**5. Discussion**

The hip region is an area where several noble elements pass including the femoral neurovascular bundle anteriorly, the LFCN anterolaterally, and the sciatic nerve and gluteal vessels posteriorly. Direct neurovascular injury is rare, except the LFNC; however, their proximity to portals and the effect of traction have to be considered by the surgeon especially during the learning curve.

In fact, during hip arthroscopy, a perineal post is used for countertraction and traction and is needed to provide space for instrument introduction which can lead to soft tissue injuries, and this is the most commonly reported complication of hip arthroscopy [20].

Risks and recommendation during hip arthroscopy and portals placement are detailed in **Table 1**.


#### **Table 1.**

*Risks incurred during traction and portal placement.*

## **6. Conclusion**

FAI is explained by morphological abnormalities reaching the femoral headneck junction or the acetabulum. Hip arthroscopy is widely used nowadays for its management.

To avoid complications of this technique, a good knowledge of hip anatomy is necessary as well as the risks incurred during its practice.

Traction and portal placement are the cause of most complications.

The lateral femorocutaneous nerve is the noble structure and the most exposed to injuries through the anterior portal. With the exception of it, direct major neurovascular injury is very rare; however, care is needed especially during the learning curve.

**35**

**Author details**

and Bouzidi Ramzi

El Manar University, La Marsa, Tunisia

provided the original work is properly cited.

\*Address all correspondence to: mouadhnefiss2@gmail.com

Nefiss Mouadh\*, Ben Maatoug Aymen, Teborbi Anis, Tekaya Asma, Ezzaouia Khelil

Orthopedic Surgery Department, Faculty of Medicine, Mongi Slim Hospital, Tunis

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Femoroacetabular Impingement: Anatomy and Pathogenesis*

*DOI: http://dx.doi.org/10.5772/intechopen.90296*

*Femoroacetabular Impingement: Anatomy and Pathogenesis DOI: http://dx.doi.org/10.5772/intechopen.90296*

*Essentials in Hip and Ankle*

increased joint loading.

by the surgeon especially during the learning curve.

Traction 1. Femoral and sciatic nerve neurapraxia

Anterior portal 1. Direct injury of the LFCN

Posterior portal Inferior gluteal artery and

*Risks incurred during traction and portal placement.*

2. Pudendal nerve injury

2. Vascular injury (rare) 3. Iatrogenic labral and chondral injuries

Iatrogenic labral and chondral injuries

sciatic nerve injury (rare)

**5. Discussion**

arthroscopy [20].

detailed in **Table 1**.

Given that cam and pincer morphologies can be present in asymptomatic individuals, Casartelli [19] propose that other factors out with the bony structures may be involved with FAI syndrome. Weakness of deep hip muscles could not only compromise hip stability but also lead to overload of secondary movers of the hip, thus causing an anterior glide of the femoral head into the acetabulum and

The hip region is an area where several noble elements pass including the femoral neurovascular bundle anteriorly, the LFCN anterolaterally, and the sciatic nerve and gluteal vessels posteriorly. Direct neurovascular injury is rare, except the LFNC; however, their proximity to portals and the effect of traction have to be considered

In fact, during hip arthroscopy, a perineal post is used for countertraction and traction and is needed to provide space for instrument introduction which can lead to soft tissue injuries, and this is the most commonly reported complication of hip

Risks and recommendation during hip arthroscopy and portals placement are

**Risks Recommendations [20]**

placement

this portal

1. Continuous traction should not exceed 2 hours The force of traction should be limited to <22.7 kg 2. Well-padded and wide enough perineal post

1. Use lateralized anterior portal, and the skin incision should not extend into the subcutaneous fat 2. Optimal landmarks spotting and portal

Avoid internal rotation of the hip while positioning

3. Adequate traction (≥10 mm) Avoid repetitive exchange of instruments

Optimal portal placement

Optimal portal placement

FAI is explained by morphological abnormalities reaching the femoral headneck junction or the acetabulum. Hip arthroscopy is widely used nowadays for its

To avoid complications of this technique, a good knowledge of hip anatomy is

The lateral femorocutaneous nerve is the noble structure and the most exposed to injuries through the anterior portal. With the exception of it, direct major neurovascular injury is very rare; however, care is needed especially during the learning curve.

Traction and portal placement are the cause of most complications.

necessary as well as the risks incurred during its practice.

**34**

**6. Conclusion**

**Table 1.**

Anterolateral portal

management.
