Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation

Abstract

Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases.

Basic Hip Arthroscopy: Diagnostic Hip Arthroscopy

“…Proper patient positioning and portal establishment is critical to efficiently and effectively perform a diagnostic hip arthroscopy (Table 3). 3,4 Systematic review of the anatomy will ensure that all pathology is identified. We strategically evaluate and treat the central compartment first and then progress to the peripheral compartment of the hip.…”

“…A consistent approach to the diagnostic arthroscopy may also maximize the efficiency of operative time to best address the identified pathology. In this series of articles, we previously described the positioning for hip arthroscopy 3 and establishment of arthroscopic portals. 4 The current article and accompanying video is the third in the series in which we outline the steps necessary to perform a diagnostic hip arthroscopy.…”

Anesthesia for hip arthroscopy: a narrative review

“…That said, some degree of relative intraoperative hypotension is often used, and it is recommended to maintain the mean arterial pressure no higher than 65 mmHg in order to provide optimal conditions for visualization. 17 Perioperative adverse events associated with intraoperative hypotension (e.g., perioperative myocardial infarction and stroke) are uncommon in this patient population. 18,19 Intra-articular visualization is also aided by continuous irrigation of the joint space using a pump system that also allows for control and monitoring of exact pressure and flow and helps to limit periarticular fluid extravasation.…”

Basic Hip Arthroscopy: Anatomic Establishment of Arthroscopic Portals Without Fluoroscopic Guidance

“…The operative hip is placed in 15 of flexion with 0 of adduction and then prepped, draped, and placed in traction as detailed by Mannava et al 1 To mark the patient's anatomy and portal sites, the surgeon starts with palpation of the anterior and posterior margins of the greater trochanter (Video 1). The location for the anterolateral portal is approximately 10 mm anterior and 10 mm distal to the greater trochanter (Fig 1).…”