Portal Anatomy and Patient Positioning

  • Hao-Che Tang
  • Michael DienstEmail author


Hip arthroscopy can be performed on patients positioned in either the lateral decubitus or the supine position. There is no significant difference in clinical outcomes and complication rates between these two positions. The hip joint can be divided into the central compartment and peripheral compartment. Appropriate placement of portals to both compartments of the hip is the key to successful hip arthroscopy. In addition, adequate distraction of the hip should be obtained when the central compartment is addressed. Different strategies to access the hip joint with arthroscopy have been published in the literature. No matter which technique is used, surgeons should be familiar with the anatomy and avoid iatrogenic damage to structures of the hip during the procedure.


Hip arthroscopy Position Portal Peripheral compartment Central compartment 


  1. 1.
    Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E. Hip arthroscopy by the lateral approach. Arthroscopy. 1987;3(1):4–12.CrossRefGoogle Scholar
  2. 2.
    Byrd JW. Hip arthroscopy utilizing the supine position. Arthroscopy. 1994;10(3):275–80.CrossRefGoogle Scholar
  3. 3.
    de Sa D, Stephens K, Parmar D, Simunovic N, Philippon MJ, Karlsson J, et al. A comparison of supine and lateral decubitus positions for hip arthroscopy: a systematic review of outcomes and complications. Arthroscopy. 2016;32(4):716–25 e8.CrossRefGoogle Scholar
  4. 4.
    Smart LR, Oetgen M, Noonan B, Medvecky M. Beginning hip arthroscopy: indications, positioning, portals, basic techniques, and complications. Arthroscopy. 2007;23(12):1348–53.CrossRefGoogle Scholar
  5. 5.
    Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy. 2005;21(12):1496–504.CrossRefGoogle Scholar
  6. 6.
    Dienst M, Seil R, Godde S, Brang M, Becker K, Georg T, et al. Effects of traction, distension, and joint position on distraction of the hip joint: an experimental study in cadavers. Arthroscopy. 2002;18(8):865–71.CrossRefGoogle Scholar
  7. 7.
    Dorfmann HBT, Henry P, de Bie B. A simple approach to hip arthroscopy. Arthroscopy. 1988;4:141–2.Google Scholar
  8. 8.
    Byrd JW, Pappas JN, Pedley MJ. Hip arthroscopy: an anatomic study of portal placement and relationship to the extra-articular structures. Arthroscopy. 1995;11(4):418–23.CrossRefGoogle Scholar
  9. 9.
    Dienst M, Seil R, Kohn DM. Safe arthroscopic access to the central compartment of the hip. Arthroscopy. 2005;21(12):1510–4.CrossRefGoogle Scholar
  10. 10.
    Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35(9):1571–80.CrossRefGoogle Scholar
  11. 11.
    Ejnisman L, Philippon MJ, Lertwanich P. Femoroacetabular impingement: the femoral side. Clin Sports Med. 2011;30(2):369–77.CrossRefGoogle Scholar
  12. 12.
    Safran MR, Epstein NP. Arthroscopic management of protrusio acetabuli. Arthroscopy. 2013;29(11):1777–82.CrossRefGoogle Scholar
  13. 13.
    Dienst M, Kusma M, Steimer O, Holzhoffer P, Kohn D. Arthroscopic resection of the cam deformity of femoroacetabular impingement. Oper Orthop Traumatol. 2010;22(1):29–43.CrossRefGoogle Scholar
  14. 14.
    Baker CL Jr, Massie RV, Hurt WG, Savory CG. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. 2007;23(8):827–32.CrossRefGoogle Scholar
  15. 15.
    Robertson WJ, Kelly BT. The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement. Arthroscopy. 2008;24(9):1019–26.CrossRefGoogle Scholar
  16. 16.
    Thorey F, Ezechieli M, Ettinger M, Albrecht UV, Budde S. Access to the hip joint from standard arthroscopic portals: a cadaveric study. Arthroscopy. 2013;29(8):1297–307.CrossRefGoogle Scholar
  17. 17.
    Grothaus MC, Holt M, Mekhail AO, Ebraheim NA, Yeasting RA. Lateral femoral cutaneous nerve: an anatomic study. Clin Orthop Relat Res. 2005;437:164–8.CrossRefGoogle Scholar
  18. 18.
    Byrd JWT. Complications associated with hip arthroscopy. In: Thomas Byrd J, editor. Operative hip arthroscopy. New York: Springer; 2005.CrossRefGoogle Scholar
