Complications of arthroscopic surgery of the hip

A V Papavasiliou, N V Bardakos, A V Papavasiliou, N V Bardakos

Abstract

Over recent years hip arthroscopic surgery has evolved into one of the most rapidly expanding fields in orthopaedic surgery. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. This article analyses the reported complications and makes recommendations based on the literature review and personal experience on how to minimise them.

Keywords: Arthroscopy; Complications; FAI; Hip; Learning curve; Literature review; Nerve injuries.

Conflict of interest statement

ICMJE Conflict of Interest:None declared

Figures

Fig. 1
Fig. 1
Photograph of a right leg after a two-hour uncomplicated hip arthroscopy using a boot and a dedicated hip distractor. Despite adequate padding, there are signs of excess pressure on the skin overlying the lateral malleolus and the mid-calf. All pressure marks had resolved upon discharge a few hours later.
Figs. 2a - 2d
Figs. 2a - 2d
Arthroscopic images of the right hip of a 53-year-old woman with mild dysplasia, showing a) significant hypertrophy of the anterosuperior labrum, leaving little room for the 5 mm dilator and guide wire inserted through the anterior portal, b) the radiofrequency ablation probe just interposed safely between the labrum and the femoral head, c) partial labral detachment (arrow), and d) improved visualisation after labral repair with a suture anchor (arrow) (L, labrum; FH, femoral head; Ac, acetabulum).
Figs. 2a - 2d
Figs. 2a - 2d
Arthroscopic images of the right hip of a 53-year-old woman with mild dysplasia, showing a) significant hypertrophy of the anterosuperior labrum, leaving little room for the 5 mm dilator and guide wire inserted through the anterior portal, b) the radiofrequency ablation probe just interposed safely between the labrum and the femoral head, c) partial labral detachment (arrow), and d) improved visualisation after labral repair with a suture anchor (arrow) (L, labrum; FH, femoral head; Ac, acetabulum).
Figs. 2a - 2d
Figs. 2a - 2d
Arthroscopic images of the right hip of a 53-year-old woman with mild dysplasia, showing a) significant hypertrophy of the anterosuperior labrum, leaving little room for the 5 mm dilator and guide wire inserted through the anterior portal, b) the radiofrequency ablation probe just interposed safely between the labrum and the femoral head, c) partial labral detachment (arrow), and d) improved visualisation after labral repair with a suture anchor (arrow) (L, labrum; FH, femoral head; Ac, acetabulum).
Figs. 2a - 2d
Figs. 2a - 2d
Arthroscopic images of the right hip of a 53-year-old woman with mild dysplasia, showing a) significant hypertrophy of the anterosuperior labrum, leaving little room for the 5 mm dilator and guide wire inserted through the anterior portal, b) the radiofrequency ablation probe just interposed safely between the labrum and the femoral head, c) partial labral detachment (arrow), and d) improved visualisation after labral repair with a suture anchor (arrow) (L, labrum; FH, femoral head; Ac, acetabulum).
Fig. 3
Fig. 3
Arthroscopic image showing iatrogenic partial-thickness chondral scuffing (black arrow) of the femoral head (FH) in a 40-year-old man undergoing labral repair with three suture anchors. The radiofrequency ablation probe (RF) was used to smooth the scuffed area of the femoral head.
Figs. 4a - 4c
Figs. 4a - 4c
Image intensifier (a) and arthroscopic (b) images showing the insertion of a cannulated 4.5 mm trocar over a bottomed out nitinol guide wire, and c) a bent nitinol guide wire inserted into the peripheral compartment and past the medial capsule of the hip. A broken guide wire in that area is difficult to retrieve.
Figs. 4a - 4c
Figs. 4a - 4c
Image intensifier (a) and arthroscopic (b) images showing the insertion of a cannulated 4.5 mm trocar over a bottomed out nitinol guide wire, and c) a bent nitinol guide wire inserted into the peripheral compartment and past the medial capsule of the hip. A broken guide wire in that area is difficult to retrieve.
Figs. 4a - 4c
Figs. 4a - 4c
Image intensifier (a) and arthroscopic (b) images showing the insertion of a cannulated 4.5 mm trocar over a bottomed out nitinol guide wire, and c) a bent nitinol guide wire inserted into the peripheral compartment and past the medial capsule of the hip. A broken guide wire in that area is difficult to retrieve.
Fig. 5
Fig. 5
Arthroscopic image showing retrieval of a broken suture anchor from the anterior joint space of the central compartment during attempted labral repair (FH, femoral head; Ac, acetabulum).
Figs. 6a - 6b
Figs. 6a - 6b
Arthroscopic images of the peripheral compartment of a left hip, a) after femoral osteochondroplasty showing the exposed bleeding surface of raw cancellous bone, and b) after treatment with the radiofrequency ablation probe for haemostasis.
Figs. 6a - 6b
Figs. 6a - 6b
Arthroscopic images of the peripheral compartment of a left hip, a) after femoral osteochondroplasty showing the exposed bleeding surface of raw cancellous bone, and b) after treatment with the radiofrequency ablation probe for haemostasis.
Fig. 7
Fig. 7
Anteroposterior standing pelvic radiograph of a 52-year-old man showing mild joint space narrowing and minor heterotopic calcification (white arrow) of the right hip, after two arthroscopies of that joint with no post-operative prophylaxis given for heterotopic ossification.
Figs. 8a - 8b
Figs. 8a - 8b
