Top Ten Pearls for Successful Hip Arthroscopy for Femoroacetabular Impingement

Abstract

Hip arthroscopy is an increasingly popular procedure used to treat femoroacetabular impingement. However, the procedure is technically challenging with a steep learning curve. To prevent complications and to optimize patient outcomes, proper patient positioning, correct portal placement, and adequate capsular closure are necessary. For central compartment procedures, creation of a minimal interportal capsulotomy, placement of traction stitches, adequate rim trimming, and balanced labral repair are recommended. For peripheral compartment procedures, adequate osteochondroplasty should be performed and assessed intraoperatively. The purpose of this technical note is to describe the senior author's top 10 pearls for a successful hip arthroscopy procedure to treat femoroacetabular impingement.

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

“…Based on the trend outlined in the present study, the force required remains in a harmful range for patients with PCR and PS TKRs. Moreover, capsulotomies have been a debated procedure to reduce traction forces [60, 61]. The size of the capsulotomy is known to reduce the traction force; however, capsule repair is essential to return the capsule to its native functionality [62, 63].…”

Noninvasive shape‐fitting method quantifies cam morphology in femoroacetabular impingement syndrome: Implications for diagnosis and surgical planning

“…All patients were recruited from a single surgeon's high‐volume hip preservation clinical practice (Shane J. Nho). To be selected for this particular study, all participants had to meet the following criteria: be diagnosed with cam‐type FAIS based on clinical examination, have radiographic evidence of alpha angle $$\gt 5{0}^{\circ }$$, be scheduled to undergo hip arthroscopic surgery with a planned surgical resection of the proximal femur to remove the cam morphology, and be scheduled to undergo both preoperative and postoperative 1.5T MRI (Figure 1[1]) 49–52 . Exclusion criteria for the study included: radiographic evidence of Tönnis Grade $$\gt 1$$ hip osteoarthritis (OA), history of prior surgery to the index or contralateral hip, and history of a developmental hip disorder such as Legg‐Calvé‐Perthes disease, slipped capital femoral epiphysis, or developmental hip dysplasia (lateral center edge angle [LCEA] $$\lt 2{0}^{\circ }$$).…”

Hip Capsular Reconstruction With Indirect Head of the Rectus Femoris Tendon

“…To secure the patient’s position during distraction and throughout the case, either a padded perineal post or a post-free pink pad device may be used (Smith & Nephew, London, United Kingdom). 5 In the setting of capsular insufficiency, ample distraction of the joint will be achieved with minimal effort, reflecting loss of the biomechanical resistance to distraction ( Fig 2 A).

Fig 2 Right hip capsular insufficiency and instability to distraction forces, reflected by ample joint space opening even upon gentle distraction on the hip arthroscopy table (A).

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“… 1 , 2 , 3 An important procedural step in hip arthroscopy is the capsulotomy, which allows for appropriate visualization and necessary instrument access. 4 , 5 The hip capsule and in particular the iliofemoral ligament, however, are important static stabilizers of the hip joint. Consequently, as the number of hip arthroscopy cases grows, so too does the incidence of capsular iatrogenic hip instability.…”