Table 1.

Pearls and Pitfalls of Acetabular Subchondroplasty

Pearls

Preoperative assessment of the cyst location with MRI is paramount for correct placement of the cannula.

Positioning of the cannula in the acetabulum must be performed under 2 incidences of fluoroscopic guidance.

Intra-articular visualization with the arthroscope through the AL portal during injection is mandatory to assess possible BSM extravasation.

Pitfalls

Holding the syringes for a long time should be avoided. The calcium phosphate hardens in an endothermic reaction at body temperature.

After feeling some resistance, the surgeon should not keep injecting the paste. Overfilling the cyst is a cause of immediate postoperative pain.

Proper patient selection is key for achieving good outcomes. Patients with advanced osteoarthritis may not benefit from the procedure.

BSM, bone substitute material; MRI, magnetic resonance imaging.