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Abstract
Hip arthroscopy has been useful for resolving unexplained pains of the hip joint, despite its clinical applicability came after many other joints. Surgical indications have been increasing recently. Moreover, additional surgical techniques allow both the anatomy and function to return to its normal state. Recently, the concepts and treatments for extra-articular pathologies, such as deep gluteal syndrome, ischiofemoral impingement, subspinal impingement and iliopsoas impingement as well as classic indication, such as femoroacetabular impingement, acetabular labral tear, loose bodies, and synovial osteochondromatosis have been introduced. We present a diagnosis and treatment for diverse indications of hip arthroscopy, preoperative considerations, surgical technique and postoperative rehabilitation.
Figures and Tables
Figure 2
Radiographic evaluation for hip arthroscopy. (A) Simple radiography. (B) Three-dimensional computed tomography of the hip. The angle in femoral head is alpha angle. Increased alpha angle is a evidence of cam impingement. (C) Magnetic resonance arthrography. (D) Ultrasonography. A, acetabulum; L, labrum; FH, femoral head.
Figure 5
Iatrogenic injury in establishing portals. (A) Labral injury: the obturator cannula perforated the labrum (L). (B) Scuffing: iatrogenic chondral injury (arrow) in the femoral head. A, acetabulum; FH, femoral head.
Figure 7
Serial fluoroscopic images of the classic portal insertion method in the central compartment. (A) Vacuum seal shadow due to negative intraarticular pressure is created by distraction of the joint. (B) Needle is inserted and the stylet is removed, then break the seal. (C) As obturator is inserted into the joint, the operator can identify successful insertion of the spinal needle by the shape of the spinal needle under fluoroscopy. (D) After check of intraarticular pin insertion, arthroscopy is inserted.
Figure 8
Paralabral space (PS; white arrow). A, acetabular bone; AC, acetabuar cartilage; L, labrum.
Figure 9
Methods of acetabular labral repair. (A) Looped repair or rolling repair: The fiber of suture anchor rolls up the torn labrum (L). In looped repair, eversion of L may be occurred after procedure. (B) Through or basement repair: The suture line is passed through the substance of the L and can fix the base area of the L. After the repair, the anatomical shape of the L may be preserved. A, acetabulum; AC, acetabular cartilage.
Figure 10
Acetabular labral reconstruction using autologous iliotibial band. (A) Labral defect by previous labral resection. (B) Harvest of iliotibial band from ipsilateral hip. (C) Harvested autogenous iliotibial band (triangle). (D) Arthroscopic labral reconstruction was performed. The harvested iliotibial band (triangle) was transferred and repaired on acetabular margin for labral defect. (E) Identification of a successful reconstructed labrum at 2nd look arthroscopy. Triangle is harvested iliotibial band. A, acetabulum; AC, acetabular cartilage; AL, anterolateral portal; HS, Harvest site; FH, femoral head.
Figure 11
Motions of ligamentum teres according to hip rotation. While ligamentus teres is relaxed on internal rotation (IR), it is tensed on external rotation (ER) of the hip. FH, femoral head; LT, ligamentum teres; AF, acetabular fossa.
Figure 12
Arthroscopic femoroplasty. (A) Subchondral bone of the femoral head (FH)-neck junction was exposed for decompression. (B) After femoroplasty (arrow), the operator has to check the relationship between labrum (L) and FH.
Figure 13
Ischiofemoral impingement occurred at the ischiofemoral space (IS) between the ischium and lesser trochanter of femur (F). The quadratus femoris muscle was injured and high signal intensity (white arrow) was shown in magnetic resonance imaging. IT, ischial tuberosity.
Figure 14
Acetabular labral tear by iliopsoas impingement is located more anteriorly than that by femoroacetabular impingement. (A) Spinal needle is located at 1 o'clock from the anterior portal and labral tear (white arrow) at the far anterior position. (B) Labral tear (white arrow) is found at 3 o'clock of acetabulum. A, acetabulum; FH, femoral head; L, labrum.
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