Hip Arthroscopy for Pincer-Type Femoral Acetabular Impingement: A Cadaveric Investigation

The purpose of this study was to evaluate the precision of central hip arthroscopy in the assessment and treatment of pincer-type femoroacetabular impingement (FAI) avoiding the posterolateral portal, with its close proximity to the main arterial blood supply of the femoral head, the medial circumflex femoral artery.

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The Role of Arthroscopy in Resurfacing Arthroplasty of the Hip

Arthroscopy of the hip joint has become a well-established procedure in treating many intra- and extra-articular disorders around the hip. As surgeons improve their expertise, indications for hip arthroscopy also expand. Persistent pain after joint replacement can be a diagnostic and therapeutic challenge, especially if the results of investigations performed to rule out loosening and infection are negative. Arthroscopy has previously proved to be a useful diagnostic and therapeutic tool in such cases in the knee and the shoulder. We report on the use of hip arthroscopy in a patient with persistent pain after resurfacing arthroplasty, identifying loosening of the acetabular component. It was perhaps the only way to identify component micromovement in the background of all other investigations’ results being normal or indeterminate. Arthroscopy of the hip in a patient with resurfacing arthroplasty is technically safe to perform and allows good visualization of the component surfaces and synovium, and the dynamic component of arthroscopy enables the surgeon to assess component loosening. In conclusion, we have found arthroscopy to be an extremely valuable technique for the evaluation of our patient with a persistently painful resurfacing arthroplasty.

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