Stepwise Safe Access in Hip Arthroscopy in the Supine Position

Tips and Pearls From A to Z

David R. Maldonado, MD; Philip J. Rosinsky, MD; Jacob Shapira, MD; Benjamin G. Domb, MD

Disclosures

J Am Acad Orthop Surg. 2020;28(16):651-659. 

In This Article

Venting the Hip Joint

Importance of Hip Joint Venting

Breaking the seal of the hip joint is vital to successfully accessing the joint arthroscopically. Venting the joint neutralizes the normal negative pressure of the hip joint, thereby enabling to increase the intra-articular space without the necessity of applying an excessive traction force to the leg.[23]

Venting Technique

Using the ASIS as a landmark, advance the spinal needle with the bevel facing toward the femoral head until the capsule is reached. A true "12-O'clock" position can be confirmed when the surgeon has a tactile feeling of reaching the capsule, although the needle is not overlapping the joint (Figure 3 and Video, Supplemental Digital Content 1, http://links.lww.com/JAAOS/A496). After confirming the "12-O'clock" position of the needle with fluoroscopy, gently perforate the capsule. The presence of an air-arthrogram after removing the stylet confirms that the suction seal of the joint has been broken. Traction should then be applied until at least 10 mm of intra-articular space is gained. The surgeon must keep in mind that while the venting entry point serves as a guide for placing the anterolateral portal, their exact position will rarely coincide.[5]

Figure 3.

Photograph showing the 12-O'clock position at the level of the right acetabulum in the supine position. The 3-O'clock, 6-O'clock, and 9-O'clock positions are also shown.

Key Points and Pearls

  1. Check pelvic rotation before venting.

  2. For venting purposes, use a small diameter spinal needle. The authors find that a 18 G × 3.5-inch pink spinal needle (BD, Franklin Lakes, NJ) is reliable for this step.

  3. Pelvic rotation is usually altered after venting and the initial application of traction. Rechecking pelvic rotation is vital.

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