Abstract
Technique Video
The fluoroscopy-free hip arthroscopy technique for the treatment of femoroacetabular impingement. Part 1: The establishment of the anterolateral (AL) portal without fluoroscopy. Patient in supine position, right hip. Part 2: The outside-in transverse capsulotomy. Patient in supine position, right hip. Arthroscopic view from the AL portal. Part 3: One-line trimming method for pincer deformity. Patient in supine position, right hip. Arthroscopic view from the AL portal. Part 4: Triangle abrasion method for cam deformity. Patient in supine position, left hip. Arthroscopic view from the AL portal. Part 5: Dynamic impingement test. Patient in supine position, left hip. Arthroscopic view from the AL portal.
Surgical Techniques
Preoperative Planning

Position and Anesthesia
Portals and Transverse Capsulotomy


Acetabuloplasty and AIISplasty


Management of Labral Injury


T-Shaped Capsulotomy

Femoroplasty

Intraoperative Dynamic Examination

Capsule Closure

Discussion
Pearls | Pitfalls |
---|---|
Preoperative planning of the removal extent of the pincer and cam deformity according to the imaging | Improper planning may result in under- or overabrasion |
Palpation of the “soft spot” of the capsule at the joint space using a semiopen hollow guide bar | Direct puncture with a needle increases the risk of iatrogenic damage |
The width of the joint space and the position of the joint capsule puncture are assessed at the soft spot and adjusted appropriately | Traction needs to be increased when the joint gap is too narrow; otherwise, it is likely to cause damage to the labrum and cartilage. The location of the joint capsule puncture should not be too close to the acetabular side |
Perform a transverse capsulotomy with radiofrequency using an outside-in technique | Inadequate incision may interfere with observation and manipulation |
The “one-line trimming method” guides the removal of pincer deformity | Poor observation angle may result in misjudgment of the extent of the pincer deformity, which may be prone to residual deformity and affect labrum healing |
T-shaped capsulotomy to ensure adequate visualization of the cam deformity | Insufficient visual field may lead to residual cam deformity and impingement |
The “triangular abrasion method” guides the grinding of cam deformity and is less likely to leave excess bone | Insufficient grinding will result in residual cam deformity |
Intraoperative dynamic examination of determining residual bony deformity and impingement | Adequate motion in all ranges of the hip joint is required; otherwise, the assessment is insufficient. Residual bony deformity and impingement will likely lead to poor outcomes and revision surgery |
Routine joint capsule closure to increase joint stability | No suturing of the joint capsule may result in the complication of joint instability |
Advantages | Limitations |
---|---|
Avoid radiation exposure to patients and surgeons | Require skill and experience from the operator |
Reduce operation and anesthesia time | Unskilled manipulation may increase the risk of iatrogenic injury |
Decrease in medical equipment and costs | |
Intraoperative dynamic assessment is more straightforward, and the technique is safe and effective when mastered |
Supplementary Data
- ICMJE author disclosure forms
- Video 1
The fluoroscopy-free hip arthroscopy technique for the treatment of femoroacetabular impingement. Part 1: The establishment of the anterolateral (AL) portal without fluoroscopy. Patient in supine position, right hip. Part 2: The outside-in transverse capsulotomy. Patient in supine position, right hip. Arthroscopic view from the AL portal. Part 3: One-line trimming method for pincer deformity. Patient in supine position, right hip. Arthroscopic view from the AL portal. Part 4: Triangle abrasion method for cam deformity. Patient in supine position, left hip. Arthroscopic view from the AL portal. Part 5: Dynamic impingement test. Patient in supine position, left hip. Arthroscopic view from the AL portal.
References
- Outcomes of hip arthroscopy for femoroacetabular impingement in Chinese patients aged 50 years or older.Orthop Surg. 2020; 12: 843-851
- Operative versus nonoperative treatment of femoroacetabular impingement syndrome: A meta-analysis of short-term outcomes.Arthroscopy. 2020; 36: 263-273
- Fluoroscopic demonstration of femoroacetabular impingement during hip arthroscopy.Arthroscopy. 2011; 27: 994-1004
- Radiation exposure from fluoroscopy during hip arthroscopy.Surg J (N Y). 2019; 5: e184-e187
- Acetabular rim reduction for the treatment of femoroacetabular impingement correlates with preoperative and postoperative center-edge angle.Arthroscopy. 2010; 26: 757-761
- Surgical treatment of femoroacetabular impingement: Evaluation of the effect of the size of the resection. surgical technique.J Bone Joint Surg Am. 2006; 88(suppl 1, pt 1): 84-91
- Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement.Am J Sports Med. 2019; 47: 488-500
- Hip arthroscopy for femoroacetabular impingement in adolescents: 10-year patient-reported outcomes.Am J Sports Med. 2021; 49: 76-81
- Mid- to long-term outcomes of hip arthroscopy: A systematic review.Arthroscopy. 2021; 37: 1011-1025
- Best practices during hip arthroscopy: Aggregate recommendations of high-volume surgeons.Arthroscopy. 2015; 31: 1722-1727
- Intraoperative radiation exposure in hip arthroscopy: A systematic review.Hip Int. 2020; 30: 267-275
- Surgeon experience in hip arthroscopy affects surgical time, complication rate, and reoperation rate: A systematic review on the learning curve.Arthroscopy. 2020; 36: 3092-3105
- Basic hip arthroscopy: Anatomic establishment of arthroscopic portals without fluoroscopic guidance.Arthrosc Tech. 2016; 5: e247-e250
- Ultrasound-assisted hip arthroscopy.Arthrosc Tech. 2014; 3: e255-e259
- Complications and reoperations during and after hip arthroscopy: A systematic review of 92 studies and more than 6,000 patients.Arthroscopy. 2013; 29: 589-595
- Revision hip arthroscopy: A systematic review of diagnoses, operative findings, and outcomes.Arthroscopy. 2015; 31: 1382-1390
Article info
Publication history
Footnotes
H.Y. and M.W. have contributed equally to this work and share the first authorship.
The authors report that they have no conflicts of interest in the authorship and publication of this article. The study was supported by National Key Technologies Research and Development Program (2019YFE0126300). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
User license
Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) |
Permitted
For non-commercial purposes:
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article (private use only, not for distribution)
- Reuse portions or extracts from the article in other works
Not Permitted
- Sell or re-use for commercial purposes
- Distribute translations or adaptations of the article
Elsevier's open access license policy