Mini-symposium: Spinal deformity(vi) An introduction to hip arthroscopy part one: surgical anatomy and technique
Introduction
Arthroscopy is rapidly becoming an important technique in the management of a number of conditions affecting the hip. Research into hip arthroscopy has increased significantly over the last 10 years, and the number of indications has increased proportionately.1 As practical experience and the base of scientific evidence evolve, hip arthroscopy is likely to become an important procedure carried out by an increasing number of orthopaedic surgeons.
Section snippets
History
Burman2 is credited as being the first to report on hip arthroscopy, although he concluded in his 1931 paper that it was “manifestly impossible to insert a needle between the head of femur and the acetabulum” and therefore not possible to visualize the acetabular fossa and its associated structures. Clinical application was first reported by Takagi3 in 1939, with a series of four cases involving two patients with Charcot joints, one with tuberculous arthritis and one with suppurative arthritis.
Gross anatomy (Figures 1–5)
Hip arthroscopy involves navigation of two areas, called the central and peripheral compartments. The peritrochanteric compartment can also be explored, but this does not form part of routine hip arthroscopy.
Patient positioning
Hip arthroscopy can be performed in either the supine or the lateral position. Each position has its advantages and disadvantages.
Portal positioning and relevant anatomy
Figure 9 is a diagrammatic representation of the arthroscopic portals that are used for the central, peripheral and peritrochanteric compartments, which will all be discussed in more details in this section.
Technique
Once the patient is in a satisfactory lateral position, the hip is placed in slight flexion, abduction and internal rotation. It is necessary to confirm that the hip can be distracted with images from the intensifier. The intra-articular negative pressure gradient generated should be released with an 18-gauge spinal needle and the surgeon should feel a give (a ‘pop’) as the needle breeches the capsule. In our centre, this first needle is inserted in the position that will allow conversion to an
Anaesthesia
Hip arthroscopy typically requires a general anaesthetic. Most patients are young and have an expectation to return to full mobility very soon after surgery. The literature concerning anaesthesia for hip arthroscopy is limited. However, some general principles and special considerations are essential in order to ensure hip arthroscopy proceeds safely.
The anaesthetic technique used should aim to deliver minimal morbidity and rapid recovery through the use of short acting agents with a rapid
Summary
Hip arthroscopy has evolved rapidly over the last decade, with significant advances in instrumentation. Despite many equipment advances, hip arthroscopy remains a technically demanding procedure that although no longer necessarily confined to specialist units, does require a significant amount of training and experience.
In experienced hands and with appropriate and safe patient positioning and portal placement, the indications and potential interventions that can be achieved are diverse.
Acknowledgements
The authors wish to thank Mr Jason McAllister, Graphic Designer in Medical Illustration at University Hospitals Coventry and Warwickshire, for producing the illustrations in this review.
No benefits in any form have been received or will be received from any commercial party related directly or indirectly to the subject of this article.
References (11)
- et al.
Hip arthroscopy: an emerging gold standard
Arthroscopy
(2006) - et al.
Traction versus distension for distraction of the joint during hip arthroscopy
Arthroscopy
(1997) - et al.
Differential diagnosis of pain around the hip joint
Arthroscopy
(2008) - et al.
Postoperative analgesia for hip arthroscopy: combined L1 and L2 paravertebral blocks
J Clin Anesth
(2008) Arthroscopy or the direct visualization of joints: an experimental cadaver study
J Bone Joint Surg Am
(1931)
Cited by (1)
(iv) Groin pain in athletes
2012, Orthopaedics and TraumaCitation Excerpt :Arthrotomy is more traumatic to the joint as well as being more expensive, but results for managing femoroacetabular impingement are similar. More detailed information on hip arthroscopy is available in previous issues of Orthopaedics and Trauma.5,6 Forced abduction of the hip may lead to an acute injury to the adductor group, usually sited at the musculotendinous junction.