H�ftarthroskopie

Abstract

Arthroscopy of the hip joint has developed into a useful tool for the hip surgeon. Hip joint anatomy, however, makes special demands of the arthroscopist. He needs to be familiar with the arthroscopic anatomy of the hip and its variations. Moreover, he should have practical training in the technique of hip arthroscopy prior to his first intraoperative experience in order to avoid complications. A complete arthroscopic inspection of the hip can be achieved by using a combined procedure: whereas the central hip compartment can be scoped only by distraction of the joint, the periphery can be better seen without traction. Whether to place the patient supine or lateral is dependent on personal experience. No matter which position is used, the positioning technique has to be exact. The literature has shown that most complications are related to traction. Before the first portal is placed, the joint vacuum force should be broken by distension of air or fluid. This leads to maximum distraction of the joint and reduces the risks of damage to labrum and cartilage during first access to the joint. For a diagnostic round through the central compartment, at least two portals have to be placed. The use of a 3-portal technique increases the range of inspection. Due to the relatively thin soft tissue mantle and greater distance to neurovascular structures, the anterolateral or lateral portal should be used as the first portals to the central compartment. In addition, the anterolateral portal is the standard portal to the periphery of the hip. The posterolateral or anterior portal should be used as a supplementary portal. The following indications have been described for an arthroscopic procedure of the hip: loose bodies, labral lesions, synovial diseases such as chondromatosis and pigmented villonodular synovitis, associated lesions in underlying osteoarthritis, ruptures of the teres ligament, malorientation of the acetabulum and proximal femur and, last but not least, "idiopathic" hip pain. The use of hip arthroscopy in infectious arthritis, avascular necrosis of the femoral head, Perthes' disease, osteochondrosis dissecans and complications after total hip replacement is less frequent. Here, in addition to its diagnostic value, operative arthroscopy of the hip offers removal of loose bodies, resection of the labrum and ligaments, synovial biopsy, partial synovectomy, microfracturing, lavage and placement of intraarticular drainage. The first results of arthroscopic procedures in the hip are promising. In addition to its diagnostic value and contribution to the understanding of intraarticular anatomy and pathology, recent studies have demonstrated the advantages of the arthroscopic treatment of the hip.

A comprehensive review of hip labral tears

“…In regard to current treatment, the literature to date has focused on arthroscopic debridement of labral tears and surgical repair of associated structural problems [13, 35, 38, 42, 54, 89, 115, 116]. In an effort to prevent subsequent joint degeneration after labral injury, open [5, 117, 118] and arthroscopic [5, 41, 119, 120] approaches have been employed. Repair is particularly important for peripheral labral tears, which have the blood supply to heal [14, 29, 56].…”

Hip Arthroscopy in Children under the Age of Ten

“…Sports with repetitive flexion and abduction movements, such as gymnastics, skating, or dancing, are particularly predisposing for labrum lesions. Debridement and refixation of the labrum in adolescent athletes has also been described in previous studies, although currently labrum refixation can only be carried out at special medical centers [30,31]. The arthroscopic extirpation of free joint bodies in the case of flake fractures is technically feasible [1,10,12].…”

Hip Arthroscopy: Spatiotemporal Analysis in Three US States and Predictor of Revisit after a Procedure

“…Their spectrum of indications has widened [1] to include labral lesions, loose bodies, synovial diseases such as chondromatosis and pigmented villonodular synovitis, lesions resulting from underlying osteoarthritis, teres ligament rupture, acetabulum and proximal femur misorientation and "idiopathic" hip pain. Avascular necrosis of the femoral head, infectious arthritis, osteochondrosis dissecans, Perthes' disease, and complications after total hip replacement are less frequent indications [3]. Arthroscopy procedures are highly sensitive in identifying intra-articular pathologies including labral tears, loose bodies, osteochondral lesions and step deformities in traumatic injuries to the hip joint [4,5] and are thus valuable in treating these conditions [5].…”