FIGURE 11.1. Arthroscopic compartments of the hip joint according to Dorfmann and Boyer.11'13 (Reprinted with permission from Dienst et al.44)

with instrument table are on the ipsilateral side. The image intensifier is placed on the opposite side. The arthroscopy unit with video monitor and image intensifier with monitor are placed toward the foot.

Positioning, Distension, and Portals

Hip arthroscopy with and without traction can be performed in the lateral20,22 or supine position.25,39,43 Some authors claim that there are advantages to the lateral position, including better access to the pos-terolateral area48,49 and better application of traction in line with the femoral neck.50 However, for HA without traction, I favor the supine position.13,35,43,51 From my experience, the decision whether to use the supine or lateral position for the traction technique appears to be more a matter of individual training and habit of use. However, the almost exclusive use of the anterolateral portal (as indicated below) during HA without traction makes the supine position preferable for this part of HA.

Cadaver experiments and in vivo experience52 have shown that free draping and a good range of movement are important to relax parts of the capsule and increase the intraarticular volume of the area that is inspected (Figure 11.3A,B).53 This consideration is important for safe movement of the scope to avoid damage to the cartilage of the femoral head and synovial folds and unwanted sliding of the scope out of the joint. The distending effect of irrigation fluid pressure is of minor importance because the pressure should not be increased over 70 mm Hg to reduce the risk of development of a severe soft tissue edema. Klapper et al.34 do not use a pump and prefer to control distension of the capsule and irrigation pressure by adjusting the sus-

surgeon fluoroscopy unit

scrub nurse and mayo

fluoroscopy unit surgeon

FIGURE 11.2. Operating room setup. (Reprinted with permission from Dienst et al.44)

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