Knee Surg, Sports TraumatoI, Arthroscopy (1994) 2:255-258 Knee Surgery j Sports Traumatology ] Arthroscopy ] 9 Springer-Verlag 1994 Arthroscopic surgery of the hip: current status E H. Norman-Taylor, R. N. Villar Department of Orthopaedic and Trauma Surgery, Addenbrooke's NHS Trust, Cambridge, England, UK Abstract. Arthroscopy of the hip is now recognised as a valuable diagnostic and therapeutic procedure [23]. It is still relatively new and remains largely in the hands of a few specialist centres, but orthopaedic surgeons are in- creasingly willing to provide it as part of their own ser- vice. This article outlines its background and details its clinical and technical application. Key words: Hip joint - Arthroscopy - Diagnosis - Oper- ative surgery History The hip has long been neglected by the arthroscopist. This may be bacause of its apparent inaccessibility or a per- ceived paucity of indications. In 1931 Michael Burman reported: "We have not been able to separate the apposing surface of the hip joint, and a separation does not seem likely after studying the anatomical structure of the joint" [2]. With the improvements in instrumentation that oc- curred in the 1970s, however, reports of hip arthroscopy began to re-emerge. These included its use in children [12] [13] the removal of prosthetic debris [21] and syn- ovial biopsy [13]. Improved access to the hip was achieved in the 1980s with the use of specialist traction devices and the instillation of air and saline into the joint to overcome its intrinsic vacuum [9] [5]. In the last 10 years the number of indications and therapeutic options has rapidly expanded. Materials and methods Equipment Hip arthroscopy can be performed using standard arthroscopy, traction and X-ray equipment. Special hip arthroscopy instruments are available, however, and the correct application of traction is most readily achieved using specialist equipment. Hip distraction A specially-designed traction apparatus, such as the Arthronix Hip Distractor (Fig. 1, Arthronix Corporation, 510 Route 304, New Correspondence to: F. H. Norman-Taylor, FRCS, Orthopaedic Registrar, Clinic 1, Box 37, Addenbrooke's NHS Trust, Hills Road, Cambridge, CB2 2QQ England, UK City, NY, 10956, USA) applies traction in the line of the femoral neck. This is achieved by simultaneous longitudinal traction via a traction boot and lateral displacement by a perineal bar. A ten- siometer measures the force applied. Excellent access to the joint is achieved and this is the method of choice for the majority of proce- dures. It allows 1.5 to 4.0 cm of distraction with less than 25 kg of traction. One of the disadvantages of this type of distraction is the need for the patient to lie in the lateral decubitus position, limiting the use of the anterior approach. In addition, at present such devices are expensive due to the low demand for them, and surgeons per- forming only occasional hip arthroscopy may prefer to use a stan- dard orthopaedic traction table. In this case the patient is supine, al- lowing the use of the anterior approach as well as the lateral ap- proach. It has the disadvantage, however, of limited distraction. A rthroscope The hip joint is deep-seated. Its shape and its sturdy surrounding structures require a 4.5 mm minimum diameter arthroscope. Stan- dard length arthroscopes are usually adequate, except in obese pa- tients for whom specially lengthened arthroscopes can be used. A viewing angle of 70 degrees is the most useful, but a 30 degree arthroscope and a range of further viewing angles should be avail- able. A camera system is essential in order not to compromise sterility. Video recordings and still photographs can be obtained in the normal way. Irrigation Standard irrigation techniques are used. Sterile normal saline can be delivered directly from a suspended bag or a high pressure pump system can be used, particularly when powered instruments are creating much debris or when bleeding is profuse. In-flow is via a cardiac needle and outflow is via the arthroscope in order to maximise articular distension. Operating instruments Manual instruments may be employed, but powered tools are pre- ferred. Those used for knee arthroscopy are generally adequate, but specially-designed instruments are helpful for awkward angles and where extra depth is required. Powered synovectomy and chondroplasty tools are the most useful. The use of laser in the hip is at present undergoing evaluation and has several possible ad- vantages. It can potentially work at any angle, produces less debris and, once in place, requires few further manoeuvres (Fig. 2). Portals of entry There are three potential portals of entry: lateral, anterior and posterior. The posterior approach has only been de- scribed as an open procedure [ 10]. A closed posterior ap- proach risks damage to the sciatic nerve and cannot be recommended. The anterior portal was favoured by early