Hip Arthroscopy

Surgical Technique

Hip Arthroscopy
This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals
in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use
their professional judgment in making any final determinations in product usage and technique.
In doing so, the medical professional should rely on their own training and experience and should conduct
a thorough review of pertinent medical literature and the product’s Directions For Use.

©Copyright Arthrex Inc., 2007. All rights reserved. Toll-Free: 1-800-934-4404. LT0302C
 EXTENDED LENGTH CANNULAS
The Hip Arthroscopy Instrumentation Set includes extended length cannulas for use with the hip length arthroscope to
account for varied surgical conditions such as patient size and positioning. When this longer arthroscope is used, one must use
the longer cannulas for both the viewing and working portals.
Procedurally, the use of the extended length cannulas is similar to that of the standard length cannulas, with one exception.
An extended length cannula adapter is needed to connect the arthroscope adapter to the longer cannula. The same portal dilators
used with the standard length cannulas are also used with the extended length cannulas to dilate the portals thereby allowing the
cannulas to pass into the hip joint.
When switching between portals, it is necessary to disconnect both the extended length cannula adapter and the arthroscope
adapter along with the arthroscope to ensure a proper fit of the arthroscope in the second cannula.

HIP ARTHROSCOPY
INSTRUMENTATION

Complete Hip Arthroscopy Cannula Set w/Instrumentation Case:

w/Storz Arthroscope Adapter AR-6512S-1
w/Dyonics Arthroscope Adapter AR-6512S-2
w/Stryker Arthroscope Adapter AR-6512S-3

Hip Arthroscopy Hand Instrument Set (AR-6511S)(a):

Punch, Medium 3.4 mm straight, 220 mm AR-15300
Punch, Medium 3.4 mm, 15˚ up curved shaft, 220 mm AR-15310
Punch, Medium 3.4 mm, reverse, straight, 220 mm AR-15530
Punch, Medium 3.4 mm, 45˚ right, straight, 220 mm AR-15800 a
Punch, Medium 3.4 mm, 45˚ left, straight, 220 mm AR-15810
Grasper, 4.2 mm, straight, 220 mm AR-16400NR
Grasper w/Hook, 4.2 mm, straight, 220 mm AR-16600NR
Probe, Hook, 4.8 mm tip, 220 mm AR-10030
Curette, Ring, 5.4 mm, cutting one side, 220 mm AR-20030
b
Disposables (sterile and single use):
Hip Arthroscopy Disposables Kit (b) AR-6509DS
Hip Arthroscopy Disposables Kit (c) AR-6512SK

Accessories:
Cannulated Obturator, Olympus Style, 4 mm AR-6505-01 c
Cannulated Obturator, Storz Style, 4 mm AR-6505-02
Cannulated Obturator, Dyonics Style, 4 mm AR-6505-03
Cannulated Obturator, Stryker Style, 4 mm AR-6505-04
References: Open Cannula AR-6506
1. McGinty JB, Editor: Hip Arthroscopy, Chapter 59, pp 663-676, Operative Arthroscopy, Raven Press, New York, 1991 Hip Chondro Pick, 0˚ AR-1751
2. McCarthy JC, Day B, Busconi B: Hip Arthroscopy: Application and Technique, Vol. 3, No. 3, May/June, 1995 Hip Chondro Pick, 45˚, curved up AR-1752
3. Keene GS, Viller RN: Arthroscopy Anatomy of the Hip: An In-Vivo Study, Arthroscopy, Vol. 10, No. 4, pp 392-399, 1994 Hip Chondro Pick, 90˚ AR-1753
4. Byrd JWT: Hip Arthroscopy Utilizing the Supine Position, Arthroscopy, Vol. 10, No. 3, pp 275-280, 1994 Low Profile SutureLasso, 45˚ AR-4065H

