Hip Joint Positioning, Portals, Impingement, Chondral Lesions

Fracture table is essential for performing hip arthroscopy to allow distraction and opening of the central compartment of the joint. The patient could be positioned in either supine or lateral position (surgeon’s preference). Relevant skin landmarks for portal placement are marked including greater trochanter, iliac crest and anterior superior iliac spine. Several portals have been described by many authors for performing hip arthroscopy. The anterolateral portal is established first. The guide needle is gently introduced with fluoroscopic guidance penetrating the distal third of the joint capsule. The next portal is placed under direct arthroscopic visualization (outside-in) through the so-called “safe triangle” between the labrum and femoral head over the anterior joint aspect. Capsulotomy needs to be performed to allow free increased mobility of the instruments followed by complete arthroscopic Inspection of the central compartment of the hip. A systematic approach is recommended. Arthroscopic evaluation of the peripheral compartment takes place after evaluation of the central compartment. Synovial disorders, cartilage lesions as well as femoral bony deformation (“bump”) could be here detected and managed. Postoperative early mobilization of the joint (using CPM machine, bicycle ergometer without resistance) must be ensured. These measures reduce postoperative pain and risk of adhesions.