Operative Indications for Hip Arthroscopy and Open Hip Preservation Surgery

Abstract

The use of hip arthroscopy has rapidly increased over the past 30 years and investigations into its use have seen an exponential increase over the past decade. Advancements in techniques and instrumentation have allowed an increasing number of orthopedists to perform this operation to address a rapidly expanding number of disorders of the hip and adjacent anatomy. Hip arthroscopy is most commonly performed for intra-articular conditions such as FAI, labral and chondral lesions, disorders of the synovium and capsule, loose bodies, ligamentum teres injuries, and septic arthritis and as a diagnostic aid in conjunction with other procedures. Periarticular conditions such as greater trochanteric pain syndrome, snapping hip, extra-articular FAI, and pathology in the posterior gluteal space are also increasingly addressed with the aid of hip arthroscopy. Contraindications to the procedure, as its strengths and limitations are better defined through increased study and use, have also evolved. These include the presence of advance stages of osteoarthritis, inflammatory arthritis, various forms of hip dysplasia, chronic muscle pathology, preexisting neurologic injury, and greater trochanter impingement, among others. This chapter will expand upon these indications and contraindications, reviewing evidence to help guide both beginner and advanced hip arthroscopists. As the use of hip arthroscopy continues to expand, the utility and limitations of its use will continue to evolve.