Preventing and Treating Complications After Hip Arthroscopy.

Abstract

Although arthroscopic procedures are less invasive than open surgical techniques, arthroscopy is not without complications. Complications of hip “scopes” may include traction-related nerve injuries, fluid extravasation, infection, osteonecrosis, and heterotopic ossification (HO). How to address and avoid these complications are the topics of this month’s “Case Connections” article. In the August 27, 2014 JBJS Case Connector , Uquillas and Youm report on a fifty-one-year-old man who presented with symptoms consistent with right-sided femoroacetabular impingement (FAI). Radiographs revealed mixed cam and pincer impingement, and MRI showed an acetabular labral tear, spurring of the acetabulum and femoral neck, a loose body, and chondral delamination. Surgeons used hip arthroscopy to address these multiple problems. Six months after the procedure, the patient had developed increasing lateral hip pain and tightness. At the eight-month follow-up, he reported a sharp spike in hip pain and showed mild impingement signs. Radiographs revealed HO near the greater trochanter, a finding validated by CT (Fig. 1). MRI revealed inflammation surrounding the area of heterotopic bone. Fig. 1 Three-dimensional CT reconstruction showing heterotopic ossification near the greater trochanter. After a year of ineffective anti-inflammatory medication and physical therapy, interventional radiologists performed an ultrasound-guided pulse lavage (1% lidocaine followed by saline solution) to irrigate and debride the 1.3 × 0.08 × 1.1-cm calcific deposit that had been observed on a preprocedure ultrasound. Dispersion of the deposition was noted during the procedure, which was followed by a steroid/anesthetic injection to provide immediate pain relief and treat inflammation. The …