  19. 19.
    Dienst M, Grun U. Complications of hip arthroscopies. Orthopade. 2008;37(11):1108–9, 11-5.CrossRefGoogle Scholar
  20. 20.
    Gautier E, Ganz K, Krugel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br. 2000;82(5):679–83.CrossRefGoogle Scholar
  21. 21.
    Dorfmann H, Boyer T. Arthroscopy of the hip: 12 years of experience. Arthroscopy. 1999;15(1):67–72.CrossRefGoogle Scholar
  22. 22.
    Horisberger M, Brunner A, Herzog RF. Arthroscopic treatment of femoroacetabular impingement of the hip: a new technique to access the joint. Clin Orthop Relat Res. 2010;468(1):182–90.CrossRefGoogle Scholar
  23. 23.
    Thaunat M, Murphy CG, Chatellard R, Sonnery-Cottet B, Graveleau N, Meyer A, et al. Capsulotomy first: a novel concept for hip arthroscopy. Arthrosc Tech. 2014;3(5):e599–603.CrossRefGoogle Scholar
  24. 24.
    Byrd JW, Chern KY. Traction versus distension for distraction of the joint during hip arthroscopy. Arthroscopy. 1997;13(3):346–9.CrossRefGoogle Scholar
  25. 25.
    Byrd JW. Avoiding the labrum in hip arthroscopy. Arthroscopy. 2000;16(7):770–3.CrossRefGoogle Scholar
  26. 26.
    Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36(2):171–8.CrossRefGoogle Scholar
  27. 27.
    Crawford MJ, Dy CJ, Alexander JW, Thompson M, Schroder SJ, Vega CE, et al. The 2007 Frank Stinchfield award. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.PubMedGoogle Scholar
  28. 28.
    Shu B, Safran MR. Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability. Clin Sports Med. 2011;30(2):349–67.CrossRefGoogle Scholar
  29. 29.
    Shindle MK, Ranawat AS, Kelly BT. Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient. Clin Sports Med. 2006;25(2):309–26, ix-x.CrossRefGoogle Scholar
  30. 30.
    Martin HD, Savage A, Braly BA, Palmer IJ, Beall DP, Kelly B. The function of the hip capsular ligaments: a quantitative report. Arthroscopy. 2008;24(2):188–95.CrossRefGoogle Scholar
  31. 31.
    Matsuda DK. Acute iatrogenic dislocation following hip impingement arthroscopic surgery. Arthroscopy. 2009;25(4):400–4.CrossRefGoogle Scholar
  32. 32.
    Ranawat AS, McClincy M, Sekiya JK. Anterior dislocation of the hip after arthroscopy in a patient with capsular laxity of the hip. A case report. J Bone Joint Surg Am. 2009;91(1):192–7.CrossRefGoogle Scholar
  33. 33.
    Mei-Dan O, McConkey MO, Brick M. Catastrophic failure of hip arthroscopy due to iatrogenic instability: can partial division of the ligamentum teres and iliofemoral ligament cause subluxation? Arthroscopy. 2012;28(3):440–5.CrossRefGoogle Scholar
  34. 34.
    Sansone M, Ahlden M, Jonasson P, Sward L, Eriksson T, Karlsson J. Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):420–3.CrossRefGoogle Scholar
  35. 35.
    Wuerz TH, Song SH, Grzybowski JS, Martin HD, Mather RC 3rd, Salata MJ, et al. Capsulotomy size affects hip joint kinematic stability. Arthroscopy. 2016;32(8):1571–80.CrossRefGoogle Scholar
  36. 36.
    Abrams GD, Hart MA, Takami K, Bayne CO, Kelly BT, Espinoza Orias AA, et al. Biomechanical evaluation of capsulotomy, capsulectomy, and capsular repair on hip rotation. Arthroscopy. 2015;31(8):1511–7.CrossRefGoogle Scholar
  37. 37.
    Frank RM, Lee S, Bush-Joseph CA, Kelly BT, Salata MJ, Nho SJ. Improved outcomes after hip arthroscopic surgery in patients undergoing T-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: a comparative matched-pair analysis. Am J Sports Med. 2014;42(11):2634–42.CrossRefGoogle Scholar
  38. 38.
    Larson CM, Ross JR, Stone RM, Samuelson KM, Schelling EF, Giveans MR, et al. Arthroscopic management of dysplastic hip deformities: predictors of success and failures with comparison to an arthroscopic FAI cohort. Am J Sports Med. 2016;44(2):447–53.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  1. 1.Chang Gung Memorial HospitalKeelungTaiwan
  2. 2.Orthopädische Chirurgie MünchenMunichGermany

Personalised recommendations