this study was approved by the chungnam national university hospital institutional review board and informed consent was waived from all patients . from july 2003 to february 2013 , we performed retrospective review of 13 patients , who underwent hip arthroscopy due to persistent pain and intraarticular pathology after major hip trauma such as acetabular fracture and hip dislocation . the exclusion criteria was as follows : ( 1 ) a history of low - energy hip trauma ( i.e. , contusion or sprain ) ; ( 2 ) history of surgery involving the femur or pelvis before the major trauma ; ( 3 ) tonnis grade 2 or above;17 ) ( 4 ) proliferative disease of the hip ( i.e. , synovial chondromatosis , pigmented villonodular synovitis ) ; ( 5 ) neuromuscular disease ( i.e. , cerebral palsy ) ; ( 6 ) legg - calve - perthes deformity ; ( 7 ) ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis ; and ( 8) developmental dysplasia of the hip . arthroscopic treatment was planned based on persistent or aggravating hip pain and intra - articular pathologies such as loose fragments , labral tears , and ligamentum teres injury on hip three - dimensional computed tomography ( 3d ct ) and magnetic resonance imaging ( mri).18 ) all arthroscopic procedures were performed by a single senior surgeon . after general anesthesia , the patient was placed in a supine position , the hip joint was abducted by 10 to 15 , and the lower extremity was placed in a neutral position and fixed to the fracture table . for procedures on the central compartment of the joint , the hip joint was extended about 8 to 10 mm under monitoring with an image amplifier . three portals ( anterior , anterolateral , and posterolateral ) were made , mainly using a 70-angled arthroscope . after the intra - articular pathologies were identified subsequent to appropriate anterolateral capsulotomy , loose fragments were removed using a grasper via the anterior or posterolateral portal , and labral tears were debrided using an arthroscopic shaver or repaired using a 2.9-mm bioraptor suture anchor ( smith & nephew , london , uk ) ( fig . ligamentum teres injury was debrided using a shaver or was shrunk by vulcan ( smith & nephew ) through the anterior or posterolateral portal , and cartilage injuries of the femoral head and acetabulum were treated by microfracture ( fig . after traction was released , the arthroscope was moved towards the peripheral compartment through the same portal while the hip joint was flexed by about 40 , at which time a 30 angled arthroscope was introduced . pathologies of the peripheral compartment , such as a femoral head neck spur or a traumatic bony deformity , were treated by femoroplasty.1318 ) all cases underwent 3d ct on the second day postoperatively to check the postoperative state of the acetabuloplasty and femoroplasty and removal of loose bodies ( fig . partial weight - bearing with crutches was permitted for four weeks in case of patients who had undergone osteoplasty and labral repair . continuous passive motion and passive pendulum exercise were started after the procedure to avoid postoperative capsular adhesion . we identified the degree of osteoarthritis based on the tonnis classification pre- and postoperatively at final follow - up.17 ) clinical outcomes were evaluated using visual analogue scale for pain ( vas ) and modified harris hip score ( mhhs ) , and range of motion ( rom ) of the hip pre- and postoperatively at final follow - up.19 ) the paired t - tests were used to assess the difference in outcomes before surgery and at the time of the final follow - up . the ibm spss ver . 19.0 ( ibm co. , armonk , ny , usa ) was used for all statistical analyses , with the  level set at 0.05 . this study was approved by the chungnam national university hospital institutional review board and informed consent was waived from all patients . from july 2003 to february 2013 , we performed retrospective review of 13 patients , who underwent hip arthroscopy due to persistent pain and intraarticular pathology after major hip trauma such as acetabular fracture and hip dislocation . the exclusion criteria was as follows : ( 1 ) a history of low - energy hip trauma ( i.e. , contusion or sprain ) ; ( 2 ) history of surgery involving the femur or pelvis before the major trauma ; ( 3 ) tonnis grade 2 or above;17 ) ( 4 ) proliferative disease of the hip ( i.e. , synovial chondromatosis , pigmented villonodular synovitis ) ; ( 5 ) neuromuscular disease ( i.e. , cerebral palsy ) ; ( 6 ) legg - calve - perthes deformity ; ( 7 ) ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis ; and ( 8) developmental dysplasia of the hip . arthroscopic