Hip arthroscopy by the lateral approach

Abstract

Performing hip arthroscopy with the patient in the lateral decubitus position is advantageous in aiding in visualization of the hip joint, in maneuvering instruments in obese patients, and in facilitating entry to the hip joint in patients with spurs on the anterolateral aspect of the acetabulum. The patient is placed in the lateral decubitus position with the hip on which the surgery is being performed on the top. The leg is placed in traction and a well-padded perineal post is applied for countertraction. An image intensifier is placed around the hip to help direct the instruments into the hip joint. Traction is necessary to reach the depths of the hip joint. After traction is applied, two portals are made over the greater trochanter and one directly anterior to the greater trochanter. A capsulotomy is performed at each portal site to maintain the portals and to aid in maneuvering the arthroscope and instruments. Traction is released and the hip is flexed to allow visualization of the intracapsular area around the femoral neck. An additional, ancillary portal (made anterior and distal to the first direct anterior portal) may be required to reach the intracapsular portion around the femoral neck. A regular traction table requires adjustments of the perineal and traction posts to apply traction to the leg of a patient in the lateral decubitus position. Special traction devices make setup easier. The lateral approach to hip arthroscopy provides a safe and consistent method of entering, visualizing, and performing surgical procedures on the hip.