Technique

The hip joint has both an intraarticular and a peripheral compartment. Most hip pathology is found within the intraarticular region; therefore, distraction is necessary to achieve arthroscopic access. The patient can be placed supine or in the lateral decubitus position for performing the procedure [5,6]. Both techniques are equally effective; therefore, the choice is simply dependent on the surgeon's preference. An advantage of the supine approach is its simplicity in patient positioning, while the lateral approach may be preferable for severely obese patients.

Performing hip arthroscopy without traction has not been popular because it does not allow access to the intraarticular region [7]. However, it is now recognized that this method can be a useful adjunct to the traction technique [8]. Hip flexion relaxes the capsule and allows access to the peripheral compartment, which is intracapsular, but extraarticular. Numerous lesions are encountered in this area that are overlooked with traction alone, such as synovial disease and free-floating loose bodies. Femoral sided impingement

Fig. 1. The patient is positioned on the fracture table so that the perineal post is placed as far laterally as possible toward the surgical hip resting against the medial thigh. (From Byrd JWT. The supine approach. In: Byrd JWT, editor. Operative hip arthroscopy. 2nd edition. New York: Springer; 2005. p. 145-69; with permission.)

Fig. 1. The patient is positioned on the fracture table so that the perineal post is placed as far laterally as possible toward the surgical hip resting against the medial thigh. (From Byrd JWT. The supine approach. In: Byrd JWT, editor. Operative hip arthroscopy. 2nd edition. New York: Springer; 2005. p. 145-69; with permission.)

lesions (cam impingement) are best addressed from the peripheral compartment. Hip flexion also allows generous access to the capsule for plication or thermal modulation.

The technique illustrated is one with the patient in a supine position (Fig. 1). The important principles for performing safe, effective, reproducible arthros-copy are the same whether the patient is in the lateral decubitus or supine orientation. Portal placements, relationship of the extraarticular structures, and arthroscopic anatomy are also the same, regardless of positioning.

A standard fracture table or custom distraction device is needed to achieve effective joint space separation. A tensiometer can be helpful to monitor the traction forces intraoperatively. The C-arm is important for precise placement of the instrumentation within the joint.

The procedure is commonly performed under general anesthesia. It can be performed under epidural anesthesia but requires an adequate motor block to ensure optimal distractibility of the joint.

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