Diagnostic Arthroscopy of the Hip Joint

Objective Refinement of diagnosis of hip disorders with the possibility of addin 8 minimally invasive surgical procedures. Indications Hip symptoms and effusions not yet diagnosed. Disorders where a decision has to be taken whether to continue conservative care or to proceed with surgery. Intraarticular loose bodies. Labral lesions. Biopsies to establish a diagnosis. Synovial diseases. Localized articular cartilage defects. Purulent arthritis. Contraindications Recent fracture of acetabulum. Advanced osteoarthritis. Impossibility to distract the joint. Surgical Technique Supine. Arthrography for imaging of labrum and femoral head. Joint distension. 3-portal technique for arthroscopy of the central compartment of the joint under traction on a fracture table. 2-portal technique for viewing of the peripheral compartment without traction. Both techniques make use of 3 o° and 7 °0 arthroscopes. Results Between October 1997 and end of 2ooo, we performed 6o hip arthroscopies: 34 of the central and peripheral compartments, 16 of only the central and ten of only the peripheral compartment. Besides synovial reactions in all, 15 of 33 hips with early or moderate osteoarthritis showed additional intraarticular lesions. These findings justified an early total hip replacement in six patients. In four out of six patients with unclear hip symptoms, a final diagnosis could be established. In another five patients the diagnosis could be confirmed (4x chondromatosis, and ix free body). In five patients indication for correctional osteotomy was validated and in one rejected due to advanced articular cartilage damage. Complications: transient hypoesthesia (4x), superficial cartilage damage (7x), instrument breakage (2x), small labral tears (4x), soft tissue edema and early termination of operation (2x).