Perform preoperative assessment of feasibility approaching the location of screw.|
Perform accurate preoperative self-assessment of surgical experience and arthroscopic skills.
Consider patient position (supine or lateral) allowing for manual manipulation of the lower limb at the knee and hip joints for the full assessment of sciatic nerve excursion
Lateral position may facilitate ease of conversion to open surgery
Prepare for possible open resection of screw or revision total hip arthroplasty (rather than endoscopic resection) if endoscopic method fails.
Consider fluoroscopic guidance to identify and confirm resection of the protruding screw.
Mobilize and development of soft tissue around sciatic notch.
Consider sciatic notch osteoplasty to expose proper cutting level of the screw.
Pay careful attention to safe position of burr to prevent superior gluteal neurovascular bundle and sciatic nerve injury (may require several accessory portals).
Circulating fluid during burr resection of screw may minimize thermogenesis and metallic debris retention.
Confirm adequate resection and smooth recontour of the screw by arthroscopic dynamic testing while envisioning the sciatic nerve
Allow early mobilization of hip commensurate with symptomatic improvement.