Hip Arthroscopy: The Peripheral Compartment

Background: Pediatric septic arthritis of the hip is a surgical emergency. Facing a hip flexum and fever, surgeons can use comparative ultrasound to confirm the diagnosis and to establish the surgical indication. While needle aspiration-irrigation is a simple and quick method, it gives rise to a high rate of recurrence. The purpose of our study was to demonstrate that hip arthroscopy by extracapsular approach is an effective and accessible alternative applicable in emergency situations. Methods: This is a report of 2 cases (7 years-135 cm; 13 years-143 cm) of needle aspiration-irrigation failure subsequently treated by hip arthroscopy. The X-ray and arthroscopy-assisted extracapsular technique was performed on a conventional orthopedic table, using a 30 degree arthroscope and a 3.5mm diameter motorized knife. Minimally invasive anterior longitudinal capsulotomy was performed by 2 anterolateral approaches via the proximal and distal tensor Fasciae Latae muscle, without dedicated instrumentation, followed by sampling, irrigation, removal of false membranes, synovial biopsies, partial synovectomy, cartilage assessment of the central then peripheral compartment and placement of a drainage. Results: In both cases, effusion completely disappeared and the inflammatory process gradually normalized with antibiotic therapy without any repeat procedure or complications related to the approach. Weight bearing was resumed in 3 weeks. Postoperatively, in 6 months and 15 months respectively, after resumption of sports activities hip examination was painless and no damage was noted on x-rays in either case. Conclusion: In our experience, hip arthroscopy by extracapsular approach can effectively address cases of failed needle aspiration-irrigation in pediatric septic arthritis of the hip. It could be provided as first-line emergency treatment in the event of purulent septic arthritis or late management, as a replacement for arthrotomy.

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Hip Arthroscopy With Initial Access to the Peripheral Compartment: A Detailed Step-by-Step Technique Description

Arthroscopy Techniques ◽

10.1016/j.eats.2020.07.006 ◽

2020 ◽

Vol 9 (11) ◽

pp. e1651-e1655 ◽

Cited By ~ 1

Author(s):

Pedro Dantas ◽

Sérgio Gonçalves ◽

Vasco Mascarenhas ◽

Mariana Barreira ◽

Oliver Marin-Peña

Keyword(s):

Hip Arthroscopy ◽

Peripheral Compartment

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Arthroscopic treatment of psoas abscess concurrent with septic arthritis of the hip joint

Hip International ◽

10.5301/hipint.5000579 ◽

2017 ◽

Vol 28 (3) ◽

pp. 336-340 ◽

Cited By ~ 1

Author(s):

Chul-Ho Kim ◽

Kekatpure Aditya ◽

Soong-Joon Lee ◽

Hyo-June Kim ◽

Kang-Sup Yoon ◽

...

Keyword(s):

Septic Arthritis ◽

Hip Joint ◽

Hip Arthroscopy ◽

Psoas Abscess ◽

Positive Culture ◽

Peripheral Compartment ◽

Drain Tube ◽

Arthroscopic Debridement ◽

Suction Drain ◽

Anterior Capsulotomy

Purpose: To describe the outcomes of 7 cases of psoas abscess concurrent with septic arthritis of the hip treated by hip arthroscopy alone. Methods: We retrospectively collected the data of patients who underwent arthroscopic drainage of psoas abscess concurrent with septic arthritis of the hip. Arthroscopic debridement was performed in both the central and peripheral hip joint compartments. In all cases, the iliopsoas compartment was accessed from the peripheral compartment through an anterior capsulotomy without limb traction. After debridement and drainage of the iliopsoas compartment, a suction drain tube was placed in the iliopsoas compartment through an enlarged anterior capsulotomy and another tube in the peripheral compartment. Postoperative intravenous antibiotics were administered on the basis of culture results; in cases with no positive culture, empirical antibiotics were administered for 4 to 6 weeks after surgery. Results: 7 patients underwent arthroscopic debridement and drainage for a psoas abscess concurrent with hip joint septic arthritis. Laboratory tests were normalized within 4 weeks after hip arthroscopy in all patients. At a median follow-up of 16 months (range, 13-30 months) after surgery, infection recurrence was absent in all patients. Conclusions: Arthroscopic debridement alone could be an effective treatment alternative to open surgery for psoas abscess concurrent with hip joint septic arthritis.

