Arthroscopic Microfracture of Hip Chondral Lesions

Microfracture of hip chondral lesions has been performed for more than a decade with modified treatment principles and techniques from knee arthroscopy. This note and accompanying video review the pertinent techniques, pearls, and pitfalls of the microfracture procedure in the treatment of hip chondral lesions. After debridement of damaged chondral tissue, the size of the lesion is approximated to determine the number of microfracture holes to create. The working portal may be adjusted based on the site of the lesion. Microfracture picks of different angles are used to ensure perpendicular advancement to a depth of 3 to 4 mm in the subchondral bone. The holes are placed at a gap of approximately 3 to 4 mm. The debris is washed out to obtain open holes connecting the marrow with the articular surface. The microfracture procedure should be performed near the end of the overall procedure to secure the bleeding bone marrow within the joint and prevent washout

Basic Hip Arthroscopy: Supine Patient Positioning and Dynamic Fluoroscopic Evaluation

Hip arthroscopy serves as both a diagnostic and therapeutic tool for the management of various conditions that afflict the hip. This article reviews the basics of hip arthroscopy by demonstrating supine patient positioning, fluoroscopic evaluation of the hip under anesthesia, and sterile preparation and draping. Careful attention to detail during the operating theater setup ensures adequate access to the various compartments of the hip to facilitate the diagnosis of disease and treatment with minimally invasive arthroscopy. Furthermore, having a routine method for patient positioning and operative setup improves patient safety, as well as operative efficiency, as the operative team becomes familiar with the surgeon's standard approach to hip arthroscopy cases

Arthroscopic Treatment of Hip Chondral Defect With Microfracture and Platelet-Rich Plasma–Infused Micronized Cartilage Allograft Augmentation

Over the past decade, arthroscopic microfracture has become increasingly popular to treat full-thickness (Outerbridge grade IV) chondral defects of the hip. This procedure borrows marrow stimulation treatment principles and techniques from knee arthroscopy, with similar mixed clinical outcomes that may be more favorable in the short term (<2 years) and poorer in the long term. Despite these varied outcomes, microfracture remains the most frequently used technique to treat small focal chondral defects because of the relative ease and cost-effectiveness of the procedure. Consequently, recent efforts have been aimed at improving or augmenting traditional microfracture to achieve more consistent success. BioCartilage (Arthrex, Naples, FL) is a biologically active scaffold containing allograft cartilage that, when combined with autologous conditioned platelet-rich plasma and placed in a defect in which microfracture was performed, may provide a superior repair that mimics native hyaline cartilage rather than the less-durable fibrocartilage that is formed with microfracture alone. This Technical Note and accompanying video review the pertinent techniques, pearls, and potential pitfalls of the microfracture procedure augmented with BioCartilage in the treatment of symptomatic full-thickness chondral defects of the hip

Arthroscopic Treatment of Slipped Capital Femoral Epiphysis Screw Impingement and Concomitant Hip Pathology

Impingement caused by screws used for stabilization of slipped capital femoral epiphysis can be treated arthroscopically. Although troublesome screws have traditionally been removed by open techniques, arthroscopic removal can successfully be achieved. In addition to affording the patient the benefits of minimally invasive surgery, surgeons also have the ability to arthroscopically address any concomitant hip pathology responsible for pain, including femoroacetabular impingement and labral tears

Arthroscopic Treatment of Bucket-Handle Labral Tear and Acetabular Fracture

Traumatic hip dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the joint. These types of injury often lead to traumatic arthritis. In some cases an osseo-labral fragment may become incarcerated in the joint that is not readily visualized preoperatively. In place of open surgery, hip arthroscopy permits a technique to remove loose bodies and repair labral tears to restore joint congruity and achieve fracture reduction and fixation

Arthroscopic Hip Labral Repair: The Iberian Suture Technique

Arthroscopic hip labral repair has beneficial short-term outcomes; however, debate exists regarding ideal surgical labral repair technique. This technical note presents an arthroscopic repair technique that uses intrasubstance labral suture passage to restore the chondrolabral interface. This “Iberian suture technique” allows for an anatomic repair while posing minimal risk of damage to the labral and chondral tissues

Single-Portal Arthroscopy of the Central Compartment of the Hip

Since hip arthroscopy has become a standard of orthopaedic practice, the indications have continued to expand as it has proved to be a helpful diagnostic, as well as therapeutic, tool. Access to the hip joint, however, remains challenging for the orthopaedic surgeon who does not routinely perform hip arthroscopy. We present a single-portal arthroscopic technique, showing the feasibility of single-portal arthroscopic access to the hip joint, as well as describing basic indications and instrumentation for single-portal hip arthroscopy. Single-portal hip arthroscopy is ideal for the patient who needs to undergo diagnostic hip arthroscopy or for treatment in patients with simple hip pathology (e.g., removal of loose bodies or debridement)

Basic Hip Arthroscopy: Diagnostic Hip Arthroscopy

Hip arthroscopy is increasing in popularity for the diagnosis and management of hip preservation. The basics of hip arthroscopy positioning, fluoroscopic assessment, and portal establishment are reviewed in the first 2 parts of this series. This article is the third installment in which we describe a systematic approach to performing a diagnostic hip arthroscopy. A mastery of diagnostic arthroscopy is necessary for surgeons treating hip disorders