Complication Of Hip Arthroscopy Research Articles

Poster 192: The Incidence and Breadth of Postoperative Pudendal Nerve Palsy and Its Relationship to Table Traction During Hip Arthroscopy With a Perineal Post

Objectives: Pudendal nerve palsy (PNP) is a poorly characterized but common postoperative complication of hip arthroscopy (HA) with a perineal post that can result in external genital numbness and sexual dysfunction in both men and women. Previous attempts to quantify the incidence of these symptoms have relied on patient-initiated reports, chart review, unvalidated questionnaires or have neglected the female experience altogether – failures which likely underestimate the incidence of this complication. We aimed to describe the incidence of postoperative PNP, the breadth of symptoms patient experience and their duration, as well as establish the relationship between PNP and table traction. Methods: We utilized a multisurgeon prospective cohort of HA patients a single academic center. All patients underwent primary unilateral hip arthroscopy, osteochondroplasty and labral repair in a supine position with a perineal post. Patients with preexisting PNP symptoms, including sexual dysfunction, and those who were not sexually active were excluded. Intraoperative traction duration and force were recorded using a Tekscan sensor applied to the perineal post. A PNP screening questionnaire and standardized, validated sexual function questionnaires were administered confidentially to patients at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Patient-reported hip function scores (iHOT-33) were completed preoperatively and at 6 months postoperatively. Results: A total of 100 patients were enrolled. The mean age was 36.2 ± 9.4 years old, 56 patients (56%) were male. The mean traction duration was 80 ± 19 minutes. In the acute postoperative period, 77 patients (77%) experienced symptoms consistent with PNP. The most common sensory symptom described was perineal numbness (n = 77, 77%), followed by paresthesias (n=26, 26%). Seventeen men (17%) and 13 women (13%) reported symptoms of sexual dysfunction postoperatively, in the form of erectile dysfunction (men) or reduced sexual lubrication/dyspareunia/anorgasmia (women). Of patients who experienced PNP symptoms (n = 77), 21% had symptoms resolve by 6 weeks, 71% by 3 months, 90% by 6 months. Two male patients (3.6%) had persistent erectile dysfunction beyond 6 months postoperatively. Persistence of PNP symptoms beyond 6 weeks was associated with lower 33-item International Hip Outcome Tool (iHOT-33) scores at 6 months (mean difference: 18.4 [95% CI: 6.5-30.4], p = 0.003). Analysis of the calibrated sensor data to establish the relationship between traction force, pressure, and duration with PNP is pending. Conclusions: In this preliminary analysis of a planned 100-patient cohort, patients experienced a high rate of PNP and sexual dysfunction symptoms following HA with perineal post, far higher than previous reports. Most symptoms resolved within the first 3 months postoperatively. Anticipated results from the sensor data within this ongoing study are likely to provide insight into the relationship between traction force and/or duration and PNP incidence. A postless HA setup could be considered as an alternative given the described morbidity.

Sex-Based Differences in Prevalence, Outcomes, and Complications of Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review and Meta-analysis.

