Supine Hip Arthroscopy: How Anterolateral and Anterior Portals Work Together

WEB SUMMARY  Supine hip arthroscopy relies on coordinated anterolateral, anterior, and posterolateral portals. This article follows the sequence from fluoroscopy and arthroscopic confirmation to irrigation and instrumentation.

Positioning and traction come before portal placement

The patient lies supine on a fracture table or a standard table with traction capability, and a perineal post provides countertraction. The hip is usually kept extended, slightly abducted, and in neutral rotation. The anterolateral portal is established only after fluoroscopy confirms adequate joint distraction. Perineal pressure and traction time should be monitored to reduce soft-tissue and neurologic risk.

Why the anterolateral portal is usually first

The anterolateral puncture site is approximately one centimeter anterosuperior to the anterior border of the greater trochanter, with the needle directed slightly cephalad and posterior. The route passes through the gluteus medius into the anterolateral capsule. The superior and sciatic nerves are the closest relevant neural structures. Because this portal is often created without direct vision, depth and needle direction require repeated fluoroscopic confirmation to avoid penetrating the labrum.

Anterior portal placement and protection

The anterior portal is located near the intersection of the line extending distally from the anterior superior iliac spine and the tangent to the trochanteric apex. Instruments pass through the sartorius and rectus femoris before entering the capsule. The lateral femoral cutaneous nerve and the ascending branch of the lateral circumflex femoral artery are nearby. A skin-only incision followed by blunt subcutaneous dissection can reduce neural risk.

Neutral rotation is critical for the posterolateral portal

Position should be confirmed with the arthroscope through the anterior portal before the posterolateral portal is created. The puncture point is above and behind the trochanteric apex, and the route passes through the gluteus medius and minimus into the posterior capsule. The sciatic nerve is the main concern. Neutral hip rotation and a slightly cephalad, anteriorly converging trajectory help create a controlled working path.

Portal roles change throughout the operation

After all three standard portals are established, the posterolateral portal often serves as the irrigation route. The anterior and anterolateral portals alternate between 30- and 70-degree scopes according to the target. Lens rotation, hip rotation, and carefully selected auxiliary portals help the surgeon reach both the central and peripheral compartments while limiting cartilage and labral trauma.

Medical content notice: This article is intended for professional health communication and website editorial use. It is not a diagnosis, treatment recommendation, or endorsement of a specific technique. Positioning, portals, traction settings, and rehabilitation must be determined by qualified orthopedic arthroscopy, anesthesia, and rehabilitation teams for the individual patient.