Arthroscopy - hip joint

Introduction

Arthroscopic surgery on the hip joint has developed dynamically in terms of technique over the preceding five years. Examination of the space between the head and acetabulum had been thought to be a highly complex problem. But the increasing experience of surgeons and development of arthroscopic technology have led to remarkable progress. As regards arthroscopy, the hip joint may be divided into two compartments:

  1. Central Compartment – this consists of the space between the head and acetabulum and allows for the treatment of Labrat lesions, as well as lig teres and cartilage lesions
  2. Peripheral Compartment – femoral neck area

We primarily employ general anesthesia for hip arthroscopy. We also use special instruments developed directly for hip joint arthroscopy, primarily with the use of 70° optics.

Position and Access Points

The hip arthroscopy patient lies supine and the lower limb is placed in traction to distract the hip joint (space is required between the head and retabula – the so-called vacuum phenomenon on the x-ray). The limb being operated on is positioned in a condition of mild flexion, abduction and internal rotation (necessary for surgery to be performed on the central compartment).

We employ the following access points, but are careful not to proceed in a direction medial to the iliaca spina anterior superior connector or the patella center, the so-called medial line:

  1. Anterolateral access point: situated 1 cm cranially and ventrally from the tuberculum majus
  2. Frontal access point: situated at the intersection of the tuberculum majus and the "medial line" - inclined 45° to the frontal plane and 30° to the sagittal plane
  3. Posterolateral access point:

Clinical Picture and Examination

Patients present with pain and a jittering motion in the hip joint. The anamnesis often reveals an injury such as a fall from a bike. Degenerative changes may also be present. During examination we pay particular attention to the gait, the range of motion in the hip joint, along with limb length, and perform rotation tests.

X-ray images, CT scans and MRI examinations –potentially with a contrast agent introduced into the joint cavity – are used to make the diagnosis.

Indications

  • femoroacetabular impingement (FAI)
  • labral lesions
  • chondral lesions
  • osteochondrosis dissecans
  • free bodies
  • synovitis
  • osteoarthritis
  • dysplasia
  • painful hip joint