1. Hip Arthroscopy: Less Invasive Technique
Alexis Nogier, M.D., Thierry Boyer, M.D., M. Tahir Khan, F.R.C.S.(Tr&Orth), M.Phil.(Orth) 
Arthroscopy Techniques 
Volume 3, Issue 1, Pages e101-e106 (February 2014)
DOI: /j.eats
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2. Fig 1
(A) Operating room setup. (B) The surgical assistant is lifting the knee and flexing the hip about 30° for access to the peripheral compartment.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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3. Fig 2
Landmarks for first incision (peripheral portal). One should note the point of entry distal and lateral to the anterior superior iliac spine to avoid damaging the lateral cutaneous nerve of the thigh.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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4. Fig 3
(A, B) The hip is flexed and internally rotated to protect the femoral head cartilage from damage by the needle initially and instruments later.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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5. Fig 4
(A-C) Signs showing intra-articular position of needle and guide.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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6. Fig 5
(A) The peripheral compartment is divided into 2 compartments, distal and proximal, separated by the orbicular fold. The arthroscope must be located in the proximal zone. (B) The direction of the instruments in the first portal is perpendicular to the femoral neck and parallel to the anterior rim of the acetabulum/anterior surface of the neck of the femur.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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7. Fig 6
(A, B) The position of the spinal needle, as well as the flexible needle, is used to confirm intracapsular positioning.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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8. Fig 7
Tilting of the arthroscope from a horizontal direction to a vertical direction is the key point of the procedure. During tilting, continuous vision of the labrum is necessary.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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9. Fig 8
(A, B) The second incision is customized, depending of the shape of the hip. Preoperative planning on a pelvic radiograph is necessary. In the case of coxa vara, the incision is close to the top of the greater trochanter. In the case of coxa valga, the skin incision is more proximal.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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10. Fig 9
(A) The spinal needle is introduced under visual control at the 12-o’clock position laterally, just in front of the acetabular labrum. (B) The surgeon introduces the needle into the central compartment under visual control, avoiding iatrogenic damage to the labrum or cartilage.
Arthroscopy Techniques 2014 3, e101-e106DOI: ( /j.eats )
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