Trends between the sexes have been reported regarding prevalence, patient-reported outcomes (PROs), and complications of hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS), yet current results lack consensus. To evaluate sex-based differences after HA for FAIS in (1) prevalence of cam and pincer morphology in FAIS and (2) PROs, pain scores, and postoperative complication rates. Systematic review; Level of evidence, 4. The EMBASE, PubMed, and Ovid (MEDLINE) databases were searched from establishment to February 28, 2022, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies had sex-based data on prevalence, outcomes, and complications of HA for FAIS. Reviews and commentaries were excluded. Data were combined, and between-sex differences were analyzed. Meta-analyses using random-effects models were performed when possible. Pooled risk ratios (RRs) and standardized mean differences were calculated. A total of 74 studies were included (213,059 patients; 132,973 female hips [62.4%] and 80,086 male hips [37.6%]). The mean age was 30.7 ± 7.7 years among male patients and 31.1 ± 7.8 years among female patients. Male patients experienced mixed-type impingement significantly more often (39.4% vs 27.2% for female patients; RR = 0.69 [95% confidence interval [CI], 0.58-0.81]; P < .001), whereas female patients experienced pincer-type impingement more often (50.6% vs 30.8% for male patients; RR = 2.35 [95% CI, 1.14-4.86]; P = .02). Male patients had higher likelihoods of undergoing femoroplasty (89.8% vs 77.4% for female patients; RR = 0.90 [95% CI, 0.83-0.97]; P = .006), acetabuloplasty (67.1% vs 59.3% for female patients; RR = 0.87 [95% CI, 0.79-0.97]; P = .01), or combined femoroplasty/acetabuloplasty (29.2% vs 14.5% for female patients; RR = 0.63 [95% CI, 0.44-0.90]; P = .01). Although female patients showed greater improvements in Hip Outcome Score-Sport-Specific subscale (P = .005), modified Harris Hip Score (P = .006), and visual analog scale pain (P < .001), both sexes surpassed the minimal clinically important difference at 1, 2, and 5 years postoperatively. Female patients had higher complication rates (P = .003), although no sex-based differences were found in total hip arthroplasty conversion rates (P = .21). Male patients undergoing HA for FAIS had a higher prevalence of mixed-type FAIS while female patients had more pincer-type FAIS. Female patients gained greater improvements in PROs, although both sexes exceeded the minimal clinically important difference, suggesting that both male and female patients can benefit from HA.

Traction-related complications in hip arthroscopy for 26 years. A systematic review.

The primary aim of the study is to determine the rate of traction-related complications in hip arthroscopy (HA) including perineal compression and distraction injuries, and the secondary objective is to report the incidence of complications in HA found on the studies selected by a systematic review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for data extraction from the PubMed and Cochrane databases obtained in February 2022. Reviewers extracted the title, author, date of publication, number of hips treated and number of complications describing the affected area, nerve and soft tissue injury related to traction. Studies on postless HA and HA combined with other procedures were excluded. Twenty-six years of HA literature was found in the search that included 35 studies and 8126 hips (89% Level IV) that reported the complications found during the procedure and described complications related to traction. A total of 623 hips (7.7%) had some sort of complications during HA, and complications related to traction were in 227 hips (36%). Injuries caused specifically by the perineal compression were in 144 hips (23%) that included the pudendal nerve and soft tissue injury of the groin area. Complications caused by the distraction were in 83 hips (13%) that included sciatic and peroneal nerve injury, numbness or pain of ankle and foot. HA complications occurred in 7.7% of hips treated, which is found in this systematic review. One-third of the complications are related to traction, 23% are caused by perineal compression and 13% are caused by distraction.

Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study.

Hip arthroscopy is a common procedure in hip preservation surgery. Its complication rate is relatively low. This prospective multicentric study evaluates complication rate in patients undergoing primary hip arthroscopy. The study cohort consisted of 908 patients mean age of 37years (14-67years). Patients were prospectively included in the study in the years 2009-2017. All complications were recorded and evaluated. The minimum follow-up was 36months. Results were statistically evaluated and risk factors for complications were identified. The overall complication rate was 7.3% (67/908 cases), the minor complication rate of 4.9% (45/908 cases) and the major complication rate 2.4% (22/908 cases). The most common severe complications were iatrogenic cartilage damage and instrument breakage, while the most common minor complications were perineal hypoaesthesia and heterotopic ossifications. The conversion rate to total hip replacement was 4.2% (39/908 patients). Hip arthroscopy is a safe procedure with low complication rates. Surgeon training and experience greatly influence the complication rates.

Immediate Versus Delayed Hip Arthroscopy for Femoroacetabular Impingement: An Expected Value Decision Analysis.

