Bone Endoscopy and Endoscopic Bony Procedures Around the Hip

Bone endoscopy of the hip can be applied to femoroacetabular impingement, osteonecrosis of the femoral head, and hip dysplasia. The concept of femoroacetabular impingement (FAI) has been popularized as a mechanical cause of hip pain and development of osteoarthritis in the hip. Bony correction with hip arthroscopy has been increasingly used as a minimally invasive means of addressing symptomatic FAI with pain relief and function improvement. Osteonecrosis of the femoral head (ONFH) is a common disease affecting young and middle aged population. Core decompression is an effective and classical procedure for early stage ONFH. With the advancement of hip arthroscopy, endoscopically assisted core decompression with expanded intra-operative visualization demonstrates a more accurate procedure and more promising outcome than traditional method. Patients with hip dysplasia have a higher incidence of acetabular labral tear and hip instability, predisposing them to osteoarthritis. An open surgical approach such as periacetabular osteotomy is commonly used for hip dysplasia. In fact, many high-demand athletes, especially hypermobile athletes, elect against a traditional open approach because it requires longer recovery times and has cosmetic issues. A new surgical technique of endoscopic shelf acetabuloplasty has been developed which is less invasive and can concurrently address the capsular, labral, and bony pathologies arthroscopically. In this chapter, the endoscopic techniques are outlined.