Hip arthroscopy. Technique for positioning and distraction

Arthroscopy of the hip joint can be performed in the supine or lateral position. The decision whether to use the supine or lateral position appears to be more a matter of individual training or habit. Both positions have specific pros and cons. The operative experience with arthroscopy of the central and peripheral compartment shows that a combined procedure with and without traction is beneficial. Whereas arthroscopy of the central compartment in normal joints of adults is feasible only with traction, the peripheral compartment can be better scoped without traction. The combination of both techniques however is technically demanding. Particularly for arthroscopy of the central compartment with traction, the success of the operative procedure is strongly correlated with a correct technique of positioning and distraction. Precise positioning and thick padding of the counterpost, secure fixation and thick padding of the foot, and the limitation of magnitude and duration of traction are important features in order to avoid soft tissue and nerve damage. Good relaxation, joint position, and distension of the joint to break the joint vacuum significantly improve distraction of the femoral head from the socket. In combination with fluoroscopy, scope trauma to the acetabular labrum and hyaline cartilage can be minimized. For arthroscopy of the peripheral compartment without traction, the counterpost is removed and the foot taken out of the traction module for free range of motion of the leg and hip joint. This allows dynamic testing of the hip and access to different parts of the peripheral labrum, proximal femur, and soft tissues.