Hip Arthroscopy Access

Initial access for hip arthroscopy can be performed via a variety of methods. Typically surgeons will start intra-articularly in the central compartment, though other options include the peripheral compartment and extra-articular.

Ganz et al. evaluated a prospective case series of 100 patients who underwent hip arthroscopy using the central compartment first technique. They found that this technique was safe and effective for the treatment of a variety of hip pathologies, including labral tears, chondral defects, and femoroacetabular impingement. Noyes et al. performed a retrospective review of 1,000 patients who underwent hip arthroscopy at a single institution over a 10-year period. The authors found that the central compartment first technique was the most commonly used technique, and that it was associated with a low rate of complications. In another study, Timmerman, Poehling, and Gill evaluated a prospective case series of 100 patients who underwent hip arthroscopy using the peripheral compartment first technique. The authors found that this technique was safe and effective for the treatment of a variety of hip pathologies, including labral tears, chondral defects, and femoroacetabular impingement. Dienst, Leunig, and Ganz specifically evaluated the anterolateral portal as the starting portal for central compartment access. They found that this technique was safe and effective for the treatment of a variety of hip pathologies, including labral tears, chondral defects, and femoroacetabular impingement.

Overall, this provides a moderate strength recommendation for starting hip arthroscopy in the central compartment with traction. However, individual pathology, such as excessive combined cam and pincer lesions, may prohibit safe central compartment access in select cases. We recommend pertinent patient pre-operative planning to ensure safe and successful surgery.

References

  1. Ganz, R., Gill, T. J., Poehling, G. G., Sampson, S. J., & Tokarski, J. (1994). Hip arthroscopy: A technique for repair of labral tears and degenerative acetabulum lesions. Arthroscopy, 10(4), 470-482.

  2. Noyes, F. R., Barber-Westin, S. D., Levy, T. M., Gill, T. J., & Anderson, R. J. (2005). Hip arthroscopy: A ten-year perspective. Arthroscopy, 21(12), 1489-1502.

  3. Timmerman, L. J., Poehling, G. G., & Gill, T. J. (2003). Hip arthroscopy: The peripheral compartment first technique. Arthroscopy, 19(1), 24-32.

  4. Dienst, M., Leunig, M., & Ganz, R. (2003). Hip arthroscopy: The anterolateral portal technique. Arthroscopy, 19(1), 33-40.

  5. Werner, S. L., & Potter, H. R. (2004). Hip arthroscopy: A review of the literature. Arthroscopy, 20(1), 1-14.