Hip arthroscopy on the orthopaedic table: Technique, tips and tricks to avoid potential complications

Background: Hip arthroscopy has evolved significantly since 1931, with expanding indications for intra-articular and extra-articular pathologies. The procedure involves a demanding learning curve and specialized instrumentation, while training is often limited by the scarcity of anatomical specimens and specialized centers.

Objective: This article provides a comprehensive review of hip arthroscopy, detailing surgical anatomy, clinical indications, potential complications, and standardized technical approaches for accessing the various arthroscopic compartments.

Key Points: The hip is categorized into central, peripheral, peritrochanteric, and posterior compartments. Accessing the central compartment requires approximately 1 cm of joint distraction under fluoroscopic guidance, typically performed in the supine position. Standard portals—anterolateral, anterior, and posterolateral—must be established within safe zones to avoid neurovascular structures like the femoral and sciatic nerves. Complication rates currently range from 0.5% to 7.9%, primarily involving traction-related neuropraxia, iatrogenic chondral injury, and fluid extravasation. For the peripheral compartment, traction is released and the hip flexed to 20°–45° to visualize the femoral head-neck junction. Peritrochanteric access enables management of extra-articular conditions, including gluteus medius tears and bursitis. Technical success relies on precise portal placement and sequential exploration of the joint spaces.

Conclusion: Hip arthroscopy is a technically complex procedure requiring precise anatomical knowledge and adherence to safety protocols. Standardized portal placement and careful patient selection are essential to minimize complications and optimize outcomes in the management of coxofemoral pathology.