Right Versus Left Hip Arthroscopy for Surgeons on the Learning Curve

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Right Versus Left Hip Arthroscopy for Surgeons on the Learning Curve Kadir Buyukdogan, M.D., Hajime Utsunomiya, M.D., Ph.D., Ioanna Bolia, M.D., M.S., Lorenzo Fagotti, M.D., George F. Lebus, M.D., Karen K. Briggs, M.P.H., M.B.A., Marc J. Philippon, M.D. Arthroscopy Techniques Volume 6, Issue 5, Pages e1837-e1844 (October 2017) DOI: 10.1016/j.eats.2017.07.013 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Surgeon's orientation during hip arthroscopy. (A) When operating on the right side, the surgeon is facing toward the patient's feet. (B) When operating on the left hip, the surgeon is facing toward the patient's head. Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 When the surgeon is operating on the left hip (L), the upper portion of the screen corresponds to the superior aspect of the surgical field. When the surgeon is operating on the right hip (R), the upper portion of the screen is reversed and corresponds to the inferior aspect of the surgical field. Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Rim trimming. The surgeon holds the arthroscope with the nondominant hand (red arrows) through the midanterior portal and the burr with the dominant hand (black arrows) through the anterolateral portal for both a left hip operation and a right hip operation. Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Anchor placement. The surgeon holds the arthroscope with the nondominant hand (red arrows) through the midanterior portal and the burr with the dominant hand (black arrows) through the anterolateral portal for anchor placement in both a left hip and a right hip. Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Suture passage to stabilize labrum against acetabulum. The dominant hand (arrows) should always be used to manipulate the instrument, which is inserted through the anterolateral portal. Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 Knot placement on capsular side of labrum (red arrow) to avoid future cartilage damage. The midanterior portal is the viewing portal (black arrows). When the surgeon is operating on the right hip, the arthroscopic image shows the surgical field in upside-down fashion (green arrow). Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 Anterolateral femoral osteochondroplasty. The burr is gripped with the dominant hand through the anterolateral portal (working portal, red arrows). The midanterior portal is the viewing portal (black arrows). (FH, femoral head.) Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 8 Posterolateral femoral osteochondroplasty. The burr is gripped with the dominant hand through the midanterior portal (working portal, red arrows). The anterolateral portal is the viewing portal (arthroscope, black arrows). Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 9 Final look of cam osteochondroplasty. The seal of the labrum and femoral head (black arrow) and a smooth head-neck offset (red arrow) prevent femoroacetabular impingement recurrence. Arthroscopy Techniques 2017 6, e1837-e1844DOI: (10.1016/j.eats.2017.07.013) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions