Technical Overview

The hip joint has an intra-articular and peripheral compartment. Most hip pathology is found within the intra-articular region, and distraction is necessary to achieve arthroscopic access. The patient can be placed in the supine or lateral decubitus position for performing the procedure.5,6 Both techniques are equally effective, and 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 intra-articular region. However, it is now recognized that this method can be a useful adjunct to the traction technique.7,8 Hip flexion relaxes the capsule and allows access to the peripheral compartment, which is intracapsular but extra-articular. Numerous lesions are encountered in this area that are overlooked with traction alone. Synovial disease often covers the capsular surface, and free-floating loose bodies can hide in the peripheral recesses. This also allows generous access to the capsule for capsulorrha-phy and is essential for addressing impingement lesions of the proximal femur.

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