Open capsulotomy vs arthroscopy
Small osteochondral fragments, as determined by MRI, can be removed either through a capsulotomy, or arthroscopically.
The indication for arthroscopic removal depends on the surgeon's skill with hip arthroscopy.
The advantages of hip arthroscopy are:
- Minimally invasive capsulotomy
- Enhanced visualization of the joint
- Visualization of the osteochondral defect in the head
The limitation of an arthroscopic approach is the size of the fragment. Larger fragments will require conversion to an open approach.
Note: Flake fractures are mostly the result of traumatic hip dislocation.
Incongruency after dislocation is very often overlooked on conventional x-rays.