9 10
A 7 mm Telescoping Cannula is then inserted into the
joint and the 5 mm cannula is removed. A 7 mm can-
nula for instruments is then inserted over the Dilating
Cannula and the Instrument Portal Cap is attached.
11
The skin incision is extended to accommodate the 10 mm
Telescoping Dilating Cannula, which is placed with the
Insertion Tool.
A 10 mm Instrument Cannula is used in situations where
removal of large size loose bodies or lavage is necessary.
The Instrument Portal Cap is removed and the 7 mm
Telescoping Cannula is placed through the instrument
cannula and into the joint.
12
The 10 mm Instrument Cannula is delivered into the joint.
The Dilating Cannula is removed and the Instrument Portal
Cap is attached. A Backflow Cap is then placed over the side
port of the Instrument Cannula.
INTRODUCTION
The techniques for performing arthroscopic procedures on various joints of the extremities have enjoyed exponential growth
over the years. Recent interest in pursuing surgical treatment options for young active patients with disabling hip pain by utilizing
minimally invasive surgical techniques has led to the development of procedure-specific instrumentation designed for hip arthroscopy
by Arthrex.
Hip diagnostic procedures may include: Hip operative procedures may include:
• Staging of avascular necrosis • Soft tissue resection
• Chondral injuries • Removal of loose bodies
• Joint sepsis • Torn labrum resection/repair
• Synovial chondromatosis • Debridement of femoro-acetabular impingement
• Unresolved hip pain
• Labral tears
• Femoro-acetabular impingement
Hip Arthroscopy Instrumentation features a uniquely designed series of extra long spinal needles, flexible guide wires, and
portal dilators, along with standard and extended length arthroscopes and instrumentation cannulas to ease access to the hip
joint. A series of interchangeable arthroscope adapters and working portal caps attach to the cannulas and can be switched from
either cannula without having to remove the access cannulas placed in the joint. This gives the surgeon flexibility in visualization
and instrumentation usage during the procedure.
The Hip Arthroscopy Instrumentation is indicated for hip arthroscopy in the lateral decubitus or supine position. Joint
distraction techniques are at the discretion of the surgeon using either a standard fracture table or specific hip arthroscopy limb
positioner.
The Continuous Wave III Arthroscopy Pump with tubing is attached to the side port on the arthroscope adapter and cannula
to create joint distention and visualization throughout the procedure. A recommended setting of 35 mmHg and 70% flow is
recommended at the start of the procedure.
Anterior Portal
Anterolateral Portal
Posterolateral Portal
 SURGICAL TECHNIQUE
PORTAL PLACEMENT

Three standard portals are used for hip arthroscopy. The anterolateral portal is established at the level of the tip of the
greater trochanter and is directed through the gluteus medius musculature until entering the lateral region of the capsule
anterior to the femoral head. The posterolateral portal is made starting at the posterior tip of the greater trochanter and is
directed through the gluteus medius and minimus entering the posterior lateral aspect of the hip joint. This portal lies superior
The anterior portal is directed through the sartorius and rectus femoris muscles before entering the anterior aspect of the
hip capsule. Particular attention is paid to the varied branches of the lateral femoral cutaneous nerve which lie within this
region. Care is taken to avoid deep and sharp penetration while making the portal incision. The femoral nerve and artery lie
approximately 3.5 cm medial to the anterior portal.
Note:
Please order the video Techniques in Hip Arthroscopy (VCD-1042) by Joseph McCarthy, M.D., Boston, MA or download it at www.arthrex.com.

CANNULA PLACEMENT

5 6

The arthroscope and pump tubing are attached to the
cannula. With fluid inflow and joint distention, a diagnostic
arthroscopy is carried out. The anterolateral portal is then
created in a similar manner with the exchange of the spinal
needle, nitinol guide wire and Dilating Cannula, leading
to the placement of an additional 5 mm cannula.
An Instrument Portal Cap is locked onto the second
5 mm cannula creating a working portal. The 5 mm
diameter of the instrument portal will allow use of an
extended length hip arthroscopy Hook Probe or a
motorized shaver.

The following procedural steps describe how to dilate

portals for larger diameter cannulas and sheaths. Also
described is the use of the longer cannulas when the hip
length arthroscope is needed.

1 2

The posterolateral portal is established by introducing
a spinal needle into the joint under fluoroscopic guid-
ance. Once the negative pressure of the hip joint is
released, fluid is injected to create distention with the
35 cc syringe. A flexible nitinol guide wire is inserted
through the spinal needle and into the joint.
The tapered 5 mm Dilating Cannula is inserted onto
the Insertion Tool and fed onto the guide wire. The
Dilating Cannula is passed until it enters the hip
joint.

7 8

The interchangeable Bridge Cannula System was designed to
provide viewing and working portals that may be switched
3 4 without having to remove the placed pair of 5 mm cannulas
from the hip joint. The arthroscope connection and portal
cap may be interchanged to create flexible viewing portals
throughout the procedure.
At this stage the appropriate style Arthroscope Mount The Nitinol guide wire is removed and the 5 mm cannula for
suited for the arthroscope is locked onto the cannula. an arthroscope is then inserted over the Dilating Cannula.
Extended length Hip Arthroscopy Hand Instrumentation
is indicated for debridement of labral tears or chondral
lesions, removing of synovial tissue, loose bodies and
lavage. This instrumentation is used in conjunction with
7 mm or 10 mm instrument cannulas. The Instrument
Portal Cap is removed and the 5 mm Telescoping Dilating
Cannula is placed into the 5 mm Instrument Cannula to
maintain joint access.
 SURGICAL TECHNIQUE
PORTAL PLACEMENT

