EP6.109 Arthroscopic removal of benign tumor from the posterior peripheral compartment of the hip without T-capsulotomy

Abstract A 19-year old football player was presented with a 4-month history of persistent hip pain. On clinical examination he had a positive impingement sign and full range of motion. Radiographic and MRI assessment revealed a well-defined mass, located in the peripheral compartment posteriorly, sized at 28x20x20 mm. A CT-guided biopsy diagnosed myxoid neoplasm. After discussion with department and oncology team, resection of the tumor was decided by arthroscopic means. A hip arthroscopy was done with patient on the lateral position. Anterolateral and posterolateral portals were used for a complete diagnostic round. A standard proximal anterolateral (Dienst) portal was used for anterior peripheral compartment, as done for removal of cam impingement lesion. Then, the same portal was used to reach posterior peripheral compartment by shifting the instruments posteriorly to the head-neck junction, with concomitant hyperextension and external rotation of the hip in order to relax posterior capsule. The posterolateral portal was used as working portal. The tumor was clearly observed and resected with arthroscopic buskets, graspers and shaver. The resected specimens were sent for second biopsy which confirmed the initial diagnosis. Patient was discharged the same day of the procedure. He had a rehabilitation period of 6 weeks on crutches and physiotherapy for 3 months. At the 6-month follow-up examination he had no complain for pain and impingement sign was negative. The modified Harris Hip Score was improved to score of 96, with an improvement of 17 points. A postoperative MRI was done at 6 months which revealed almost complete removal of the tumor. Hip arthroscopy is an excellent alternative to open resection, especially in young adults. Posterior peripheral compartment remains a difficult area to approach arthroscopically. Careful portal establishment, hyperextension and external rotation of the hip may cause relaxation of posterior capsule and distance sciatic nerve, creating an adequate space for the working portal, without the need for an extensive T-shaped posterior capsulotomy. This technique offered excellent results to this patient and we suggest arthroscopic removal of such lesions as a minimal and non-traumatic technique.