**6. Conclusions**

92 Modern Arthroscopy

where the fibrous bands make the cavity difficult to visualize and therefore more time is

At follow up, three months after surgery, patients that underwent psoas tenotomy had recovered the range of hip flexion to grade 4 and by 6 months all patients had regained

We have found that patients with lumbar spine disorders experience more back and

In all the cases of capsulorraphy the instability and the episodes of subluxation had disappeared. This was maintained at the 6-month and 1-year follow-ups. None of the patients had to undergo further surgery in relation to their hip replacement. They were given instructions to avoid hip flexion of more than 100º, especially together with external

In 1% of the cases the reason for the persistence of pain following hip replacement surgery remains unknown (Witvoët, 2001). Despite this, the cause of pain should always be investigated and we should not rush in carrying out revision surgery (Witvoët, 2001). This is where arthroscopy plays an important role enabling a progress in the diagnosis and a potential treatment in certain patients whose prostheses, although apparently properly implanted, continue to cause pain (McCarthy et al., 2009). This is already being used as a diagnostic and therapeutic tool in some painful complications associated with total knee replacements (Bocell et al., 1991; Johnson et al., 1990; Lawrence & Kan, 1992; Lucas et al., 1999; Markel et al., 1996; Scranton, 2001; Tzagarakis et al., 2001; Wasilewski & Frankl, 1989a,

Access can be gained to the prosthetic joint using the arthroscopic technique and instruments. It is possible to apply this to resurfacing type prostheses, as indicated in the

Regarding the use of ultrasound-guided steroid injections into the psoas (Adler et al., 2005; Ala Eddine et al., 2001; Bricteaux et al., 2000; Dora et al., 2007; O'Sullivan et al., 2007; Wank et al., 2004), we believe that this technique has few advantages: it is not easy to perform; and in our opinion doesn´t provide much information, even in cases in which it was clear intraoperatively that there was tendon involvement. The outcomes reported in the literature are very variable and it is often not successful (Adler et al., 2005; Ala Eddine et al., 2001; Bricteaux et al., 2000; Cuéllar et al., 2009; Jasani et al., 2002; McCarthy et al., 2009; O'Sullivan et al., 2007; Witvoët, 2001). For this reason, we recommend that this technique is not used

It is possible to perform endoscopy-guided trochanteric bursoscopy and fasciotomy.

To date we have not treated any patients with acute or subacute arthritis, but we believe that the arthroscopy technique could be used in such cases, similarly to when indicated in

To avoid prosthetic dislocation in the immediate postoperative period, unnecessary wide capsulotomies should not be done, and the patents should be given clear instructions about

required to perform the debridement procedure.

radiating leg pain after having their painful prosthetic hips treated.

We have not observed any neurovascular complications.

only paper that we found on this topic (Khanduja & Villar, 2008).

Additionally, if necessary, gluteal muscle repair can be performed.

infected total knee replacements (Hyman et al., 1999; McCarthy et al., 2009).

systematically, but rather only in selected cases.

postural training (Cuéllar et al., 2009).

We favour capsular plication using sutures rather than thermal methods.

grade 5 strength.

rotation and adduction.

**5. Discussion** 

1989b).

Arthroscopy can be successfully applied to the diagnosis and treatment of pain of unknown origin after hip replacement surgery. This very often associated with lumbar spine disorders, other medical conditions and old age. This association makes the differential diagnosis difficult.

The technique has proven to be especially useful in the treatment of instability, muscular and tendon pain and arthrofibrosis.

On the other hand, the technique has not been found to be reliable for identifying cases of loosening of prosthetic components.
