Indications and Technique: Contemporary Hip Arthroscopy for Treatment of Femoroacetabular Impingement

Editor’s note: The following article is a review of a video available via the AAOS Orthopaedic Video Theater (OVT). AAOS Now routinely reviews OVT Plus videos, which are vetted by topic experts and offer CME. For more information, visit aaos.org/OVT.

One of the most common indications for hip arthroscopy is the treatment of femoroacetabular impingement (FAI), a potentially disabling condition that can result in pain and limitations in activities of daily living and sports participation. Hip arthroscopy has proven to be an effective treatment for patients with FAI who have persistent pain after nonsurgical management. In an OVT video narrated by Mario Hevesi, MD, PhD, titled “Indications and Technique: Contemporary Hip Arthroscopy for Femoroacetabular Impingement,” the authors masterfully demonstrate arthroscopic treatment of FAI step by step.

The authors present a case of a male aged 22 years with chronic hip pain who had failed nonoperative treatment. They review the classic findings noted in FAI—including C-shaped pattern of groin pain and a positive flexion, adduction, internal rotation maneuver. Preoperative imaging demonstrates a well-preserved hip joint space and an alpha angle of 71 degrees consistent with a cam deformity. MRI demonstrates a well-preserved chondral surface and an anterior superior labral tear. The patient had transient relief following a diagnostic hip injection. Because he failed conservative management, he was indicated for surgery.

The patient is transferred to a lower-extremity suspension table and placed under general anesthesia. The hip is distracted and lateralized over a well-padded perineal post to improve central compartment access.

The distraction technique and placement of the anterolateral and modified anterior portals are shown. This is followed by interportal capsulotomy and capsular tagging to improve visualization.

Next, the authors demonstrate acetabular rim work, including reflection of the labral recess and pincer resection. A burr is then used to remove any pincer deformity and prepare the bony rim for labral repair. At this point, the authors demonstrate acetabular anchor placement and the use of a distal anterolateral accessory portal for improved access to the anterolateral acetabular rim. Bone models nicely demonstrate the anatomy.

After labral repair, the steps for peripheral compartment access and capsulotomy are shown. Femoral neck osteochondroplasty is demonstrated, with tips on the best choice of portals for viewing and instrumentation based on hip laterality to avoid crossing hands.

The degree of hip flexion, burr position, and fluoroscope tilt necessary to perform osteoplasty are well-detailed. Dynamic fluoroscopy is used to confirm adequate cam resection, and capsular plication is then performed. The postoperative physical therapy protocol is described.

Overall, this is a detailed and technically excellent demonstration of the steps of hip arthroscopy and will be of high educational value to both novice and expert hip arthroscopists.

Michael DeRogatis, MD, MS, is an orthopaedic surgery resident at St. Luke’s University Health Network in Bethlehem, Pennsylvania, and serves as a resident member of the AAOS Now Editorial Board.

Paul S. Issack, MD, PhD, FAAOS, FACS, is a clinical associate professor in the Department of Orthopaedic Surgery at Weill Cornell Medical College and a trauma and adult reconstruction orthopaedic surgeon at New York–Presbyterian Lower Manhattan Hospital. He is also a member of the AAOS Now Editorial Board.

Video details

Title: Indications and Technique: Contemporary Hip Arthroscopy for Femoroacetabular Impingement SyndromeAuthors: Mario Hevesi, MD, PhD; Jorge Chahla Jr, MD; Reagan Chapman, MS; Thomas W. Fenn, BS; Shane Jay Nho, MD, FAAOS
Published: Feb. 27, 2023
Time: 19:20
Tags: Hip Arthroscopy, Femoroacetabular Impingement, Labral Tear, CME

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