Loose body removal in hip arthroscopy: Rigid versus flexible instrumentation

PURPOSE:: To compare arthroscopic access to the acetabulum for loose body removal using a standard rigid straight grasper and a flexible grasper. METHODS:: Using a standard hip arthroscopy teaching model, the acetabulum was divided into 6 zones. Small pieces of rubber, used to simulate loose bodies, were evenly distributed throughout each zone and secured to the acetabulum using adhesive. Anterolateral and anterior portals were created for viewing and working. Using a standardized amount of femoral distraction, the rigid straight grasper and the flexible grasper were used to retrieve loose bodies from each portal in separate trials. Twenty loose bodies were available for retrieval from each zone, through each portal, and for each instrument. A total of 480 loose bodies were available for retrieval across all variables. RESULTS:: Both the rigid and the flexible graspers were effective in retrieving loose bodies from zone 3 through the anterior and anterolateral portals. The rigid grasper and the flexible grasper were equally effective in removing loose bodies from zone 4 through the anterior portal but not the anterolateral portal. The rigid straight grasper was not effective in reaching anterior and inferior zones of the acetabulum from either portal. Overall, the rigid grasper was able to retrieve 42% of the loose bodies (48% from the anterior portal and 36% from the lateral portal). The flexible grasper was able to retrieve 100% of the loose bodies from both working portals. CONCLUSIONS:: Through standard arthroscopy portals, the rigid straight grasper can be effective for accessing some portions of the acetabulum with better access obtained from the anterior portal. The flexible grasper allows greater arthroscopic access to the acetabulum. CLINICAL RELEVANCE:: Use of flexible instrumentation in hip arthroscopy may improve our ability to treat pathologic conditions in all areas of the hip joint.