Hip Arthroscopy of the Central and Peripheral Compartments by the Lateral Approach

Arthroscopically the hip joint can be divided into 2 compartments: the central compartment or iliofemoral joint and the peripheral compartment, which includes structures in the capsule and lateral to the labrum. The central compartment can only be accessed with hip distraction. Supine or lateral positioning of the patient on traction devices has been described in the literature as a means to obtain adequate joint distraction for hip arthroscopy. The peripheral compartment is better examined without traction. Most of the literature describes this procedure after central compartment arthroscopy, traction is released, and the peripheral compartment is accessed. This has been described using the supine position. This study describes the same technique using the lateral position. We describe findings in a series of 24 hip arthroscopies in which both compartments were accessed with the patient in the lateral position. The standard anterolateral, posterolateral, and anterior portals were used for arthroscopy of the central compartment. Inferior accessory portals were used to access the peripheral compartment. Central compartment pathology was found in every case. Peripheral compartment arthroscopy was done successfully in all cases. Only 5 patients presented pathology, which included hypertrophic synovial folds in two cases, and inferior osteophytes, loose bodies, and synovitis in one case, respectively. We found that the peripheral compartment can be accessed reproducibly and safely using the lateral position, although we do not access it routinely in cases with loose bodies and synovial disease or cases in which peripheral compartment pathology is demonstrated, are good indications for the procedure.