Introduction:Hip arthroscopy is an increasingly used surgical procedure for both intra- and extra-articular hip pathologies, including femoroacetabular impingement (FAI). Although the arthroscopic approach is known to be preferable to open, the optimal timing of such intervention is unclear. The purpose of this study was to carry out an expected value decision analysis of immediate versus delayed hip arthroscopy for FAI. Its hypothesis is immediate hip arthroscopy is the preferable treatment option.Methods:An expected value decision analysis was implemented to systematize the decision-making process between immediate and delayed hip arthroscopies. A decision tree was created with options for immediate and delayed surgeries with utilities characterizing each state obtained from surveying 70 patients. Fold-back analysis was then carried out, calculating expected values by multiplying the utility of each health outcome by the probability of that outcome. Corresponding expected values were then summed to “fold back” the decision tree one layer at a time. This was repeated until overall expected values (0 to 100) for immediate and delayed hip arthroscopies resulted with the higher value indicating the preferable option.Results:Fold-back analysis demonstrated that immediate hip arthroscopy is the preferred treatment for FAI over delayed with expected values of 78.27 and 72.63, respectively. Restoration of good function after hip arthroscopy was the most notable contributor to this difference. Immediate hip arthroscopy remained superior even as vast adjustments to preoperative physical function were made in one-way sensitivity analysis. Complications of hip arthroscopy leading to total hip arthroplasty were the least notable contributors to overall expected values.Discussion:This study confirms that immediate surgery is the preferred option when using decision-making analysis combining patient-reported utilities of health outcomes and the probabilities of those outcomes from the literature. This is consistent across a range of estimates of poor function in both the delayed and immediate surgery arms.

Incidence and location of heterotopic ossification following hip arthroscopy

BackgroundWe investigated the incidence and location of heterotopic ossification (HO) following hip arthroscopy.MethodsThis retrospective study enrolled 327 patients who underwent hip arthroscopy from January 2010 to December 2015. From this cohort, we extracted an HO group with simple radiographs or three-dimensional computed tomography (3D CT). Findings consistent with HO were classified according to the Brooker classification aided with 3D CT for the location of HO. The indication for revision arthroscopic excision of HO was painful, functional impairment of the hip. Patient clinical outcomes were assessed pre- and postoperatively, with modified Harris Hip Scores (mHHS), a visual analogue scale (VAS) for pain, and the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport Specific Subscales (HOS-SSS).ResultsIn all, 14 (4.28%) of the 327 patients had confirmed HO radiographically. The mean follow-up was 39 months. In 13 patients, HO formed in the central area of the arthroscopic portals or capsulotomy. Ten patients had Brooker Grade 1 and four had Grade 2. At the last follow-up, 12 asymptomatic patients had significant (P < 0.001) improvements in all clinical outcome scores (mHHS, pain VAS, HOS-ADL, and HOS-SSS). Two patients developed symptoms sufficient to require revision hip arthroscopy for HO excision. After revision hip arthroscopy, both symptomatic patients had improved significantly in all clinical outcomes at the final follow-up.ConclusionsHO is a minor complication of hip arthroscopy, but sometimes induces severe pain and functional impairment. Usually, HO forms in the arthroscopic portal or capsulotomy area.

Functional Outcomes of Hip Arthroscopy for Pediatric and Adolescent Hip Disorders.

BackgroundThere is a paucity of literature on the use of hip arthroscopy for pathologic conditions in skeletally immature patients. Thus, the indications and safety of the procedure are still unclear. The purpose of this study was to investigate the safety and functional outcomes of hip arthroscopy for pediatric and adolescent hip disorders. We further attempted to characterize arthroscopic findings in each disease.MethodsWe retrospectively reviewed 32 children and adolescents with hip disorders who underwent 34 hip arthroscopic procedures at a tertiary care children's hospital from January 2010 to December 2016. We evaluated functional limitations and improvement after operation by using the modified Harris hip score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective pain assessment with a visual analog scale (VAS), and range of hip motion as well as the complications of hip arthroscopy. Arthroscopic findings in each disease were recorded.ResultsHip arthroscopy was performed for Legg-Calvé-Perthes disease (n = 6), developmental dysplasia of the hip (n = 6), slipped capital femoral epiphysis (n = 5), idiopathic femoroacetabular impingement (n = 6), sequelae of septic arthritis of the hip (n = 3), hereditary multiple exostosis (n = 2), synovial giant cell tumor (n = 3), idiopathic chondrolysis (n = 2), and posttraumatic osteonecrosis of the femoral head (n = 1). Overall, there was a significant improvement in the modified HHS, WOMAC, VAS, and range of hip motion. Symptom improvement was not observed for more than 18 months in four patients who had dysplastic acetabulum with a labral tear (n = 2) or a recurrent femoral head bump (n = 2). There were no complications except transient perineal numbness in five patients.ConclusionsOur short-term follow-up evaluation shows that hip arthroscopy for pediatric and adolescent hip disorder is a less invasive and safe procedure. It appears to be effective in improving functional impairment caused by femoroacetabular impingement between the deformed femoral head and acetabulum or intra-articular focal problems in pediatric and adolescent hip disorders.

