HIP ARTHROSCOPY USING A LIMITED ANTERIOR EXPOSURE

Participants: J.K. Sekiya, E.M. Wojtys, R.T. Loder, R. N. Hensinger

Keywords: hip arthroscopy, loose bodies, labral tears

Introduction

Hip arthroscopy is a technically difficult procedure to perform. A limited anterior approach to the joint has made hip arthroscopy technically less difficult in our hands and has enabled us to treat a wider range of hip pathology.

Materials and Methods

Five hip arthroscopies were performed at the University of Michigan Hospitals using a modified 4 cm Smith-Petersen anterior approach to the hip. The plane between the tensor fascia latae and sartorius was developed with identification and protection of the lateral femoral cutaneous nerve. The direct head of the rectus femoris was incised, and the iliopsoas tendon was retracted medially, exposing the joint capsule as manual traction was applied. The arthroscope was usually easily introduced making visualization of the femoral head and acetabulum, fovea and labrum possible.

Results

Three of the arthroscopies performed resulted in debridement of either an osteochondral fragment, synovitis, or cartilaginous debris. Two of the arthroscopies involved removal of loose bodies. In all five cases, there were no complications and the patients have been followed post-operatively from 3 to 9 months with a mean follow-up of 4.8 months.

Conclusion

We feel that hip arthroscopy through a limited anterior approach combines the benefits of an arthroscopic and open procedure. The risk of neurovascular trauma is decreased due to direct visualization of key structures and minimal manual traction. As the approach minimizes the need to navigate through extensive soft tissues, there is improved maneuverability with arthroscopic instruments and a decreased risk of iatrogenic damage to the articular cartilage and acetabular labrum, especially when introducing instruments into the joint. Hip motion is possible during the procedure allowing increased visualization of the joint. This exposure allows the Orthopaedic surgeon with basic arthroscopic skills and familiar with the anterior approach to the hip, the ability to perform this otherwise technically difficult procedure.