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Portal enlargement in hip arthroscopy preserving the iliofemoral ligament: a novel access technique protecting soft tissue restraints

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa019 ◽

2020 ◽

Vol 7 (2) ◽

pp. 313-321 ◽

Cited By ~ 1

Author(s):

Victor M Ilizaliturri ◽

Ruben Arriaga Sánchez ◽

Rafael Zepeda Mora ◽

Carlos Suarez-Ahedo

Keyword(s):

Soft Tissue ◽

Hip Joint ◽

Hip Arthroscopy ◽

Central Compartment ◽

Peripheral Compartment ◽

Hip Instability ◽

Hip Stability ◽

Relevant Role ◽

Iliofemoral Ligament

Abstract Capsulotomy in different modalities has been used to provide adequate exposure to access both the central and peripheral compartment in hip arthroscopy. Even though the hip joint has inherent bony stability, soft tissue restraints may be important in patients with ligaments hyperlaxity or in some cases with diminished bony stability. Biomechanical studies and clinical outcomes have shown the relevant role of the capsule in hip stability, mainly the role of the iliofemoral ligament. Although is not very common, iatrogenic post-arthroscopy subluxation and dislocation have been reported and many surgeons are concerned about the role aggressive capsulotomy or capsulectomy in this situation, thus capsule repair has become very popular. We present a novel technique to access the hip without cutting the iliofemoral ligament. With this technique we can obtain adequate arthroscopic access to the hip joint in order to treat adequately the central compartment pathologies reducing the risk of iatrogenic post-operative hip instability.

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Peripheral Compartment Approach to Hip Arthroscopy

Techniques in Hip Arthroscopy and Joint Preservation Surgery ◽

10.1016/b978-1-4160-5642-3.00011-6 ◽

2011 ◽

pp. 105-112 ◽

Cited By ~ 1

Author(s):

Michael Dienst

Keyword(s):

Hip Arthroscopy ◽

Peripheral Compartment

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Hip arthroscopy via a peripheral compartment first capsular-preserving technique: a step-by-step description

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa061 ◽

2020 ◽

Author(s):

Hao-Che Tang ◽

Jason Brockwell ◽

Michael Dienst

Keyword(s):

Hip Arthroscopy ◽

Central Compartment ◽

Peripheral Compartment ◽

Popular Approach ◽

Secondary Exposure ◽

Fluoroscopic Control ◽

Iatrogenic Damage ◽

Current Article ◽

Portal Placement ◽

Reduced Risk

Abstract Hip arthroscopy is a well-recognized procedure for the treatment of several hip pathologies. Different methods of arthroscopic access to the hip have been published. The most popular approach is the central compartment first technique, where the first portal to the central compartment is placed under traction and fluoroscopic control. This technique, however, carries the risk of iatrogenic damage to the cartilage and labrum, especially when adequate distraction cannot be obtained. In addition, secondary exposure of the peripheral compartment frequently requires larger capsulotomies. The current article is to describe an alternative arthroscopic approach to the hip with the peripheral compartment being first accessed. The peripheral compartment first technique offers the advantages of a limited capsular release for peripheral compartment exposure and a reduced risk of iatrogenic cartilage and labrum damage during subsequent central compartment portal placement.

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Hip Arthroscopy: Peripheral Compartment Access

Hip Arthroscopy and Hip Joint Preservation Surgery ◽

10.1007/978-1-4614-6965-0_121 ◽

2014 ◽

pp. 335-342

Author(s):

Richard C. Mather ◽

Andrew E. Federer

Keyword(s):

Hip Arthroscopy ◽

Peripheral Compartment

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Indications for Hip Arthroscopy

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117712675 ◽

2017 ◽

Vol 9 (5) ◽

pp. 402-413 ◽

Cited By ~ 14

Author(s):

James R. Ross ◽

Christopher M. Larson ◽

Asheesh Bedi

Keyword(s):

Young Adults ◽

Hip Arthroscopy ◽

Orthopaedic Surgery ◽

Invasive Procedure ◽

Central Compartment ◽

Loose Body ◽

Peripheral Compartment ◽

Minimally Invasive Procedure ◽

Level Of Evidence ◽

Surgical Dislocation

Context: Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved techniques has resulted in improved access to the hip joint and ability to treat various hip pathologies. Evidence Acquisition: Electronic databases, including PubMed and MEDLINE, were queried for articles relating to hip arthroscopy indications (1930-2017). Study Design: Clinical review. Level of Evidence: Level 4. Results: Initially used as a technique for loose body removal, drainage/debridement of septic arthritis, and treatment of pediatric hip disorders, hip arthroscopy is currently used to treat various hip conditions. The recognition of femoroacetabular impingement (FAI) as a source of hip pain in young adults has rapidly expanded hip arthroscopy by applying the principles of osseous correction that were previously described and demonstrated via an open surgical dislocation approach. Hip pathologies can be divided into central compartment, peripheral compartment, peritrochanteric space, and subgluteal space disorders. Conclusion: Although hip arthroscopy is a minimally invasive procedure that may offer decreased morbidity, diminished risk of neurovascular injury, and shorter recovery periods compared with traditional open exposures to the hip, it is important to understand the appropriate patient selection and indications.

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