Figure 8a – arthroscopic image of a successful labral repair with use of the vertical mattress technique leaving the articular edge of the labrum free, with the suture barely visible (arrow). Figure 8b – arthroscopic image after an unsuccessful labral repair (cinch stitch technique) in which the suture cut through the labrum, showing the final appearance of debridement of the anterosuperior labrum (short arrow). Acetabular chondroplasty was also performed in that case (long arrow) (L, labrum; FH, femoral head; Ac, acetabulum).
Figs. 8a - 8b
Figs. 8a - 8b
Figure 8a – arthroscopic image of a successful labral repair with use of the vertical mattress technique leaving the articular edge of the labrum free, with the suture barely visible (arrow). Figure 8b – arthroscopic image after an unsuccessful labral repair (cinch stitch technique) in which the suture cut through the labrum, showing the final appearance of debridement of the anterosuperior labrum (short arrow). Acetabular chondroplasty was also performed in that case (long arrow) (L, labrum; FH, femoral head; Ac, acetabulum).
Figs. 9a - 9c
Figs. 9a - 9c
Arthroscopic images of the left hip of a 36-year-old woman who had a previous hip arthroscopy three years earlier, showing a) capsulolabral adhesions (arrow) in the area of the perilabral sulcus corresponding to the previous surgical intervention, in contrast to the normal capsule seen further anteriorly, b) removal of the adhesions, and c) chondroplasty with labral repair using a suture anchor. Symptoms improved as early as eight weeks post-operatively (FH, femoral head; Ac, acetabulum; L, labrum; C, capsule).
Figs. 9a - 9c
Figs. 9a - 9c
Arthroscopic images of the left hip of a 36-year-old woman who had a previous hip arthroscopy three years earlier, showing a) capsulolabral adhesions (arrow) in the area of the perilabral sulcus corresponding to the previous surgical intervention, in contrast to the normal capsule seen further anteriorly, b) removal of the adhesions, and c) chondroplasty with labral repair using a suture anchor. Symptoms improved as early as eight weeks post-operatively (FH, femoral head; Ac, acetabulum; L, labrum; C, capsule).
Figs. 9a - 9c
Figs. 9a - 9c
Arthroscopic images of the left hip of a 36-year-old woman who had a previous hip arthroscopy three years earlier, showing a) capsulolabral adhesions (arrow) in the area of the perilabral sulcus corresponding to the previous surgical intervention, in contrast to the normal capsule seen further anteriorly, b) removal of the adhesions, and c) chondroplasty with labral repair using a suture anchor. Symptoms improved as early as eight weeks post-operatively (FH, femoral head; Ac, acetabulum; L, labrum; C, capsule).
Fig. 10
Fig. 10
Magnetic resonance arthrographic appearance (STIR sequence) of a left hip, 15 months following arthroscopic labral repair. The presence of adhesions (vertical arrow) is noted between the labrum (thin horizontal arrow) and the capsule (thick horizontal arrow).
Figs. 11a - 11c
Figs. 11a - 11c
Arthroscopic images of the left hip of a 64-year-old woman with persistent pain following arthroscopic release of the iliotibial band (ITB) and excision of the trochanteric bursa. A revision endoscopy (a) revealed that the ITB flaps had healed back together. Upon opening of the ITB, significant adhesions (arrow) were found to have formed in the lateral compartment (b), tethering the ITB to the greater trochanter. After adhesiolysis and release of the ITB as distal as the origin of the vastus lateralis (c), there were marked improvements in symptoms, and the procedure was repeated on the right hip after seven months, with similar success (SF, subcutaneous fat; GT, greater trochanter; VL, vastus lateralis; aITB/pITB, anterior/posterior flap of the iliotibial band).
Figs. 11a - 11c
Figs. 11a - 11c
Arthroscopic images of the left hip of a 64-year-old woman with persistent pain following arthroscopic release of the iliotibial band (ITB) and excision of the trochanteric bursa. A revision endoscopy (a) revealed that the ITB flaps had healed back together. Upon opening of the ITB, significant adhesions (arrow) were found to have formed in the lateral compartment (b), tethering the ITB to the greater trochanter. After adhesiolysis and release of the ITB as distal as the origin of the vastus lateralis (c), there were marked improvements in symptoms, and the procedure was repeated on the right hip after seven months, with similar success (SF, subcutaneous fat; GT, greater trochanter; VL, vastus lateralis; aITB/pITB, anterior/posterior flap of the iliotibial band).
Figs. 11a - 11c
Figs. 11a - 11c
Arthroscopic images of the left hip of a 64-year-old woman with persistent pain following arthroscopic release of the iliotibial band (ITB) and excision of the trochanteric bursa. A revision endoscopy (a) revealed that the ITB flaps had healed back together. Upon opening of the ITB, significant adhesions (arrow) were found to have formed in the lateral compartment (b), tethering the ITB to the greater trochanter. After adhesiolysis and release of the ITB as distal as the origin of the vastus lateralis (c), there were marked improvements in symptoms, and the procedure was repeated on the right hip after seven months, with similar success (SF, subcutaneous fat; GT, greater trochanter; VL, vastus lateralis; aITB/pITB, anterior/posterior flap of the iliotibial band).

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