Acetabular Subchondral and Cortical Perforation During Labral Repair With Suture Anchors: Influence of Portal Location, Curved Versus Straight Drill Guides, and Drill Starting Point

To evaluate the impact of the portal used for drilling, the position of the drill guide on the acetabular rim, and the use of straight versus curved drill guides on drill perforation of the acetabular subchondral bone and the outer cortex of the acetabulum. Sixty acetabular models were marked at the 3-, 2-, 1-, 12-, and 11-o'clock positions. Simulated anterior, anterolateral, and distal anterolateral accessory (DALA) portals were created. Twelve groups of 5 acetabula were drilled at each clock-face position using all combinations of variables. A total of 38 of 300 drillings (12.7%) perforated the subchondral bone, and 45 of 300 (15%) breached the outer cortex. Drilling from the anterior, anterolateral, and DALA portals perforated the acetabular subchondral bone on 21 of 100 attempts (21%), 17 of 100 attempts (17%), and 0 of 100 attempts (0%), respectively (P < .001), and perforated the outer acetabular cortex on 36 of 100 attempts (36%), 1 of 100 attempts (1%), and 8 of 100 attempts (8%), respectively (P < .001). The use of a curved or straight drill guide did not make a statistically significant difference. Drilling with a starting point on the acetabular rim perforated the acetabular subchondral bone on 29 of 150 attempts (19.3%) compared with 9 of 150 attempts (6%) when the starting point was 2mm removed from the acetabular rim (P < .001). The use of the DALA portal and a drill starting point slightly off the acetabular rim was associated with the lowest rate of acetabular subchondral perforation and is recommended to reduce the risk of iatrogenic chondral injury. Iatrogenic chondral injury is a relatively common complication of hip arthroscopy. Increased awareness of factors associated with drill perforation during suture anchor placement can help surgeons mitigate this risk.

Heterotopic ossification after arthroscopy for hip impingement syndrome.

Background:Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome.Methods:A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11–34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision.Results:A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = −1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = −1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = −1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = −55.23, P < 0.01) and NAHS by 28.75 points (t = −6.03, P < 0.01), and VAS decreased by 4 points (t = 9.80, P < 0.01). HO and non-HO patients were similar for demographic and surgical data, and clinical and functional scores.Conclusion:HO incidence after arthroscopic treatment of FAI is similar to that found in previous studies. Most HO have no effect on clinical symptoms. Patients who undergo revision HO resection show improvement in pain and joint function.

Complications in Hip Arthroscopy

Complications in Hip Arthroscopy

Incidence and risk factors for development of postoperative heterotopic ossification in a high-volume hip arthroscopy practice: A case series

Background and objective: Heterotopic ossification (HO) is a known complication of hip arthroscopy and may significantly affect the outcomes of patients undergoing hip arthroscopy. Its incidence in the literature varies from 0–44% following hip arthroscopy without prophylaxis. Our primary goal was to find the local rate of HO after hip arthroscopy as determined by the Brooker Classification. Secondary outcomes included determining risk factors for development of HO by sex, age, body mass index, hip pathology and effects on outcome scores. Subjects and methods: Patients who underwent hip arthroscopy by a local high-volume surgeon from July 2012 to June 2015 were reviewed for the presence of pre- and postoperative HO retrospectively. Patients required at least 12 months of postoperative radiographic follow-up with anteroposterior pelvis radiographs. Patients were excluded if they had any other procedure performed at the time of hip arthroscopy or if medical records were not accessible. Radiographs were reviewed for HO according to the Brooker Classification. Demographic data including sex, age, body mass index, presence of labral tear and repair and outcome score were obtained. The incidence of HO and demographic averages were calculated and compared. This study received approval from the Nova Scotia Health Authority (NSHA) Research Ethics Board (REB) (approval No. 1021503) on August 8, 2016. Results: A total of 307 hips met inclusion criteria, 152 females and 155 males. The overall incidence of HO was 23.45% (72 hips). Fifty-six hips (78%) had Brooker class I HO, 13 (18%) hips had Brooker class II HO, and 3 (4%) hips had Brooker class III HO. No specific demographic variables or the pathology were seen to be associated significantly with development of HO. Outcome score differences were not significantly different between the HO and non-HO groups (P = 0.94). Conclusion: The incidence of HO in our series matched the range found in other studies of HO incidence in the literature. The incidence of HO dose not appear to be influenced by demographic variables including sex, age, and body mass index in our study. This data will add to the developing base of literature on HO incidence in hip arthroscopy and will serve as a comparison and benchmark for future study on HO prophylaxis.

