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Published on: May 1, 2020
Access to the hip joint from standard arthroscopic portals: a cadaveric study
Fritz Thorey1, Marco Ezechieli, Max Ettinger
1Department of Sports Traumatology, Center for Hip, Knee, and Foot Surgery, ATOS Hospital Heidelberg, Germany. fritz.thorey@atos.de
Purpose:
Our purpose was to study and describe the areas of the hip joint that can be safely visualized and operated on using a variety of portals for the central and peripheral compartments.
Methods:
Twelve hip joints in 6 human cadavers were examined through 9 different central and peripheral arthroscopic portals. Markings of the accessible areas within the joint were made through an arthroscope. Dissection of the cadavers was carried out for final evaluation of the visible areas and those accessible for instruments. During dissection, anatomic proximity of the portals to relevant neurovascular structures was measured.
Results:
The central compartment was sufficiently accessible using the anterior, anterolateral, and posterolateral portals, with slight limitations in the posteromedial corner. A more medial portal did not offer substantial advantages regarding accessibility but decreased the safety distance to the femoral nerve. With regard to the peripheral compartment, the combination of the anterolateral and posterolateral portals allowed visualization of most of the joint. It was observed that the structure at highest risk of injury for the central anterior and the peripheral anterolateral portals was the lateral femoral cutaneous nerve.
Conclusions:
In hip arthroscopy, the use of the standard anterior, anterolateral, and posterolateral portals allows proper accessibility of the central compartment, with slight limitations in the posteromedial corner. A more medial portal is not recommended with regard to its risk-benefit ratio. The peripheral compartment of the hip joint is sufficiently visible using the anterolateral and posterolateral portals. For treatment of specific pathologic conditions, a variation of these portals improves surgical accessibility. The anatomic structure at highest risk of injury during hip arthroscopy is the lateral femoral cutaneous nerve.
Clinical Relevance:
The general objectives of this study were to prepare surgeons to develop appropriate concepts of surgery and to facilitate preoperative planning.
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