Three standard portals are used for hip arthroscopy. The anterolateral portal is established at the level of the tip of the
greater trochanter and is directed through the gluteus medius musculature until entering the lateral region of the capsule
anterior to the femoral head. The posterolateral portal is made starting at the posterior tip of the greater trochanter and is
directed through the gluteus medius and minimus entering the posterior lateral aspect of the hip joint. This portal lies superior
The anterior portal is directed through the sartorius and rectus femoris muscles before entering the anterior aspect of the
hip capsule. Particular attention is paid to the varied branches of the lateral femoral cutaneous nerve which lie within this
region. Care is taken to avoid deep and sharp penetration while making the portal incision. The femoral nerve and artery lie
approximately 3.5 cm medial to the anterior portal.
Note:
Please order the video Techniques in Hip Arthroscopy (VCD-1042) by Joseph McCarthy, M.D., Boston, MA or download it at www.arthrex.com.

CANNULA PLACEMENT

5 6

The arthroscope and pump tubing are attached to the
cannula. With fluid inflow and joint distention, a diagnostic
arthroscopy is carried out. The anterolateral portal is then
created in a similar manner with the exchange of the spinal
needle, nitinol guide wire and Dilating Cannula, leading
to the placement of an additional 5 mm cannula.
An Instrument Portal Cap is locked onto the second
5 mm cannula creating a working portal. The 5 mm
diameter of the instrument portal will allow use of an
extended length hip arthroscopy Hook Probe or a
motorized shaver.

The following procedural steps describe how to dilate

portals for larger diameter cannulas and sheaths. Also
described is the use of the longer cannulas when the hip
length arthroscope is needed.

1 2

The posterolateral portal is established by introducing
a spinal needle into the joint under fluoroscopic guid-
ance. Once the negative pressure of the hip joint is
released, fluid is injected to create distention with the
35 cc syringe. A flexible nitinol guide wire is inserted
through the spinal needle and into the joint.
The tapered 5 mm Dilating Cannula is inserted onto
the Insertion Tool and fed onto the guide wire. The
Dilating Cannula is passed until it enters the hip
joint.

7 8

The interchangeable Bridge Cannula System was designed to
provide viewing and working portals that may be switched
3 4 without having to remove the placed pair of 5 mm cannulas
from the hip joint. The arthroscope connection and portal
cap may be interchanged to create flexible viewing portals
throughout the procedure.
At this stage the appropriate style Arthroscope Mount The Nitinol guide wire is removed and the 5 mm cannula for
suited for the arthroscope is locked onto the cannula. an arthroscope is then inserted over the Dilating Cannula.
Extended length Hip Arthroscopy Hand Instrumentation
is indicated for debridement of labral tears or chondral
lesions, removing of synovial tissue, loose bodies and
lavage. This instrumentation is used in conjunction with
7 mm or 10 mm instrument cannulas. The Instrument
Portal Cap is removed and the 5 mm Telescoping Dilating
Cannula is placed into the 5 mm Instrument Cannula to
maintain joint access.

