1. 13th INDIAN ARTHROSCOPY SOCIETY CONGRESS
10th – 12th October 2014 Hyderabad
Hip Arthroscopy
- How to do it -
Dr. M. Lais
Orthopedic surgeon
Freiburg
www.praxisklinik2000.com

2. introduction
• Concept of FAI is a revolution in joint
preservation surgery (R. Ganz)
• FAI is a frequent reason for groin pain
• Cartilage and labrum damages lead to
Osteoarthritis (Beck M. JBJS 2005)
• In the meantime treatment of FAI is an
essential part in our daily operation program

3. Problems in the beginning
• don`t underestimate the first few hip
arthroscopies
• every surgeon starts in hip arthroscopy as
a `bloody` beginner
• do some hospitations before you start this
procedure
• check your equipment before you start
• no time pressure in the beginning

4. Anatomy and problems
o Strong capsule – limited distraction
o Thick soft tissue mantle – less motion
o Ball-socket-joint – limited orientation
o Constrained joint – bony coverage
o Neurovascular bundles
o 70 degree scope
o high risc of cartilage damages

5. HIP ARTHROSCOPY
Different steps are necessary for a succesful procedure

6. Orthopedic surgeon
• Arthroscopic surgeon
> 500 operative cases
• Experiences in knee and
especially shoulder
arthroscopy
• cartilage treatment
• Operative shoulder
surgery
• Labrum refixation
techniques

7. Orthopedic surgeon
 create a small team
1 or 2 „young“ orthopedic surgeons
1 or 2 scrub nurses
all should be motivated learning new techniques
 teaching for the surgeon and the nurse necessary
 the same team should operate a large number of
cases
 experienced anaesthesia
for reducing blood pressure

8. HIP ARTHROSCOPY

9. Indications for Hip Arthroscopy
• Femoroacetabular Impingement (FAI)
• Loose bodies
• Labral tears
• chondral damages
• Disorders iliopsoas tendon
• Lig. Teres injuries
• Synovial disease
(Contra) Indication for Hip Arthroscopy
• increasing osteoarthritis (joint space < 2mm)

11. HIP ARTHROSCOPY

12. Patient positioning
Central compartment
Peripheral compartment

13. Fluoroscopy
C-Arc
Endoscopy unit
Patient position and order of the OR

14. Abduction - Traction 40-60 kp - Adduction
Flexion 10 degrees

15. Patient positioning
25 cm 30 cm
peroneal post
Measering the diameter from the original post
An upholsterer will create different diameter of
oversized posts

16. Avoid complications
• nerve lesions because of insufficient post
• soft tissue damages
• Insufficient traction leads to cartilage
damages
• for avoiding complications precise
positioning, padding of the counterpoint
and save fixation of the foot are necessary
• start the operation with distraction of the
hip (central compartment)

17. HIP ARTHROSCOPY

18. Technical equipment
 Traction table
 30 º and 70 º scope
 special instruments
 Shaver
 RF Device (Waper)
 Pump
 Fluoroscopy unit

19. High Flow Sheath 6 mm
(working length,
double in/outflow)
Spinalneedle with guide wire
Canulated trocar

20. Scope system and instruments

22. left hip

27. Creating antero lateral portal - Scope lateral
approach - penetration capsule – dilatation –
half pipe - splitting of the capsule
left hip

28. Preparation
Halp pipe system necessary to introduce the instruments
Banana knife for cutting the capsule

30. Fluoroscopy unit
• Control the traction
• Placement of the lateral
and anterolateral portal
• Position of the arthroscope and
the instruments
• Area of resection (Rim and neck of the
femur)

31. Summary
• Demanding procedure
• Long operation time (> 3hrs)
• Long learning curve
• a lot of complication in the beginning
(cartilage damages)
• Trouble with the traction
• Unusual 70 degrees scope
• Patient selection
(no osteoarthritis, stiff hip, overweighted people)

32. dhanyawad