Introduction Overview increasingly common procedure as advances in technology and familiarity expands technically difficult procedure due to deep location of hip joint and high congruity (as compared to knee and shoulder) login to view 1 more bullet Epidemiology incidence login to view 1 more bullet Indications intra-articular pathology login to view 8 more bullets extra-articular pathology login to view 9 more bullets Contraindications advanced DJD hip ankylosis acetabular dysplasia joint contracture severe osteoporotic bone significant protrusio acetabuli Prognosis lower morbidity than open arthrotomy with expeditious post-operative course Setup, Positioning, and Joint access Setup dedicated hip arthroscopy instruments required login to view 3 more bullets fluoroscopy positioned so both fluoroscopic and arthroscopic towers visible Positioning may be done supine or in lateral decubitus position login to view 1 more bullet perineal post, if used, must be well padded traction placed through operative leg to distract joint for safe entry login to view 2 more bullets Access needle insertion at anterolateral portal site spinal needle placed into hip joint (central compartment) with aid of fluoroscopy to avoid femoral head and labrum can load joint with saline to distend login to view 1 more bullet guidewire, cannula, and arthroscope inserted into joint subsequent portals placed under direct visualization and/or fluoroscopy login to view 1 more bullet Portals Anterolateral portal (AL) function login to view 2 more bullets location and technique login to view 2 more bullets structures at risks login to view 1 more bullet Anterior portal (AP) function login to view 1 more bullet location and technique login to view 6 more bullets structures at risk login to view 3 more bullets Distal anterolateral portal (DALA) function login to view 1 more bullet location and technique login to view 3 more bullets structures at risk login to view 1 more bullet Mid-anterior portal (MAP) functions login to view 1 more bullet location and technique login to view 2 more bullets Posterolateral portal (PL) function login to view 1 more bullet location and technique login to view 2 more bullets structures at risk login to view 1 more bullet Compartments Central compartment consists of login to view 4 more bullets requires traction for access and instrumentation Peripheral compartment portion of hip joint lateral to the labrum no traction required consists of login to view 5 more bullets Lateral compartment trochanteric and peri-trochanteric area no traction required consists of login to view 2 more bullets Deep gluteal space extra-articular posterior hip space no traction required consists of login to view 2 more bullets Rehabilitation Rehab protocols vary by procedure and surgeon physical therapist involvement prior to procedure to discuss expectations immediate post-operative full or brief protected weight-bearing login to view 1 more bullet early range of motion strengthening is started after full ROM is achieved login to view 1 more bullet Return to full activity earlier reports of faster recovery following arthroscopic procedures compared with open Complications Chondrolabral injuries iatrogenic chondral injuries most commonly reported complication due to scope or instrumentation placement avoid by login to view 1 more bullet Hip instability iatrogenic hip instability due to capsular insufficiency risk factors login to view 2 more bullets avoided with login to view 2 more bullets Neurovascular injury traction related login to view 14 more bullets portal related login to view 10 more bullets Fluid extravasation risk factors login to view 2 more bullets prevention login to view 2 more bullets Heterotopic ossification prevention login to view 1 more bullet Conversion to total hip arthroplasty risk factors login to view 6 more bullets