Transacetabular arthrotomy of the hip joint

Removal of a loose body or some other lesion in the acetabular fossa by an ordinary arthrotomy of the hip joint can be extremely difficult and may necessitate dislocation of the femoral head with the ensuing risk of vascular disturbances. A method has been developed to overcome these difficulties. Essentially it implies that a hole is made centrally in the acetabular fossa from the intrapelvic side via an inferior midline abdominal incision and extraperitoneal dissection. After the hole has been made in the bone, the fat pad in the acetabular fossa (pulvinar acetabuli) is incised and the pathological lesion, e.g. a loose body, can easily be removed. Large areas of the femoral head can be inspected by movements of the joint in different directions. If indicated, the whole acetabular fossa can be removed leaving only the cartilage-covered part of the acetabulum (facies lunata) intact. The method has been successfully used in four hip joints in three patients.