Complications of hip arthroscopy

Complications of hip arthroscopy

Research progress in complications of hip arthroscopy

Hip arthroscopy has become a routine treatment for the localized hip lesions. With the rapid development of arthroscopy, the number of surgeries has increased greatly. Though hip arthroscopy is considered as low risk operation, its complications have been constantly reported and noted. There are two major types in hip arthroscopy surgeries: conventional operative complications and special complications. Conventional operative complications include venous thromboembolism, hemorrhage, and pain. Special complications are associated with arthroscopic techniques and local anatomical structures of the hip, such as the perineal nerve, the lateral femoral cutaneous nerve, the acetabular labium or the iatrogenic injury of the cartilage surface of the femoral head. Hip arthroscopy has obvious advantages such as small surgical wound and rapid recovery, but its complications can not be ignored. Joint surgeons must fully recognize it and keep vigilant so as to avoid complications as much as possible. This review will systematically elaborate the complications of hip arthroscopic surgery from general and special aspects so as to provide ideas for reducing the occurrence of complications in hip arthroscopic surgery. Key words: Arthroscopy; Hip injuries; Complications

Pudendal nerve injury is a relatively common but transient complication of hip arthroscopy.

Hip arthroscopy is emerging as the standard of care for conditions involving the hip, and has a unique set of complications. The purpose of this review was to identify (1) the crude rate of pudendal nerve injury following hip arthroscopy and (2) the specific factors leading to pudendal nerve injury. MEDLINE, EMBASE, and PubMed were searched from database inception to October 2016. Patient demographics, indications, surgical technique, complication rates, treatment approaches, and rehabilitation strategies were extracted. Twenty-four studies (n = 3405) were included, withthe majority (66%) of studies being level IV evidence. The mean age was 33.9 ± 9.7years (range 12-78) and 48.2% were males. Average follow-up was 30.2 ± 19.1months. 62 patients were reported to have sustained pudendal nerve injury (1.8%) post-operatively, and all resolved within 6 weeks to 3 months. Of the seven studies that reported using a perineal post, 20 patients were diagnosed with pudendal nerve injury (4.3%), in contrast to two studies (189 patients) reporting only 0.5% pudendal nerve injury without the use of perineal post. Two studies commented on time of traction during surgical intervention with mean times of 98 and 68min with complication rates of 10% and 6.6%, respectively. Pudendal nerve injury is not uncommon following hip arthroscopy, with a reported rate found in this review of 1.8%. Potential risk factors may include the use of a perineal post and long traction times. All reported cases resolved within 3 months. Patients should be informed of complications related to pudendal nerve injury, which include sexual and urinary dysfunction. Level IV, systematic review of level I-IV studies.

Diagnosis of Intraabdominal Fluid Extravasation After Hip Arthroscopy With Point-of-Care Ultrasonography Can Identify Patients at an Increased Risk for Postoperative Pain.

