Basics

Osteochondroplasty is the arthroscopic reshaping of abnormal bone that produces mechanical impingement around the hip. It can be performed on the femoral side (femoroplasty) or acetabular side (acetabuloplasty/rim trimming). The basic principle is the same: remove enough abnormal bone to restore hip range of motion while preserving normal bone, cartilage, labrum, and the capsule. It is the fundamental technique that allows for arthroscopic correction of FAI.

There is no single fixed amount of bone that should be removed in every patient. The planned correction should come from the patient's preoperative imaging and intraoperative assessment. Specific techniques for cam and pincer deformities are discussed separately in the following sections. This section will focus on the basic methods and tools involved in osteochondroplasty.

Common tools

Tool	Role during osteochondroplasty
70-degree arthroscope	Unlike the knee and shoulder joint where a 30 degree arthroscope is commonly used, the deep location and anatomy of the hip usually requires a 70 degree arthroscope which makes triangulation and instrumentation more technically challenging.
Motorized arthroscopic burr	The burr is the primary tool used for bone-remodeling in osteochondroplasty.
Shaver	The shaver can clear synovium, periosteal tissue, and capsular tissue from the planned resection surface so the bony anatomy can be identified.
Cannula and switching sticks	The deep passage required to access the hip means that a cannula and switching stick are commonly used to maintain patent access and allow for instrument exchange.
Fluoroscopy	Fluoroscopy allows for direct visualization of location and extent of osteochondroplasty.

General principles

1. Obtain adequate exposure

Bone resection is unreliable if the capsule, synovium, or labrum obscures the working surface. Capsular traction sutures and a shaver can improve exposure without unnecessarily removing capsule.

2. Use the minimum bone resection required to restore normal mechanics

Fluoroscopy and dynamic range-of-motion testing can help determine if resection is adequate to restore normal movement and reduce pain.

3. Create a smooth transition between resected and normal bone

Sharp notches, troughs, or abrupt changes in contour can act as stress risers and may also impair normal contact between the femoral head and labrum.

General technique

1. Complete the diagnostic arthroscopy

Identify the bone that is contributing to impingement. Associated labral and chondral pathology should be understood before bone is removed.

2. Expose the planned resection surface

Remove only enough soft tissue to clearly see the bony landmarks and maintain safe access for the burr. Keep the capsule retracted and the labrum and articular cartilage out of the burr path.

3. Confirm the planned boundaries of resection

This should be done with direct visualization and fluoroscopy. This is particularly important because the hip cannot be viewed circumferentially from a single portal or fluoroscopic image.

4. Resect bone in controlled passes

Keep the burr in view, maintain a stable hand position, and avoid plunging or creating a focal notch. Larger amounts of bone should be removed progressively rather than in a single pass.

5. Stop periodically and reassess

Alternate between burring, fluoroscopy, and repositioning of the hip so that the correction can be evaluated from different angles.

How to determine when the resection is adequate

1. Arthroscopic confirmation

The resection has a smooth contour without an obvious residual prominence or abrupt notch.

2. Fluoroscopic confirmation

The planned bony correction should be identifiable on fluoroscopy in more than one view or at more than one hip position.

3. Dynamic examination

The hip moves through the relevant range without pathologic bony contact or impingement.

References