Indications for Hip Arthroscopy

Abstract

Context: Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved techniques has resulted in improved access to the hip joint and ability to treat various hip pathologies.

Evidence acquisition: Electronic databases, including PubMed and MEDLINE, were queried for articles relating to hip arthroscopy indications (1930-2017).

Study design: Clinical review.

Level of evidence: Level 4.

Results: Initially used as a technique for loose body removal, drainage/debridement of septic arthritis, and treatment of pediatric hip disorders, hip arthroscopy is currently used to treat various hip conditions. The recognition of femoroacetabular impingement (FAI) as a source of hip pain in young adults has rapidly expanded hip arthroscopy by applying the principles of osseous correction that were previously described and demonstrated via an open surgical dislocation approach. Hip pathologies can be divided into central compartment, peripheral compartment, peritrochanteric space, and subgluteal space disorders.

Conclusion: Although hip arthroscopy is a minimally invasive procedure that may offer decreased morbidity, diminished risk of neurovascular injury, and shorter recovery periods compared with traditional open exposures to the hip, it is important to understand the appropriate patient selection and indications.

Keywords: femoroacetabular impingement; hip arthroscopy; indications; labral tear; synovial disorders.

Figure 1.

Left hip combined femoroacetabular impingement with labral tear. (a and b) Preoperative anteroposterior and Dunn lateral radiograph demonstrating the combined cam- and pincer-type pathomorphology (arrows). (c and d) Postoperative radiographs demonstrate correction of the acetabular overcoverage and restoration of the femoral head-neck offset (arrows). (e) Intraoperative view of the acetabular labral tear (*). (f and g) Labral repair with base-type configuration and restoration of the labral suction-seal.

Figure 2.

(a) Full-thickness defect of the acetabular cartilage adjacent to a labral tear. (b) After microfracture of the underlying subchondral bone, an injectable, minced extracellular matrix has been placed. This is further sealed and covered with fibrin glue with the goal of promoting the production of hyaline-like tissue rather than the fibrocartilage-like tissue most commonly noted after microfracture.

Figure 3.

Synovial chondromatosis. (a) A loose fragment is noted in the anterior aspect of the hip near the midanterior portal. (b) An additional fragment is noted laterally while viewing through the midanterior portal. (c) A large grasper is used to retrieve an additional loose body in the peripheral compartment along the femoral neck. (d) Gross view of the multiple loose fragments that were removed.

Figure 4.

Pigmented villonodular synovitis (PVNS). (a) Sagittal T2-weighted magnetic resonance image demonstrating the intra-articular soft tissue mass along the anterior femoral neck (arrow). (b) Visualization of the lobular, nodular PVNS mass. (c) A stalk is noted that connects the mass with the hip synovium of the anterior capsule (*). (d) Gross specimen demonstrating the multinodular and lobular nature of the PVNS mass.

Figure 5.

(a) Intraoperative fluoroscopic radiograph profiling the lesser trochanter. (b) Lesser trochanter resection has been performed for ischiofemoral impingement. (c) Arthroscopic visualization of the lesser trochanter through the distal anterolateral portal. (d) Visualization after resection of the lesser trochanter.