Hip Arthroscopy: Portal Placement

The indications for hip arthroscopy are expanding. Initially, works within the central and peripheral compartments were described using a combination of three portals: anterolateral, anterior, and posterolateral. The anterolateral portal is typically the first portal made and is the only portal created without direct visualization. Fluoroscopy and tactile sensation are used to guide the spinal needle and cannula into the correct location, but iatrogenic chondral and labral injuries are potential risks. The anterior portal is in greatest proximity to a neurovascular structure, with the lateral femoral cutaneous nerve located more than 3 mm away. The mid-anterior portal is becoming more popular as it offers similar visualization as the anterior portal yet is more distant from the lateral femoral cutaneous nerve and offers an improved trajectory for suture anchor placement in labral repairs. Accessory portals and peritrochanteric space portals offer viewing and working abilities to address pathologies such as internal and external snapping hips, ischiofemoral impingement, gluteus medius and minimus repairs, and trochanteric bursectomy.