Intraabdominal fluid extravasation (IAFE) after hip arthroscopy has historically been diagnosed in catastrophic circumstances with abdominal compartment syndrome requiring diuresis or surgical decompression. A previous retrospective study found the prevalence of symptomatic IAFE requiring diuresis or decompression to be 0.16%, with risk factors including surgical procedure and high pump pressures. IAFE can be diagnosed rapidly by using point-of-care ultrasound (POCUS) via the Focused Assessment With Sonography for Trauma (FAST) examination, which is a well-established means to detect free fluid with high specificity and sensitivity. In this study, we used POCUS to determine the incidence of IAFE in patients undergoing hip arthroscopy. We predicted a higher incidence and that patients with IAFE would have symptoms of peritoneal irritation such as pain and nausea. One hundred patients undergoing ambulatory hip arthroscopy were prospectively enrolled. A FAST examination was performed after induction by a trained anesthesiologist to exclude the preoperative presence of intraperitoneal fluid. Postoperatively, the same anesthesiologist repeated the FAST examination, and patients with new fluid in the abdominal or pelvic peritoneum were diagnosed with IAFE. Patients were followed up in the postanesthesia care unit (PACU) for 6 hours assessing pain, antiemetic and opioid use, and length of stay. Sixteen of 100 patients were found to have IAFE (16.0%; 99% confidence interval [CI], 8.4-28.1). These patients had, on average, a greater increase in pain score from their baseline assessment throughout their entire PACU stay (adjusted difference in means [99% CI]: 2.1 points [0.4-3.9]; P = .002). Patients with IAFE used more opioids, but this difference did not meet statistical significance (adjusted difference in means [99% CI]: 7.8 mg oral morphine equivalents [-2.8 to 18.3]; P = .053). There were no differences in postoperative nausea interventions or length of stay. Our incidence of IAFE was 16%, showing that IAFE occurs quite commonly in hip arthroscopy. Patients with IAFE had a greater increase in pain scores from baseline throughout the PACU stay. None of our patients required interventions. These findings suggest that even a small amount of new fluid in the peritoneum may be associated with a worse postoperative experience. This study brings awareness to a common yet potentially life-threatening complication of hip arthroscopy and highlights a unique and meaningful way that anesthesiologists in the perioperative setting can use POCUS to rapidly identify and guide management of these patients. Further studies with a larger sample size are needed to identify surgical and patient risk factors.

Femoral neck fractures as a complication of hip arthroscopy: a systematic review.

The purpose of this study was to identify the causes and risk factors for hip fractures, a rare but devastating complication, following hip arthroscopy. The electronic databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate for relevant clinical and basic sciences studies and pertinent data was abstracted and analysed in Microsoft Excel. Nineteen studies (12 clinical studies and seven biomechanical studies) with a total of 31 392 patients experiencing 43 hip fractures (0.1% of patients) met the inclusion criteria for this systematic review. Femoral osteochondroplasty was performed in 100% of patients who sustained a hip fracture. Six of the 12 (50%) studies identified early weight bearing (prior to 6 weeks post-operatively) as the cause for the hip fracture. Other causes of this complication included over resection during femoral osteochondroplasty, minor trauma and intensive exercise. The results suggest that early weight bearing is the largest modifiable risk factor for hip fracture after femoral osteochondroplasty. For this reason, an extended period of non-weight bearing or restricted weight bearing should be considered in select patients. Studies report a correlation between risk for post-operative hip fracture and increased age. Increased resection during osteochondroplasty has been correlated with increased risk of fracture in various basic science studies. Resection depth has significantly higher impact on risk of fracture than resection length or width. The reported amounts of resection that depth that can be performed before there is a significantly increased risk of fracture of the femoral neck varies from 10 to 30%.

Hip arthroscopy complications regarding surgery and early postoperative care: retrospective study and review of literature.

The purpose is to describe the rate of complications in a series of hip arthroscopies performed at our center, as well as perform a systematic review of the current literature in order to compare our outcomes. Two hundred and fifty-eight patients affected of femoroacetabular impingement and treated with hip arthroscopy have been studied. All minor and major complications were studied during the first postsurgery year. Furthermore, a systematic review was performed comparing major and minor complications with our series. Two attending orthopedic surgeons selected the different studies with the same inclusion and exclusion criteria, remaining with 48 studies that have been reviewed and included in the present study. Mean age was 36.6years old (SD 17.45), and the ratio men:women was 137:121. The mean complication rate observed was 14.34% (37/258) of global complications. Only three patients showed major complications: femoral neck fracture, septic arthritis and avascular necrosis of the femoral head. Any of these patients had permanent side effects. Hip arthroscopy has a low rate of major complications, but a higher number of minor complications that could be avoided with certain preventive measures.

