Basic Hip Arthroscopy: Anatomic Establishment of Arthroscopic Portals Without Fluoroscopic Guidance

Abstract

Hip arthroscopy has gained popularity in recent years for diagnostic and therapeutic hip preservation management. This article details the establishment of arthroscopic portals of the hip, specifically the anterolateral and modified anterior portals without fluoroscopic guidance. The anterolateral portal is established anatomically, and the modified anterior portal is then established under arthroscopic guidance. A through understanding of the hip anatomy allows for these portals to be made both safely and reliably for hip arthroscopies in the modified supine positioned patient. The reduced use of fluoroscopy with this technique lowers the risk of ionizing radiation exposure to the patient and surgeon.

Fig 1

External anatomy of portal placement during arthroscopic right hip surgery. The anatomic locations of the hip arthroscopy portals are shown, with the surgeon's long finger placed on the tip of the greater trochanter to guide placement. (AL, anterolateral portal; Ant, standard anterior portal location; ASIS; anterior inferior iliac spine; GT, greater trochanter; MAP, modified anterior portal; PL, posterolateral portal.)

Fig 2

Spinal needle is angled (15° posterior and 15° cephalad) for the establishment of the anterolateral portal of the right hip (arrow).

Fig 3

External view of the right hip redemonstrating the anatomic location of the modified anterior portal (MAP) and angulation of the arthroscope in the anterolateral (AL) portal for visualization.