A minimalist approach to hip arthroscopy: the slotted cannula

Adequate patient positioning with a traction device to provide sufficient distraction of the hip to access the femoral-acetabular joint is the first and most important step in hip arthroscopy. Cannulated instruments provide reproducible access to the hip joint from every portal by following guidewires into the joint. These guidewires are positioned through long spinal needles via fluoroscopic navigation and, subsequently, direct arthroscopic vision. By using these techniques adequately, the risk of iatrogenic damage to the hip joint is reduced. The traditional option for introduction of instruments to the hip joint has been the use of closed working cannulas of increasing diameters to accommodate instruments of different sizes. Curved instruments usually require large-diameter standard cannulas or flexible plastic cannulas. Large cannulas increase the risk of damage to the articular cartilage and may not accommodate every curved instrument. Flexible cannulas may leave debris inside the joint if damaged. Slotted cannulas allow curved instruments to be introduced into the hip joint by sliding them through their open side. With the instrument inside the joint, the slotted cannula can be slid out for better instrument mobility. It can also be reinserted around the previous instrument for instrument or portal exchange.