COMPLICATIONS OF HIP ARTHROSCOPY
Section snippets
MATERIALS AND METHODS
We have looked at all of our complications in 530 cases done since 1977 by JMG and TSG, and have found 34 cases. Of those, we felt 27 were transient and 3 were significant as outlined in Table 1. All except 11 patients were done in the lateral decubitus position. All hips were distracted with one of three devices, of which two used electronic tensiometers. The indications for arthroscopy are well reported.3, 6, 89
RESULTS
There were 20 transient nerve injuries, in which 10 were peroneal, 4 pudendal, and 4 sciatic, with one case both femoral and sciatic. The high number of peroneal neuropraxias could be related to the early developments and evolution of hip distractors for the lateral approach. All neuropraxias occurred from prolonged traction times (5 to 6 hours) on complex cases despite relieving the traction intermittently thoughout the surgery.
The high numbers of fluid extravasation (nine cases) are due to
DISCUSSION
Most complications occurring from hip arthroscopy are related to traction. Too much force for too long causes neuropraxias from stretching of the nerves or compression injuries to the perineum and pudendal nerve. Traction is necessary to see the innermost depths of the hip socket; without it, only a small portion of the extraarticular structures can be visualized.2 If done with good padding on the foot plate and in the perineum, and a peroneal post 7 to 9 cm in diameter, compression problems
SUMMARY
Complications associated with hip arthroscopy occur between 1.6% and 5%. Fortunately, with the greater understanding of the causes and advancements in techniques and equipment, the incidence is declining. Most of the complications were transient neuropraxias and fluid extravasations resulting in no permanent damage. Severe scuffing of two femoral heads and one case of avascular necrosis were considered serious and permanent, thereby resulting in a 0.5% rate in our series for significant
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Cited by (218)
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2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Associated complications from traction include soft-tissue injuries and neuropraxia.64-67 Studies have, thus, recommended to limit traction time to less than 2 hours to prevent such complications.65,66,68 In the current systematic review, traction time was reported in 2 studies with a mean time of 56.5 minutes, with no instances traction-related complications.27,38
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Address reprint requests to Thomas G. Sampson, MD, 1150 Bush Street, Suite 4B, San Francisco, California 94109; e-mail: [email protected]