9 10
A 7 mm Telescoping Cannula is then inserted into the
joint and the 5 mm cannula is removed. A 7 mm can-
nula for instruments is then inserted over the Dilating
Cannula and the Instrument Portal Cap is attached.
11
The skin incision is extended to accommodate the 10 mm
Telescoping Dilating Cannula, which is placed with the
Insertion Tool.
A 10 mm Instrument Cannula is used in situations where
removal of large size loose bodies or lavage is necessary.
The Instrument Portal Cap is removed and the 7 mm
Telescoping Cannula is placed through the instrument
cannula and into the joint.
12
The 10 mm Instrument Cannula is delivered into the joint.
The Dilating Cannula is removed and the Instrument Portal
Cap is attached. A Backflow Cap is then placed over the side
port of the Instrument Cannula.
INTRODUCTION
The techniques for performing arthroscopic procedures on various joints of the extremities have enjoyed exponential growth
over the years. Recent interest in pursuing surgical treatment options for young active patients with disabling hip pain by utilizing
minimally invasive surgical techniques has led to the development of procedure-specific instrumentation designed for hip arthroscopy
by Arthrex.
Hip diagnostic procedures may include: Hip operative procedures may include:
• Staging of avascular necrosis • Soft tissue resection
• Chondral injuries • Removal of loose bodies
• Joint sepsis • Torn labrum resection/repair
• Synovial chondromatosis • Debridement of femoro-acetabular impingement
• Unresolved hip pain
• Labral tears
• Femoro-acetabular impingement
Hip Arthroscopy Instrumentation features a uniquely designed series of extra long spinal needles, flexible guide wires, and
portal dilators, along with standard and extended length arthroscopes and instrumentation cannulas to ease access to the hip
joint. A series of interchangeable arthroscope adapters and working portal caps attach to the cannulas and can be switched from
either cannula without having to remove the access cannulas placed in the joint. This gives the surgeon flexibility in visualization
and instrumentation usage during the procedure.
The Hip Arthroscopy Instrumentation is indicated for hip arthroscopy in the lateral decubitus or supine position. Joint
distraction techniques are at the discretion of the surgeon using either a standard fracture table or specific hip arthroscopy limb
positioner.
The Continuous Wave III Arthroscopy Pump with tubing is attached to the side port on the arthroscope adapter and cannula
to create joint distention and visualization throughout the procedure. A recommended setting of 35 mmHg and 70% flow is
recommended at the start of the procedure.
Anterior Portal
Anterolateral Portal
Posterolateral Portal
 EXTENDED LENGTH CANNULAS
The Hip Arthroscopy Instrumentation Set includes extended length cannulas for use with the hip length arthroscope to
account for varied surgical conditions such as patient size and positioning. When this longer arthroscope is used, one must use
the longer cannulas for both the viewing and working portals.
Procedurally, the use of the extended length cannulas is similar to that of the standard length cannulas, with one exception.
An extended length cannula adapter is needed to connect the arthroscope adapter to the longer cannula. The same portal dilators
used with the standard length cannulas are also used with the extended length cannulas to dilate the portals thereby allowing the
cannulas to pass into the hip joint.
When switching between portals, it is necessary to disconnect both the extended length cannula adapter and the arthroscope
adapter along with the arthroscope to ensure a proper fit of the arthroscope in the second cannula.

HIP ARTHROSCOPY
INSTRUMENTATION

Complete Hip Arthroscopy Cannula Set w/Instrumentation Case:

w/Storz Arthroscope Adapter AR-6512S-1
w/Dyonics Arthroscope Adapter AR-6512S-2
w/Stryker Arthroscope Adapter AR-6512S-3

Hip Arthroscopy Hand Instrument Set (AR-6511S)(a):

Punch, Medium 3.4 mm straight, 220 mm AR-15300
Punch, Medium 3.4 mm, 15˚ up curved shaft, 220 mm AR-15310
Punch, Medium 3.4 mm, reverse, straight, 220 mm AR-15530
Punch, Medium 3.4 mm, 45˚ right, straight, 220 mm AR-15800 a
Punch, Medium 3.4 mm, 45˚ left, straight, 220 mm AR-15810
Grasper, 4.2 mm, straight, 220 mm AR-16400NR
Grasper w/Hook, 4.2 mm, straight, 220 mm AR-16600NR
Probe, Hook, 4.8 mm tip, 220 mm AR-10030
Curette, Ring, 5.4 mm, cutting one side, 220 mm AR-20030
b
Disposables (sterile and single use):
Hip Arthroscopy Disposables Kit (b) AR-6509DS
Hip Arthroscopy Disposables Kit (c) AR-6512SK

Accessories:
Cannulated Obturator, Olympus Style, 4 mm AR-6505-01 c
Cannulated Obturator, Storz Style, 4 mm AR-6505-02
Cannulated Obturator, Dyonics Style, 4 mm AR-6505-03
Cannulated Obturator, Stryker Style, 4 mm AR-6505-04
References: Open Cannula AR-6506
1. McGinty JB, Editor: Hip Arthroscopy, Chapter 59, pp 663-676, Operative Arthroscopy, Raven Press, New York, 1991 Hip Chondro Pick, 0˚ AR-1751
2. McCarthy JC, Day B, Busconi B: Hip Arthroscopy: Application and Technique, Vol. 3, No. 3, May/June, 1995 Hip Chondro Pick, 45˚, curved up AR-1752
3. Keene GS, Viller RN: Arthroscopy Anatomy of the Hip: An In-Vivo Study, Arthroscopy, Vol. 10, No. 4, pp 392-399, 1994 Hip Chondro Pick, 90˚ AR-1753
4. Byrd JWT: Hip Arthroscopy Utilizing the Supine Position, Arthroscopy, Vol. 10, No. 3, pp 275-280, 1994 Low Profile SutureLasso, 45˚ AR-4065H
 Hip Arthroscopy

Surgical Technique

Hip Arthroscopy
This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals
in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use
their professional judgment in making any final determinations in product usage and technique.
In doing so, the medical professional should rely on their own training and experience and should conduct
a thorough review of pertinent medical literature and the product’s Directions For Use.

©Copyright Arthrex Inc., 2007. All rights reserved. Toll-Free: 1-800-934-4404. LT0302C