Hip arthroscopy via a peripheral compartment first capsular-preserving technique: a step-by-step description

Abstract

Hip arthroscopy is a well-recognized procedure for the treatment of several hip pathologies. Different methods of arthroscopic access to the hip have been published. The most popular approach is the central compartment first technique, where the first portal to the central compartment is placed under traction and fluoroscopic control. This technique, however, carries the risk of iatrogenic damage to the cartilage and labrum, especially when adequate distraction cannot be obtained. In addition, secondary exposure of the peripheral compartment frequently requires larger capsulotomies. The current article is to describe an alternative arthroscopic approach to the hip with the peripheral compartment being first accessed. The peripheral compartment first technique offers the advantages of a limited capsular release for peripheral compartment exposure and a reduced risk of iatrogenic cartilage and labrum damage during subsequent central compartment portal placement.

Noninterportal capsulotomy of hip arthroscopy showed improved outcomes in borderline hip dysplasia: A retrospective study with minimum 2‐year follow‐up

“…The favourable result presented herein confirms this hypothesis. Time consumption is a potential disadvantage described in a previous article [40]; however, we achieved shorter surgery and traction times with the NIPC technique described herein, which may be the result of practised technology.…”

“…The surgical procedure for the NIPC hip arthroscopy has been previously described [40] and included femoroplasty and labral repair conducted by the same senior surgeon since 2018. Each patient was placed in a modified supine position on a traction table with general anaesthesia.…”

“…Dienst et al [12] and Tang et al [40] described an arthroscopic technique entering via the peripheral compartment (PC) to preserve the capsule and its original structural stability; however, there is a lack of data on the outcomes of this technique for patients with BHD. Therefore, based on patient selection criteria, our group performed noninterportal capsulotomy (NIPC) hip arthroscopy on patients with BHD to preserve the original structure of the hip capsule.…”

Distraction Gap Needed for Safe Central Compartment Access in Hip Arthroscopy

“…All hip arthroscopic surgeries were performed by the senior author using the peripheral compartment-first technique. 20 With the patient under general anesthesia, the unsterile traction test was performed before draping. Patients were placed in the supine position on a fracture table (Maquet) with a wide perineal post situated against the perineum.…”

“…The intracapsular region of the hip is divided into the central compartment (CC) and the peripheral compartment. 8 Hip arthroscopy can be performed with different starting points, including the CC, 2 the peripheral compartment, 6,20 and the extra-capsular compartment. 9,12,21 No matter which technique is used, sufficient distraction of the hip is the key to a successful and safe arthroscopic approach to the CC.…”