Table 1.

Critical Concepts in Hip Arthroscopy for Femoral Head Fracture and Hip Trauma

Indications

Pain of unknown origin with or without loose bodies after hip trauma

Contraindications

Unstable hip joint caused by surrounding soft-tissue injuries

Pitfalls

Hip trauma

Clinical experience with femoroacetabular impingement surgery is needed.

Surgical techniques for a torn labrum are not like those for flap tears of the labrum, because on 1 side there is a tear and it is freely moving in the joint. An additional third portal should be made on the midanterior side; this can be used in the capsular repair procedure also. Through the anterior portal, the surgeon should grasp the medial border of the torn labrum. The reattachment procedure should be performed through the midanterior portal.

Capsulotomy

To examine the inner joint space, a T-shaped capsulotomy is preferred. Although capsulotomy is typically made along the midneck region, we prefer going through the midanterior portal. This allows for better visualization of the head-neck area and all around the labrum.

Torn labrum

Torn labrum should be reattached to its original site with a suture anchor.

Loose bodies or osteochondral fragments

Loose bodies or osteochondral fragments are usually impacted in the cotyloid fossa, but some are also impacted on the articular surface. These fragments are not easily removed with a hip arthroscopic shaver alone; sometimes they need curettage. Some larger fragments cannot be removed by a grasper, but it is much better to remove fragments by a grasper or shaver.

Advantages

Excellent cosmetic results are obtained.

Early ambulation and rehabilitation are permitted.

Disadvantages

Surgical skill in hip arthroscopic surgery is required.

The procedure is recommended for skillful hip arthroscopists only. An inexperienced hip arthroscopist may damage the chondral part by, for example, scuffing.

Sometimes surgeons should be willing to open the hip joint if hip arthroscopy does not allow proper examination of the hip joint.

Tip and pearls

The surgeon should start with hip traction and always use a cannula for labral reattachment and removal of osteochondral fragments.

Labral side: torn labrum (same as an avulsion fracture)

Reattach the flap-like tear (as in femoroacetabular impingement).

If 1 side is detached, the tear side should be grasped or fixed to the margin and reattached by a loop-around technique made at the midanterior portal.

We think that using a mattress stitch may do more damage to the torn labrum.

Osteochondral fragments

Fragments located in the joint should be curetted first; a shaver alone is not enough.

The surgeon should use a grasper for large fragments and remove them through a cannula. (If one is using a gasper, the cannula's rubber side or silicone valve should be opened first.)

Take-home messages

To diagnose pain of unknown origin or limited range of motion after hip trauma is difficult with magnetic resonance imaging because of metal artifact.

Hip arthroscopy now presents useful alternative methods for diagnosis and treatment in the trauma setting.

Hip arthroscopic management should be performed only after one has significant experience with femoroacetabular impingement.