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Hip Arthroscopy

Hip Arthroscopy

Matthew L Costa and Richard N Villar

Introduction

  • Hip arthroscopy has been performed since the early 1900s
  • Technical challenges have taken longer to overcome than in knee and shoulder arthroscopy
  • Recent advances have increased the number of hip conditions amenable to arthroscopic interventions

Technique

  • Longer instruments required – 160mm arthroscopes now standard
  • 70 degree arthroscopes required for the smaller joint space
  • Positioning is vital – lateral and supine appear to give equally good results
  • 20 degrees of flexion and neutral abduction/adduction is recommended
Glick JM. Hip arthroscopy. The lateral approach. Clin Sports Med. 2001 Oct;20(4):733-47.
Byrd JW. Hip arthroscopy utilizing the supine position. Arthroscopy. 1994 Jun;10(3):275-80.
  • Traction is required to open up the joint space
  • This is usually supplemented with fluid/air distension of the joint
    (The acetabular labrum contributes considerably to the suction effect of the ball and socket joint)
  • Excess traction can result in neuropraxia – femoral and sciatic injuries have been reported
  • Damage is limited by the use of distraction gauges – less than 300N reduces the risks – and by the use of large well padded groin posts for counter-traction
  • A Seldinger approach is generally used to introduce the portals – Under arthroscopic control a wire is passed down the needle used to distend the joint. The needle is removed and the cannula inserted into the joint space over the wire.
    (NB The traction must be released to access the peripheral joint space)

Portal Positions

  • 2 portals are usually required
  • The lateral portal is the most common starting place – this is positioned just above the greater trochanter to avoid the superior gluteal nerve
  • Since most labral pathology is anterior, the anterolateral portal is the other common entry point -   the lateral cutaneous nerve of the thigh must be avoided
  • Posterolateral and inferomedial portals are used less commonly


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