Endoscopic hip osteotomies: less invasive approaches to peri-acetabular, proximal femoral and pubic symphyseal procedures

Abstract

Beyond the recent expansion of extra-articular hip arthroscopy into the peri-trochanteric and subgluteal space, this instructional course lecture introduces three innovative procedures: endoscopy-assisted periacetabular osteotomy, closed derotational proximal femoral osteotomy and endoscopic pubic symphysectomy. Supportive rationale, evolving indications, key surgical techniques and emerging outcomes are presented for these innovative less invasive procedures.

Endoscopy-Assisted Periacetabular Osteotomy

“…Although 2 cadaveric studies have been published 11,12 and an endoscopic triple osteotomy has been used in children, 13 we present a technical note and lessons learned from the performance of endoscopy-assisted PAO.…”

“…16 Our cadaver work showed the proximity of the osteotome tip during these bone cuts (Fig 8). 12 Although the obturator internus muscle is interposed between the ischium and the sciatic nerve, it would provide minimal protection from a wayward osteotome. Endoscopy of the posterior peritrochanteric region (subgluteal space) without hip distraction enables visualization and mobilization of the sciatic nerve, which may be followed proximally and distally with blunt dissection via a switching stick.…”

Combined Hip Arthroscopy and Periacetabular Osteotomy (PAO): Technical Focus on Arthroscopically Elevating the Iliocapsularis and Performing the Open PAO

“…3 The PAO technique as a stand-alone procedure has been described in detail, 3,5 as well as the PAO in conjunction with hip arthroscopy, [6][7][8][9] and even an endoscopy-assisted PAO. 10,11 Patients with symptomatic dysplasia have a very high incidence of intra-articular cartilage or labral damage, reported as high as 78% of prearthritic hips (in female adolescents aged 12-19 years) having cartilage damage and 78% having labral tears. 12 It is for that reason that combining the PAO with concomitant hip arthroscopy can be a useful strategy to address all extra-and intra-articular pathology in one surgical setting in appropriately selected individuals with symptomatic hip pathology.…”