Surgical Anatomy

The deeply recessed femoral head lies within the bony acetabulum. The hip joint is enclosed within a thick fibrocapsular and muscular envelope in close proximity to the sciatic nerve, lateral femoral cutaneous nerve, and femoral neurovascular structures.

Fluoroscopic images determine the relative distraction of the femoral head from the acetabulum (see accompanying video).

Treatment Options

• Lateral approach

• Supine approach

• The negative intra-articular pressure that results from the distraction force is released using a 6-inch, 18-gauge spinal needle with a Nytinol wire and an image intensifier if necessary. The needle is placed superior to the greater trochanter and tangential to the acetabulum, and a “give” sensation is felt upon capsule entry.

• A second 6-inch, 18-gauge spinal needle is then advanced into the hip capsule, and then the joint is injected with approximately 30 to 40 ml of normal saline. Flow from the second spinal needle confirms intra-articular placement of both needles.

   

  Hip Arthroscopy

   

   

   

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  FIGURE 1

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  Hip Arthroscopy

   

  FIGURE 2

   

   

   

  FIGURE 3

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