Hip Arthroscopy for Femoroacetabular Impingement.

Background: The first recorded attempt at arthroscopic visualization of the hip can be attributed to Dr. Michael Burman in 1931. Since then, hip arthroscopy has become widely used for the management of femoroacetabular impingement (FAI) because of its clear benefits, including a low complication rate and limited patient morbidity as compared with traditional open approaches.

Description: Arthroscopic management of FAI begins with arthroscopy of the central compartment, where the intra-articular damage is identified. Standard portal placement provides optimal access for surveying and accessing intra-articular injury. The pathological findings identified preoperatively and confirmed during diagnostic arthroscopy dictate the necessary arthroscopic procedures. Correction of acetabular overcoverage and repair of the labrum to the acetabular rim can correct pincer lesions. Femoral-sided cam lesions require removal of traction and application of hip flexion in order to perform a femoral osteoplasty to recreate a normal anatomic femoral head-neck offset. Finally, capsular management is performed as clinically indicated.

Alternatives: Appropriate management of FAI typically begins with nonoperative care consisting of rest, nonsteroidal anti-inflammatory drugs (NSAIDs), activity modification, and physical therapy. Intra-articular corticosteroid injections can also provide relief. Open procedures involving surgical hip dislocation can be utilized to address pathological conditions not accessible arthroscopically. Additionally, a "mini-open" procedure in which intra-articular disorders are treated arthroscopically and cam lesions are resected via a small anterior exposure can be employed.

Rationale: Hip arthroscopy offers a minimally invasive technique that can be effective for treating intra-articular hip disorders and is usually favored over open surgical dislocation. Hip arthroscopy has been shown to result in higher functional outcome scores than open procedures, with lower rates of complications. Hip arthroscopy is playing an increasingly important role as an adjunct diagnostic and therapeutic tool in conjunction with open femoral and/or periacetabular osteotomy for complex hip deformities.