treatment was planned based on persistent or aggravating hip pain and intra - articular pathologies such as loose fragments , labral tears , and ligamentum teres injury on hip three - dimensional computed tomography ( 3d ct ) and magnetic resonance imaging ( mri).18 ) the patient was placed in a supine position , the hip joint was abducted by 10 to 15 , and the lower extremity was placed in a neutral position and fixed to the fracture table . for procedures on the central compartment of the joint , the hip joint was extended about 8 to 10 mm under monitoring with an image amplifier . three portals ( anterior , anterolateral , and posterolateral ) were made , mainly using a 70-angled arthroscope . after the intra - articular pathologies were identified subsequent to appropriate anterolateral capsulotomy , loose fragments were removed using a grasper via the anterior or posterolateral portal , and labral tears were debrided using an arthroscopic shaver or repaired using a 2.9-mm bioraptor suture anchor ( smith & nephew , london , uk ) ( fig . ligamentum teres injury was debrided using a shaver or was shrunk by vulcan ( smith & nephew ) through the anterior or posterolateral portal , and cartilage injuries of the femoral head and acetabulum were treated by microfracture ( fig . after traction was released , the arthroscope was moved towards the peripheral compartment through the same portal while the hip joint was flexed by about 40 , at which time a 30 angled arthroscope was introduced . pathologies of the peripheral compartment , such as a femoral head neck spur or a traumatic bony deformity , were treated by femoroplasty.1318 ) all cases underwent 3d ct on the second day postoperatively to check the postoperative state of the acetabuloplasty and femoroplasty and removal of loose bodies ( fig . partial weight - bearing with crutches was permitted for four weeks in case of patients who had undergone osteoplasty and labral repair . continuous passive motion and passive pendulum exercise were started after the procedure to avoid postoperative capsular adhesion . we identified the degree of osteoarthritis based on the tonnis classification pre- and postoperatively at final follow - up.17 ) clinical outcomes were evaluated using visual analogue scale for pain ( vas ) and modified harris hip score ( mhhs ) , and range of motion ( rom ) of the hip pre- and postoperatively at final follow - up.19 ) the paired t - tests were used to assess the difference in outcomes before surgery and at the time of the final follow - up . the ibm spss ver . 19.0 ( ibm co. , armonk , ny , usa ) there were 13 patients ( nine males and four females ) with a mean age of 28 years ( range , 20 to 50 years ) at the index operation . the mean follow - up period was 59.8 months ( range , 24 to 115 months ) . the mean interval from initial trauma to arthroscopic surgery was 40.8 months ( range , 1 to 144 months ) ( table 1 ) . the cause of injury was traffic accident in ten patients and sports injury in three patients , of them , six patients had undergone hip surgery after acetabular fracture or hip dislocation . arthroscopically , we performed loose bony fragment removal , debridement or repair of a torn acetabular labrum , debridement or shrinkage of a torn ligament teres remnant , excision of osteophytes , synovectomy , or microfractures ( table 1 ) . at the final follow - up , vas and mhhs improved significantly from 6.3 and 53.4 to 3.0 and 88.3 , respectively ( p = 0.002 and p < 0.001 , respectively ) . however , there were no significant differences in hip flexion , abduction , adduction , external rotation , and internal rotation as improvement was seen from 113.1 , 38.5 , 28.5 , 36.5 , and 22.7 to 118.5 , 39.0 , 29.2 , 38.9 , and 26.5 , respectively ( p = 0.070 , p = 0.414 , p = 0.317 , p = 0.084 , and p = 0.136 , respectively ) ( table 2 ) . none of the patients exhibited progression of osteoarthritis of the hip at the final follow - up . eight and five patients with preoperative tonnis grade 0 and 1 were successful in maintaining their grade , respectively . hip arthroscopy provides a clear view of the articular surface of the femoral head , the acetabular labrum , the ligamentum teres and synovium.7 ) today , hip arthroscopy is becoming popular for procedures not only inside the hip joint but also surrounding it.62021 ) therefore , arthroscopic surgery of the hip joint can facilitate diagnosis and treatment of labral tears and other intra - articular and peripheral pathologies.818222324 ) however , few reports have focused on arthroscopic treatment of coxarthrosis after fracture or dislocation of the hip joint . in