As noted earlier arthroscopy is not a substitute for sound clinical judgment. Surgical intervention is proscribed for joint conditions amenable to medical management, such as the arthralgias associated with hepatitis or colitis. Similarly, hip pain referred from other sources precludes surgery, such as compression fracture of L1. (See Chapters 2 and 4.)

Periarticular conditions such as stress fractures of the femoral neck, insufficiency fractures of the pubic ischium, and transient osteoporosis are best treated by non-endoscopic means.

Certain joint conditions, in the absence of mechanical symptoms, do not warrant arthroscopy. These include os-teonecrosis and synovitis.

Acute skin lesions or ulceration, especially in the vicinity of anterior or lateral portals, would proscribe arthroscopy. In addition, sepsis with accompanying osteomyelitis or abscess formation requires open surgery.

Conditions that limit the potential for hip distraction may also preclude arthroscopy. These include joint ankylosis, dense heterotopic bone formation, or significant protrusio.

Morbid obesity is a relative contraindication for arthros-copy, not only because of distraction limitations but also because of the requisite length of the instruments necessary to access and maneuver within the deeply receded joint. Finally, advanced osteoarthritis is, in the author's opinion, a contraindication for arthroscopy, as noted earlier.

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