Hip arthroscopy technique

Abstract

Arthroscopy of the central and peripheral compartment is an obligatory part of hip arthroscopy to evaluate, confirm or find pathologies and their treatment. Loose bodies, lesions of the labrum and ligamentum capitis femoris, cartilage damage, femoroacetabular impingement, synovial diseases, initial osteoarthritis, femoral head necrosis (ARCO stage1-2) and adhesions. Local infections, bone tumors near the joint, extensive peri-articular ossification, severe arthrofibrosis with peri-articular involvement, advanced osteoarthritis, protrusio acetabuli, advanced femoral head necrosis (from ARCO stage3-4 extended), recent fracture of the acetabulum and extensive joint capsule tears. Precise positioning of the patient on afracture table is essential to avoid complications. Central and peripheral compartment arthroscopy requires at least2, in some cases more than 3portals. Arthroscopy of the central compartment is carried out under traction by an anterolateral (AL) and anterior portal(A). Aposterolateral (PL) portal and distal ventrolateral portal (DVL) may also be required. For peripheral compartment arthroscopy, ananterolateral (AL) and anterior (A), alternatively/additively aproximal ventrolateral portal (PVL) and/or and distal ventrolateral (DVL) portal are established in 45° flexion and no traction of the hip joint. Mobilization with full weight bearing from the day of the operation, crutches are optional. After stimulating cartilage surgery or autologous chondrocyte transplantation, partial weight bearing of 10 kg on crutches is indicated until the end of postoperative week6. Physiotherapy with full range of motion allowed, except for labrum refixation, should take place from postoperative day1. From 01/2010-12/2019, 2815 hip arthroscopies were performed; average patient age 43 (12-81) years. All procedures include adiagnostic arthroscopy of the hip. Two to 5portals were used. Average operation time was 70 (18-48) min. In 26cases (0.9%), arthroscopy of the central compartment at ahigh CE angle was not possible or not performed, even after previous arthroscopy of the peripheral compartment with capsule release. Intraoperative or directly postoperative problems and complications were rare, e.g., damage to the skin/genitals due to contact pressure (0.7%), instrument breakage (0.5%), transient lesions of the pudendus nerve (<1.5%).