Younger, more active patients are opting to undergo surgery to repair deteriorating hip joints before their minor discomfort devolves into a debilitating condition. By outfitting your facility for outpatient hip arthroscopy, you'll be poised to capitalize on that burgeoning opportunity. Let's take a look at what that entails by examining how the ProHealth Ambulatory Surgery Center in Lake Success, N.Y., recently added the procedure to its orthopedic case mix.

Gaining traction
Professional, collegiate and high school athletes looking to return to high-level competition are interested in undergoing hip arthroscopy (see "Athletes Benefit From Arthroscopic Hip Surgery"), but so are weekend warriors who want to maintain active lifestyles. The procedure is ideally suited for patients without significant cartilage loss who would respond well to a cleaning of bone impingements from the joint that cause discomfort and limited range of motion, says Steve Golon, RN, a circulating nurse at ProHealth ASC.

The procedure can stabilize the joint, decrease pain and postpone the need for hip replacement, according to Mr. Golon, who has seen patients in their 20s, 30s and 40s present for hip arthroscopy in the 8 months since his facility started hosting the cases. In some instances, he says, hip replacement can be avoided altogether.

Centers with an orthopedic service line already up and running have the basic equipment and supply needs covered — C-arm, power drill, laparoscopic camera and video tower — but adding outpatient hip will still demand the purchase of specialty devices, which can add up to a significant capital investment that includes:

• Instrument trays. The advancement of minimally invasive instrumentation is what has made outpatient hip procedures possible, says Mr. Golon. Gaining access to the hip joint through 2 small incisions demands longer instruments than the standard tools used during shoulder or knee cases. The instrument tray needed for hip arthroscopy contains specially designed trocars, graspers, probes and cannulas, and can cost between $10,000 and $15,000, says Mr. Golon.
• Disposables. Single-use items cost around $300 and include banana blades (which are blades attached to longer-than-standard-sized probes) of various angles, long arthroscopic needles and slotted cannula. It's a good idea to have drill bits and several anchors on hand, which run a couple hundred dollars each, in case your surgeons need to repair tendons or reattach a labrum that has torn away from the pelvic bone.
• Table attachment. You'll also need a specialized hip access system that positions the patient for an easier approach to the surgical site. These systems, which attach to standard OR tables, put patients in traction before surgery and allow for easy maneuvering of the hip throughout the procedure if the surgeon needs access to the posterior portion of the joint. Since the system holds the patient's hip in space away from the OR table and can accommodate a standard-sized C-arm, you won't need to invest in a radiolucent surgical surface.

When all's said and done, you'll spend at least $30,000 to add hip arthroscopy to your center, says Claude Baconcini, CRNA, the administrator of ProHealth ASC.

Positioned for success
When trialing various distraction table attachments to decide which is right for your facility, work closely with each company's rep to learn the products' ins and outs. And when making a purchase, base the decision on patient safety, ease of use and cost effectiveness — in that order — says Mr. Golon.

Table attachment manufacturers should provide extensive in-service training for your staff on how to properly position patients before surgery. "At the start of the procedure, patients are placed in the supine position with a traction pillow placed in his groin area," says Mr. Golon. "The foot on the operative side is locked in a boot that allows for knee flexion and distraction of the hip when the knee is fully extended." He explains that the positioning system helps staff manipulate patients during surgery by internally or externally rotating the leg, which gives surgeons various views of the joint and anterior access if needed.

The training that staff undergoes can be labor intensive; understanding how the hip access system works and how to properly position patients using the system will occupy a majority of your surgical team's time as they travel along outpatient hip's learning curve. Even though many of Mr. Baconcini's nurses came from a nearby community hospital and were familiar with patient handling during complex hip cases, he still allowed for a solid month of training before bringing the service online at his surgery center.

It's important to know that complications can arise if patients are left in static traction for too long. Hip arthroscopy cases that involve labrum debridement — not repair — typically last about an hour, says Mr. Golon, which is about how long patients should remain in traction without being repositioned. Keep track of how long your patients remain positioned for surgery, especially if the case extends past that 1 hour threshold. "You don't want to cause nerve damage or further harm to the joint," says Mr. Golon, adding that patients complaining of post-op soft tissue pain after being in traction are fairly common, but those who complain of numbness around the groin should be cause for concern.