Complications after Hip Arthroscopy: A Prospective, Multicenter Study Using a Validated Grading Classification

Abstract

Objectives: There is very little published literature looking at comprehensive complication rates after hip arthroscopy with current techniques and indications. Methods: Between 01/2011 and 11/2012, 1,026 consecutive hips (507 males, 519 females) with a mean age of 31.2 years (range 12 -73) underwent hip arthroscopy at three institutions. The diagnosis, demographic information, and procedures were recorded, and a validated complications grading classification for hip joint surgery (Clavian classification) was utilized for all patients prospectively. Results: There were 951 primary hip arthroscopies and 75 revision hip arthroscopies. Arthroscopy was performed for FAI in 936 hips (91.2%), and 760 hips (74.1%) had a labral repair and 229 hips (22.3%) had a labral debridement. The most common event (18.7% of hips) noted was post-operative sensory disturbance adjacent to the portals or involving the distal anterolateral thigh consistent with LFC nerve disturbance. This was typically not noticed by patients and found on physical examination and only persisted beyond 6 months in 7 hips (0.7%). Iatrogenic chondral injury was noted for 20 hips (1.9%), iatrogenic labral puncture in 11 hips (1.1%), superficial portal infection in 6 hips (0.6%), sensory deficit about the foot in 9 hips (0.9%), deep venous thrombosis in 3 hips (0.3%), pulminary embolism in 1 hip (0.1%), pulmonary edema in 1 hip (0.1%), wound hematoma in 2 hips (0.2%), perineal numbness (pudendal nerve) in 9 hips (0.9%), heterotopic ossification in 4 hips (0.4%), reflex sympathetic dystrophy in 1 hip (0.1%) and wound/skin (traction) dehiscence in 1 hips (0.1%). There were no femoral neck fractures, iatrogenic instability, AVN, or extra-abdominal fluid extravasation in this cohort. The overall complication rate not including temporary periportal and thigh numbness (sequalae) was 6.9% (71 hips). Overall 88.7% had a grade 1, 5.6% Grade 2, 4.2% grade 3, and 1.4% grade 4 complication. There was no difference in the rate of complications between males and females (p=.221), primary vs revision cases (p=.159) or labral repair vs debridement (p=.173), and BMI had no effect on complication rate. Conclusion: The overall complication rate after hip arthroscopy was 6.9% and higher than previously reported in the literature. This rate of complications is in line with complication rates after open surgical dislocation using the same classification system.

Anterior Hip Dislocation 5 Months After Hip Arthroscopy

“…2 Previous reports of hip dislocation after arthroscopy have occurred in periods ranging from in the recovery room 3 up to 3 months postoperatively. 4,5 We report a case of low-energy hip dislocation that occurred in a track and field athlete while jumping 5 months after arthroscopy.…”

Arthroscopic Hip Capsule Reconstruction for Anterior Hip Capsule Insufficiency in the Revision Setting

“…Standard hip arthroscopy complications, including nerve injury and complications associated with concurrent osteoplasty, as well as cartilage or labral work, may occur. [16][17][18] Our technique uses a dermal allograft that has been shown in a cadaveric biomechanical study to restore distractive strength after hip capsule reconstruction. 19 Other grafts have been used in capsular reconstruction, including Achilles tendon allograft and iliotibial band allograft.…”

The Modified Mid-Anterior Portal for Hip Arthroscopy

“…8,9 Perhaps more importantly, the distal location facilitates labral reparative and reconstructive procedures while minimizing iatrogenic acetabular chondral damage. 2 We are typically able to safely place suture anchors from the anteroinferior acetabulum (generic 4-o'clock position) to the posterior acetabulum (9-o'clock position), the latter being used in cases of posterior labral tears or global pincer FAI (coxa profunda and protrusio acetabuli). 8,9,11 Although the typical labral tear is seen in the anterosuperior or superior region, anterior tears occur and may be related to iliopsoas impingement.…”

“…However, the learning curve is substantial, and the rate of hip arthroscopy complications, though typically small in prevalence and severity, may be higher than initially appreciated. 2 Historically, 3 portals were typically used for hip arthroscopy: anterolateral portal (ALP), posterolateral portal, and anterior portal (AP). The ALP continues to be popular and remains the primary viewing portal, often used with a 70 arthroscope.…”