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H I P AR TH ROSCO PY HA S now become a commonly utilized surgical technique for treating intra-articular pathology of the hip joint. Orthopedic conditions such as labral tears, femoroacetabular impingement, snapping hip syndrome, synovitis and loose bodies can now all be treated arthroscopically. H ip endo scop y i s a n emerg i n g technique where the arthroscope is inserted into the area between the ilio- tibial band and the greater trochanter, also known as the peritrochanteric space. This approach can allow for the repair of abductor tendon tears, removal of the trochanteric bursa and even sciatic neuroplasty for sciatic nerve entrapment. A 39-year-old female was initially referred to an orthopedic oncologist for a bony lesion noted on the anterior proximal femur consistent with an osteochondroma. The patient was then referred to me for evaluation of a pos- sible concomitant labral tear. The patient initially complained of both deep groin pain consistent with intra-articular hip pathology as well as a pain in the deep anterior thigh. Upon physical examina- tion, the patient had a positive dynamic impingement sign which reproduced her groin pain but not the anterior thigh pain. X-rays and a CT scan showed both femoroacetabular impingement and the osteochondroma. The decision was made to obtain an MRI arthrogram with intra-articular local anesthetic to try to elucidate the cause of the pain. The MRI showed an anterosuperior labral tear, and the patient described 50 percent relief of pain after the intra-articular injection. A decision was made to address both problems concomitantly. The surgical plan consisted of hip arthroscopy with labral repair and correction of femoroacetabular impingement, and endoscopic versus open resection of the osteochondroma. The labral tear was approached via a two-portal technique utilizing an anterolateral and mid anterior portal. The femoroacetabular impingement was addressed in the standard fashion, and the labrum was repaired with suture anchors using a labral base stitch in a vertical mat- tress technique. The peritrochanteric space was then entered using our anterolateral portal and a third distal anterolateral portal. Fluoroscopic visualization was used to localize the osteochondroma. The vastus lateralis tendon was incised and dissected down to the femur and localized the tumor. A fourth distal anterior portal was then established to allow for a burr to resect the tumor. Using fluoroscopy as well as direct endoscopic visualization, the tumor was resected completely. A mixture of thrombin and powdered gel foam was utilized for local bleeding control. Post-operatively, the patient was dis- charged from same-day surgery, made non-weight bearing for six weeks and started a physical therapy rehab pro- tocol for a labral repair. Narcotic pain medication was utilized for one week post- operatively, and celecoxib was prescribed for heterotopic ossification prophylaxis. The combination of both an arthroscopic and an endoscopic technique allowed this patient to have both pathologies treated simultaneously through four small portals rather than a large open approach. This novel approach can help avoid surgical morbidity and decrease surgical blood loss, pain and recovery time. As we continue to innovate and expand techniques in hip arthroscopy and hip endoscopy, I believe we will be able to utilize arthroscopic techniques to treat even more complex problems of the hip and provide better outcomes for our patients. Dr. Jovan Laskovski is a fellowship-trained orthopedic surgeon who specializes in hip arthroscopy and sports medicine. He is a member of the Crystal Clinic and practices at the Crystal Clinic Orthopedic Center on South Arlington Road in Akron, Ohio. ■ Novel Hip Arthroscopic and Endoscopic Techniques for Treatment of a Labral Tear and Osteochondroma of the Hip By Jovan Laskovski, MD Benign bony tumor exposed intraoperatively Resection of the tumor T U M O R R ES EC TI O N ++++++++++++++++++ + +++ + +++ ++++++++++++++++++ CASE STUDY 2 4 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ M AY/J U N E 2 0 1 4