Hip Arthroscopy: Pitfalls and Pearls
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Published March 15, 2015

Hip Arthroscopy: Pitfalls and Pearls

Knowledge of femoroacetabular impingement (FAI) as a source of hip pain, possibly leading to hip arthritis, has caused an exponential increase in arthroscopic surgical techniques to correct abnormal hip anatomy and address labral tears. This increased recognition of hip preservation techniques has lead to an impetus in teaching centers to train residents and fellows in the art of hip arthroscopy. There are unique challenges of hip arthroscopy that are not present in other more commonly scoped joints. These include the use of a 70 degree scope with a variable focal length, time constraints of applying traction while scoping the central compartment, and difficulty triangulating due to the depth of the joint. Adding to these challenges is the attempt to use instruments that are rigid, straight, and more ideally suited for less constrained joints such as the knee or shoulder and unfamiliarity of the hip joint with a steep learning curve encountered even by trained arthroscopists. Surgical instruction is provided on a safe and reproducible approach to hip arthroscopy procedures. Correct anatomic location of accessory portals, proper portal placement avoiding wire breakage, prevention of iatrogenic labral and chondral injuries during hip arthroscopy are topics discussed. Proper placement of portals to facilitate labral repair, anchor placement, and overcoming a tight hip joint are also reviewed. Surgical techniques are demonstrated in removal of broken wires, inadvertent anchor placement, iatrogenic labral and chondral injury, avoiding skiving of articular surfaces during portal placement, migration of wires, and use of the head drop technique to assist joint distraction. By utilizing a surgical cadaveric lab, a unique visual surgical experience is provided. The video is complemented by 3D animations to give a macroscopic overview of the surgical field and an increased awareness of the anatomic surroundings to the viewer.