Labral tears can lead to disabling hip pain however underlying structural (femoroacetabular impingement) and developmental abnormalities predisposing to labral pathology may be left untreated if the peripheral compartment is ignored during hip arthroscopy. Femoroace-tabular impingement (FAI) can be secondary to abnormal morphologic features involving either the proximal femur and/or the acetabulum. Both acetabular labral tears and FAI lead to premature osteoarthritis of the hip. Early diagnosis and treatment of these hip pathologic abnormalities is important, not only to provide pain relief but also to prevent the development of osteoarthritis.

Purpose: To describe the technique for arthroscopy of the peripheral compartment of the hip joint without traction.

Methods: We performed 9 hip arthroscopies without traction from a lateral and and anterolateral portals in the supine position.

After a traditional central arthroscopy with traction, 60 degrees of flexion at the hip joint without traction allowed relaxation of the anterior capsule and increased the intra-articular volume of the peripheral compartment.

Results: Inspection of the peripheral compartment was obtained from the anterolateral portal. The anterior neck area, medial neck area, medial head area, anterior head area, lateral head area and lateral neck area were viewed. In 3 patients, loose bodies were removed. In 1 patient with PVNS synovial biopsy was taken and synovectomy was performed. Osteochondroplasty was performed in 5 patients for femoroacetabular impingement. No complications were observed.

Conclusions: Hip arthroscopy without traction is mandatory to complete assessment and adequate treatment of the painful hip.