Nomenclature

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Special mention should be made of the nomenclature used in describing arthroscopy portals. The anterior portal is not a true anterior approach to the hip. However, it is as far anterior as can safely and reliably be positioned. Thus, for distinction from the various lateral portals, it is referred to as the anterior portal.

FIGURE 7.8. The superior gluteal nerve (arrow) is shown coursing transversely on the deep surface of the gluteus medius. It passes above the anterolateral portal (double arrows), which is seen between the deep surface of the gluteus medius and the capsule. (Reprinted with permission from Byrd et al.13)

FIGURE 7.8. The superior gluteal nerve (arrow) is shown coursing transversely on the deep surface of the gluteus medius. It passes above the anterolateral portal (double arrows), which is seen between the deep surface of the gluteus medius and the capsule. (Reprinted with permission from Byrd et al.13)

Rat Dissection

FIGURE 7.10. The relationship of the postero-lateral portal is shown with the piriformis tendon (p) and the sciatic nerve (s). Note the anomaly where the sciatic nerve is formed from three divisions distal to the sciatic notch and the lateralmost division passes through a split muscle belly of the piriformis. (Reprinted with permission from Byrd et al.13)

FIGURE 7.10. The relationship of the postero-lateral portal is shown with the piriformis tendon (p) and the sciatic nerve (s). Note the anomaly where the sciatic nerve is formed from three divisions distal to the sciatic notch and the lateralmost division passes through a split muscle belly of the piriformis. (Reprinted with permission from Byrd et al.13)

Hip Arthroscopy Portal Placement
FIGURE 7.11. Neutral rotation of the operative hip is essential for protection of the sciatic nerve during placement of the posterolateral portal. (Courtesy of Smith & Nephew Endoscopy, Andover, MA.)

Glick et al.10 refer to the portals placed over the anterior and posterior margins of the superior aspect of the greater trochanter as anterior paratrochanteric and posterior paratrochanteric portals. This nomenclature has also been adopted by McCarthy et al.14 in their review of hip arthroscopy.

I have used the terms anterolateral and posterolateral for simplicity and consistency with the terminology commonly used for other joints. Standard portals are usually described in an abbreviated fashion, defining only their relationship to the joint. Portal descriptions in relationship to a topographic landmark are usually reserved for specialty portals or portals that are only occasionally used.

I recommend that, until the nomenclature becomes truly standardized, when referencing literature on hip arthroscopy, it is always important to review the details regarding the description of portal placement. One must not rely solely on the portal name to automatically create an image of which portal is being discussed.

References

1. Blitzer CM: Arthroscopic management of septic arthritis of the hip. Arthroscopy 1993;9:414-416.

2. Klapper R, Silver DM: Hip arthroscopy without traction. Con-temp Orthop 1989;18:687-693.

3. Holgersson S, Brattstrom H, Mogensen B, Lidgren L: Arthroscopy of the hip in juvenile chronic arthritis. J Pediatr Orthop 1981;1:273-278.

4. Eriksson E, Arvidsson I, Arvidsson H: Diagnostic and operative arthroscopy of the hip. Orthopaedics 1986;9:169-176.

5. Frich LH, Lauritzen J, Juhl M: Arthroscopy in diagnosis and treatment of hip disorders. Orthopaedics 1989; 12:389391.

6. Gross RH: Arthroscopy in hip disorders in children. Orthop Rev 1977;6:43-49.

7. Ide T, Akamatsu N, Nakajima I: Arthroscopic surgery of the hip joint. Arthroscopy 1991;7:204-211.

8. Johnson L: Hip joint. In: Johnson L (ed). Diagnostic and Surgical Arthroscopy, 3rd ed. St. Louis. Mosby, 1986:1491-1519.

9. Dorfmann H, Boyer T, Henry P, DeBie P: A simple approach to hip arthroscopy. Arthroscopy 1988;4:141-142.

10. Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E: Hip arthroscopy by the lateral approach. Arthroscopy 1987;3:4-12.

11. Watanabe M: Arthroscopy of Small Joints. Tokyo: Ogaku Shoin, 1985.

12. Byrd JWT: Hip arthroscopy utilizing the supine position. Arthroscopy 1994;10:275-280.

13. Byrd JWT, Pappas JN, Pedley MJ: Hip arthroscopy: an anatomic study of portal placement and relationship to the extra-articular structures. Arthroscopy 1995;11:418-423.

14. McCarthy JC, Day B, Busconi B: Hip arthroscopy: applications and technique. J Am Acad Orthop Surg 1995;3:115-122.

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Arthritis Joint Pain

Arthritis Joint Pain

Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.

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