Hip arthroscopy - Minimally invasive diagnosis and treatment of diseased or injured hip joints

Arthroscopy of the hip joint has developed into a useful tool for the hip s urgeon. Hip joint anatomy, however, makes special demands of the arthroscop ist. He needs to be familiar with the arthroscopic anatomy of the hip and i ts variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order t o avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a co mbined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without tractio n. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force shou ld be broken by distension of air or fluid. This leads to maximum distracti on of the joint and reduces the risks of damage to labrum and cartilage dur ing first access to the joint. For a diagnostic round through the central c ompartment, at least two portals have to be placed. The use of a 3-portal t echnique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the antero lateral or lateral portal should be used as the first portals to the centra l compartment. In addition,the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should b e used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondr omatosis and pigmented villonodular synovitis, associated lesions in underl ying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least,"idiopathic" hip pain . The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complica tions after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, syn ovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in t he hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studie s have demonstrated the advantages of the arthroscopic treatment of the hip .