Is There a Role for Ultrasound in Hip Arthroscopy? A Systematic Review

Abstract

Purpose The purpose of this study is to identify and summarize the current utility of intraoperative ultrasound (US) during hip arthroscopy. Methods A systematic database query of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, EMBASE, PubMed (1980 to 2019), and Ovid MEDLINE (1980 to 2019) was performed. After article identification, descriptions of the surgical procedure, use of intraoperative US, procedural complications, and conclusions from each article were recorded and summarized. Results Five studies met inclusion criteria, all of which were surgical techniques or technical notes. Four of the 5 studies described US used for placement of arthroscopic portals, and 1 described the use of an intraarticular US catheter for the assessment of an osteochondritis dissecans (OCD) lesion. Of the 4 studies using US for portal placement, 3 were performed supine and 1 was performed in the lateral decubitus position. All studies recognized the need for additional US training or the required assistance of a radiologist to incorporate US into a surgical practice. Conclusion Descriptions of intraoperative US during hip arthroscopy are limited in the literature. However, existing technique reports demonstrate the feasibility of US for both portal placement with superficial probes and limited evaluation of cartilage using intraarticular US catheters. Level of Evidence V, systematic review.

Intraoperative Use of Ultrasound for Assessing Cam Deformity and Cam Resection

“…Several studies and technical articles have examined intraoperative use of US during hip arthroscopy for portal placement and for diagnoses other than FAIS. 21 , 22 , 23 , 24 , 26 Technique articles describing US-guided portal placement found it to be effective and reported low rates of chondral or labral injury; however, they did not compare US with conventional fluoroscopy. 21 , 22 , 23 , 24 In a recent cadaveric study in which portals were made by the same surgeon under US versus fluoroscopic guidance, Trasolini et al.…”

“… 21 , 22 , 23 , 24 , 26 Technique articles describing US-guided portal placement found it to be effective and reported low rates of chondral or labral injury; however, they did not compare US with conventional fluoroscopy. 21 , 22 , 23 , 24 In a recent cadaveric study in which portals were made by the same surgeon under US versus fluoroscopic guidance, Trasolini et al. 25 found rates of iatrogenic injury to be significantly greater with US guidance.…”

“… 16 , 17 , 18 Although US can be used to assess the alpha angle, 16 , 17 , 18 , 19 , 20 much of the literature regarding the use of US in hip arthroscopy has addressed arthroscopic portal placement. 21 , 22 , 23 , 24 , 25 Given the significant disadvantages of fluoroscopy, the use of US to assess the alpha angle intraoperatively and, thereby, the adequacy of cam resection is of substantial interest in the arthroscopic treatment of FAIS. The purpose of this technical article is to provide instruction and guidance on the use of intraoperative US to measure the alpha angle and determine the adequacy of cam resection.…”

Ultrasound Can Determine Joint Distraction During Hip Arthroscopy but Fluoroscopic-Guided Portal Placement Is Superior

“…The use of a musculoskeletal-trained radiologist for the administration and interpretation of the US may have affected our results. 28 However, the intent of this study was to assess the feasibility of a fluoroscopic-trained hip arthroscopist to incorporate US into their practice; having an musculoskeletal-trained radiologist present at every hip arthroscopy case to establish portals would not be a reasonable option. Our cadaveric model also does not account for synovitis or bleeding, which may limit US visualization during surgery.…”

“…A recent systematic review found 5 technique articles that described the use of US for the hip intraoperatively. 28 Studies referring to hip arthroscopy for the treatment of FAIS showed arthroscopic portal placement under US guidance. 29 , 30 A clinical study demonstrated favorable complication rates for US-guided hip arthroscopy compared with a conventional fluoroscopic approach, but information regarding the external validity of this result is limited.…”