The benefits of arthroscopic treatment include a minimally invasive procedure with a subsequent decrease in rehabilitation time. However, there is a steep learning curve, training is essential and it is certainly not a procedure for the occasional operator. But, in expert hands and centres which deal with this condition regularly, the results of arthroscopic treatment appear promising with one series reporting a 93% return to high-level competition for athletes following arthroscopic treatment for FAI.
Arthroscopies are typically performed under general anaesthesia with the patients either in a lateral or supine position. Both traction and fluoroscopic guidance are required. Applying traction under fluoroscopy until a vacuum sign secondary to the negative intra-articular pressure is evident accesses the central compartment of the hip.
The joint capsule is then distended with normal saline, a 17 G needle is inserted into the joint avoiding the labrum and then a flexible nitinol guide wire is inserted into the joint over which the arthroscopic cannula is passed. A 70° arthroscope is typically used for the procedure.
The labrum and chondral damage and the pincer lesion can be addressed via the central compartment (Fig. 5). The impingement lesion or the asphericity of the femoral head on the other hand is addressed via the peripheral compartment (Fig 6). The peripheral compartment is accessed with the hip in flexion and no traction. Labral tears can be effectively treated with hip arthroscopy. However, the issue of whether to remove and refix or debride labral tears remains unresolved. The acetabular labrum acts to enhance joint stability and debridement, therefore has implications with regard to hypermobility and ongoing subluxation of the hip.
Complications of hip arthroscopy can be attributed to either those caused by traction or those by instruments and have been reported in 0.5–5% of patients. The majority are related to transient neuropraxia secondary to distraction of the joint. Injuries to the sciatic nerve (posterior portal), lateral femoral cutaneous nerve (anterolateral portal) and femoral nerves have all been reported. Traction may have a detrimental effect on the joint capsule, the ligamentum teres or the acetabular labrum; however, this has yet to be proven.