the previous study , arthroscopic debridement of 23 ligamentum teres ruptures that occurred after major hip trauma showed a satisfactory outcome on the harris hip score with a 20-point improvement or better , and 15 cases had intra - articular pathologies such as loose bodies , cartilage injury , and labral tears.8 ) the most common intra - articular pathologies that occur in athletes after hip dislocation are labral tears , cartilage injury , loose bodies , and ligamentum teres injury.10 ) in our study , loose bodies , labral tears , ligamentum teres injury , and cartilage injury as intra - articular lesions were checked , and the vas and mhhs improved significantly at the final follow - up after surgery . in particular , an intra - articular loose body , frequently observed after hip trauma , could cause progression of traumatic osteoarthritis.252627 ) svoboda et al.11 ) reported that arthroscopic removal of the loose body in patients with posterior dislocation of the hip was safe and effective . yamamoto et al.12 ) reported that among 11 patients with fracture and/or dislocation of the hip joint , who underwent arthroscopic treatment , nine patients were treated with loose body removal , which safely prevented traumatic arthritis . in our study , five patients underwent arthroscopic removal with effective relief of their symptoms . furthermore , it has been reported that labral tear results in hip pain and osteoarthritis.2328 ) ilizaliturri et al.13 ) reported that among 17 patients , who underwent arthroscopic treatment after posterior dislocation of the hip , 14 patients had anterior labral tears and six patients had posterior labral tear and most of the patients had significant improvement after hip arthroscopy . in our study , ten patients had labral tear on arthroscopy and experienced relief of symptoms after treatment with debridement and/or repair ( table 3 ) . however , patients , who underwent arthroscopic treatment due to acetabular fracture or hip dislocation , were exceptional . first , there exist only few studies discussing the use of arthroscopy for the treatment of hip pain following high - energy acetabular fracture or traumatic hip dislocation . second , we demonstrated that arthroscopic treatment for coxarthrosis after acetabular fracture or hip dislocation effectively prevents progression of traumatic arthritis on short - term follow - up . in conclusion , arthroscopic treatment for painful hip after acetabular fracture or hip dislocation could result in satisfactory outcomes including relief of symptoms and prevention of the progression of traumatic arthritis on a minimum follow - up of 2 years . consequently , the hypotheses that arthroscopic treatment of painful hip after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis were supported through the present study . however , future study demands mid- and long - term results in more patients , which will provide detailed insights to this area of study .
backgroundpainful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology 
 . however , there is limited literature discussing the use of arthroscopy for the treatment of painful hip . 
 the purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma.methodsfrom july 2003 to february 2013 , we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years . 
 the degree of osteoarthritis based on the tonnis classification pre- and postoperatively at final follow - up was determined . 
 clinical outcomes were evaluated using visual analogue scale for pain ( vas ) and modified harris hip score ( mhhs ) , and range of motion ( rom ) of the hip pre- and postoperatively at final follow-up.resultsthere were nine male and four female patients with a mean age at surgery of 28 years ( range , 20 to 50 years ) . 
 the mean follow - up period of the patients was 59.8 months ( range , 24 to 115 months ) , and the mean interval between initial trauma and arthroscopic treatment was 40.8 months ( range , 1 to 144 months ) . at the final follow - up , vas and mhhs improved significantly from 6.3 and 53.4 to 3.0 and 88.3 , respectively ( p = 0.002 and p < 0.001 , respectively ) . 
 however , there were no significant differences in hip flexion , abduction , adduction , external rotation , and internal rotation as minor improvements from 113.1 , 38.5 , 28.5 , 36.5 , and 22.7 to 118.5 , 39.0 , 29.2 , 38.9 , and 26.5 were observed , respectively ( p = 0.070 , p = 0.414 , p = 0.317 , p = 0.084 , and p = 0.136 , respectively ) . 
 none of the patients exhibited progression of osteoarthritis of the hip at the final follow-up.conclusionsarthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis .