Specialized Toolkit Series: Arthroscopic Hip Treatments-Hip Arthroscopy Access: Keys to Improving the View

Video Transcription

In this video, we present several keys to improving the view during hip arthroscopy. Following a thorough diagnostic arthroscopy in the central compartment, as described elsewhere,  we prefer to come off traction. We come off traction for two primary reasons. One, to relax the capsule and allow for mobility and increased proximal capsule retraction during  acetabular rim work. And two, to provide for a more thorough diagnostic arthroscopy by allowing  the surgeon to directly visualize areas of impingement and instability. With the scope in  the anterolateral portal, two traction sutures are placed in the proximal capsule leaflet. One  medial and one lateral, both via the mid-anterior portal. Tension is maintained on the sutures via  the use of a hemostat to secure the sutures against the skin of the mid-anterior portal.  The hip is then flexed to 30 degrees, relaxing the capsule tissue. With the superficial proximal  capsule now retracted and out of the operative field, a more complete diagnostic arthroscopy may  be performed. We now have excellent visualization around the entirety of the acetabular rim,  allowing us to access the posterior joint as well as the anterior joint, deep to the psoas,  as seen here. At this time, the capsule labral interval is developed via gentle resection of  deep capsule tissue. An acetabuloplasty or subspine decompression may be performed at this time if necessary. We then typically switch portals, viewing from the mid-anterior portal  and working through the anterolateral portal. This will give improved access to the anterior  acetabular rim and subspine region if any work is required. Following this, we typically go  back on traction and perform the labor repair, which is not demonstrated in this video. Following  completion of the labor repair, attention is then turned back to the femoral head-neck junction for  the femoralplasty. Visualization is again optimized via the use of traction sutures, one anterior and one posterior in the distal capsule leaflet. With the hip flexed and capsule  retracted, the entirety of the femoral neck should be easily accessible for a thorough femoralplasty. Following this, the capsule is repaired with care to avoid entrapment of the  indirect head of the rectus femoris fibers, as demonstrated here. Thank you.

Video Summary

This video outlines techniques to enhance visualization during hip arthroscopy. After initial diagnostic arthroscopy, traction is released to relax the capsule, allowing better access and visualization of the acetabular rim. Traction sutures help retract the capsule, and the hip is flexed for optimal viewing. With improved access, surgeons can perform necessary procedures like acetabuloplasty or subspine decompression. The procedure involves alternating portal views to optimize surgery on different hip regions. Following labral repair, attention shifts to femoral head-neck work, using traction sutures for clear access, and careful capsule repair is emphasized to avoid tissue entrapment.

Asset Caption

Michael B. Ellman, MD
Nicole Anderson, PA-C

Keywords

hip arthroscopy

acetabular rim

traction sutures

labral repair

capsule repair