Atlanta based arthroscopic surgeon, Dr. Dominic Carreira will debate medical approaches to hip arthroscopy at the annual meeting of the International Society for Arthroscopy. In a point-counterpoint session, Dr. Carreira will support of the inside-to-outside technique, versus the outside-to-inside technique. The meeting for the International Society for Arthroscopy is scheduled for October 2017.
Hip Arthroscopy: Outside-to-Inside vs. Inside-to-Outside
Different surgical approaches have been described in hip arthroscopy relative to the incision of the capsule (also known as the capsulotomy). The inside out technique consists of the the capsule being penetrated first with the insertion of the camera, followed by the capsulotomy. Alternatively, the capsule can be cut first when visualized from outside the joint, known as the outside in technique. The most commonly used approach in the United States is the inside out approach. In this approach, the patient is placed in traction, prepped and draped, and a needle is inserted into the joint. The needle is confirmed using fluoroscopy for adequate placement. Over the needle, the cannulas placed for establishment of the first portal. The second portal is placed using “needle localization” under direct visualization, as the surgeon cuts the capsule while looking from inside the joint.
An alternative approach, used more commonly in Europe, is the outside in approach. With this approach, the joint is approached from the peripheral compartment. The capsule is identified and cut from outside in at the level of the hip joint.
Advantage of the Inside-to-Outside Approach
The main advantage of the inside out approach is preservation of the hip joint capsule. Preservation of the capsule is important for long-term success, especially in patients who have more lax joints. Cutting the capsule when looking from the inside helps to preserve as much of the capsule as possible, because it is very precise. The localization of the incision in terms of its distance from the labrum, as well as a straight cut perpendicular to the capsule, are possible with this inside out technique.
Disadvantages of the Inside-to-Outside Approach
The main disadvantage of the inside out technique is penetration of the labral tissue itself. Another disadvantage may be limited visualization, particularly in large, bucket handle like tears.
Surgical Experience is Key with Both Approaches
Surgeon experience is very important when considering either technique. There’s a learning curve associated with each approach.
As an arthroscopic surgeon, Dominic Carreira has performed hundreds of such surgeries. He is highly respected in his medical field for the depth of his surgical experience, and for the high rates of success that he achieves with his surgical patients.
