Hip Arthroscopy by the Lateral Approach

Hip arthroscopy performed with patients positioned on their sides is designed to help visualize the hip joint and maneuver instruments in obese patients and to enter the hip joint in patients with spurs on the anterolateral aspect of the acetabulum. The patient is placed on his/her side with the hip for surgery on top. The leg is placed in traction and a well-padded perineal post is applied for counter traction. An image intensifier is placed around the hip to aid in directing the instruments into the hip joint. Traction is necessary to reach the depths of the hip joint. After traction is applied, 2 portals are made over the greater trochanter and one directly anterior. To help in maintaining the portals and in maneuvering the arthroscope and instruments, a capsulotomy is performed at each portal sight. To visualize the intracapsular area around the femoral neck, traction is released and the hip flexed. An additional, ancillary portal may be required to reach the intracapsular portion around the femoral neck. This portal is made anterior and distal to the first direct anterior portal. We found this approach to be highly effective in all cases. A regular traction table requires adjustments of the perineal and traction posts to apply traction on legs in patients on their sides. Special traction devices make the set up easier. The lateral approach to the hip for arthroscopy provides a safe and consistent way of entering, visualizing and performing surgical procedures in the hip.