Hip arthroscopy is the predominant surgical procedure for the treatment of femoroacetabular impingement syndrome (FAI). Usually, hip arthroscopy requires intraoperative fluoroscopic guidance for portal establishment, acetabuloplasty, suture anchor placement, and femoroplasty, which has disadvantages such as radiation exposure and prolonged operative time. This article presents a technique of hip arthroscopy without fluoroscopy throughout. By establishing portals through a semiopen hollow guide bar, “one-line trimming” for pincer deformity removal, modified distal anterolateral portal for anchor placement, “triangular abrasion” for cam deformity resection, and intraoperative dynamic examination to ensure adequate relief of impingement, we provide a safe and effective surgical procedure for hip arthroscopy to treat FAI without fluoroscopy. After placement of the arthroscope, cartilage of the femoral head, labrum, acetabular fossa, and the ligamentum teres are first examined. Based on the degree and extent of the labral injury and preoperative imaging, the range of pincer deformity can be initially determined. Subsequently, the adhesions between the acetabular rim and the joint capsule should be separated sufficiently to fully reveal the overgrew bone of the pincer deformity behind the injured labrum.

Key Teaching Points

Atrial fibrillation (AF) is relatively rare in pregnancy and is mostly managed medically. Sotalol is preferred for rhythm control, whereas beta-blockers and digoxin are preferred for rate control. Cardioversion can be performed for hemodynamically unstable AF. Catheter ablation for AF has not been performed historically. Significant potential for maternal and fetal risks from electrophysiology study, anesthesia, and radiation exposure exists. However, in highly symptomatic patients zero-fluoroscopy catheter ablation can be considered. We describe a successful zero-fluoroscopy catheter ablation procedure in a pregnant woman in her second trimester who was highly symptomatic and failed sotalol therapy. We also describe the use of intracardiac echocardiography in monitoring the fetus during the procedure.

With Regards,
Sara Giselle
Associate Managing Editor
Journal of Medical Physics and Applied Scinces