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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.