Complications of Hip Arthroscopy: Patient Perspectives.

In recent years, hip arthroscopy has rapidly evolved, offering patients evidence-based interventions with the merits of minimally invasive surgery and a relatively short rehabilitation period. Although considered a safe procedure, hip arthroscopy has associated complications that may be underreported depending on how patients are asked about their complications. The aim of this study was to evaluate hip arthroscopy complications from the patient's perspective. Between February 2006 and April 2010, a total of 78 consecutive patients underwent arthroscopy of the hip by a single surgeon. A questionnaire was created that included questions regarding demographic data, functional data, and the patient's opinion as to the operation's indications, subjective evaluation of the success of the procedure, and the presence of specific complications. Patients were asked about the presence of specific complications rather than being asked about the presence of any complication in general. Sixty-two patients participated. The mean time postsurgery was 27.9 months (range = 5-55 months). Main indications for surgery were correction of femoroacetabular impingement in 31 (50%) patients. Mean surgery time was 1.2 hours (range = 0.5-2.43 hours), mean postoperative modified Harris hip score (MHHS) was 76.2 (range = 15-100), and mean postoperative pain score was 4 (range = 2-10). Fifteen (24%) patients reported complications after surgery, with 20 complications reported overall (32%). Eight (12.9%) patients reported transient neuropraxias. No significant differences were found between patients reporting complications and patients not reporting complications in terms of age, gender distribution, surgery time, visual analog scale score, MHHS, and time from surgery. When patients are asked a general question, whether they suffer from any complications, they tend to underreport the presence of such complications. Complete and comprehensive interviews of the patient may give us a better understanding of the true incidence of complications.

Hip Arthroscopy Surgical Volume Trends and 30-Day Postoperative Complications

To determine hip arthroscopy surgical volume trends from 2006 to 2013 using the National Surgical Quality Improvement Program (NSQIP) database, the incidence of 30-day complications of hip arthroscopy, and patient and surgical risk factors for complications. Patients who underwent hip arthroscopy from 2006 to 2013 were identified in the NSQIP database for the over 400 NSQIP participating hospitals from the United States using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. Trends in number of hip arthroscopy procedures per year were analyzed. Complications in the 30-day period after hip arthroscopy were identified. Univariate and multivariate regression analyses were performed to identify risk factors for complications. We identified 1,338 patients who underwent hip arthroscopy, with a mean age of 39.5 ± 13.0 years. Female patients comprised 59.6%. Hip arthroscopy procedures became 25 times more common in 2013 than 2006 (P < .001). Major complications occurred in 8 patients (0.6%), and minor complications occurred in 11 patients (0.8%); overall complications occurred in 18 patients (1.3%) (1 patient had 2 complications). The most common complications were bleeding requiring a transfusion (5, 0.4%), return to the operating room (4, 0.3%), superficial infection not requiring return to the operating room (3, 0.2%), deep venous thrombosis (2, 0.1%), and death (2, 0.1%). Multivariate analysis showed that regional/monitored anesthesia care as opposed to general anesthesia (P= .005; odds ratio, 0.102) and a history of patient steroid use (P= .05; odds ratio, 8.346) were independent predictors of minor complications in the 30days after hip arthroscopy. Hip arthroscopy is an increasingly common procedure, with a 25-fold increase from 2006 to 2013. There is a low incidence of 30-day postoperative complications (1.3%), most commonly bleeding requiring a transfusion, return to the operating room, and superficial infection. Regional/monitored anesthesia care and steroid use were independent risk factors for minor complications. Level III, retrospective comparative study.

Hip arthroscopy

Hip arthroscopy represents an important component in the treatment of diseases of the hip joint and is nowadays an indispensible tool in modern hip-preserving surgery. This article provides a review of the basic technical principles, typical indications and complications of hip arthroscopy. Furthermore, current developments as well as possibilities and limitations of the arthroscopic technique are reviewed.