Elsevier

Orthopaedics and Trauma

Volume 25, Issue 6, December 2011, Pages 441-447
Orthopaedics and Trauma

Mini-symposium: Spinal deformity
(vi) An introduction to hip arthroscopy part one: surgical anatomy and technique

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Abstract

Although first described in the 1930’s, it was not until the late 20th century that hip arthroscopy became a well-recognized procedure. Correct patient positioning and portal placement are critical, and failure of either may result in inability to access the joint or damage to important local neurovascular structures. In the hands of an experienced surgeon and anaesthetist the risks are small, but attention to detail is critical. The future of hip arthroscopy is exciting and as the scientific evidence builds it is likely to be an important adjunct to more traditional open hip procedures.

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)

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