Fluid Extravasation during Hip Arthroscopy

Abstract

The amount of fluid that may be lost into the soft tissues during hip arthroscopic surgery is unknown. We measured the volumes of irrigation fluid infused, operating time, fluid pressures and volumes of fluid recovered in 36 therapeutic hip arthroscopies. We excluded those where fluid was lost to the floor, leaving 28 patients. The majority were undergoing surgery for the treatment of femoroacetabular impingement. In 5 patients an intra-articular contrast medium was instilled, in order to establish the likely location of any extravasated fluid. The mean operating time was 68 minutes (31 to 120), and the mean infusion pressure was 46 mm Hg (30 to 70). The mean volume of infused fluid was 9677 ml (95% confidence interval (CI) 7715 to 11638) and the mean volume of fluid recovered was 8544 ml (95% CI 6715 to 10373). The mean fluid extravasation loss into the peri-articular tissues was 1132 ml (95% CI 808 ml to 1456 ml). There was a significant correlation between the volume of extravasated fluid and both the length of operation and the volume of infused fluid used. We had no adverse events in our series. During arthroscopic hip surgery more than a litre of irrigation fluid may be extravasated into the soft tissues. In order to reduce problems related to this we attempt to keep operating times low, and maintain intra-operative fluid pressures as low as possible.

Complications in Hip Arthroscopy

“…Aside from iliopsoas release, the length of the operation and the volume of fluid infused during the procedure are significant predictors of fluid extravasation. 43 Strategies for preventing large-volume fluid extravasation include avoiding hip arthroscopy in the setting of acetabular fracture; decreasing pump pressures; frequent palpation of the abdomen by the surgeon; good communication with the anesthesia team regarding the potential of fluid extravasation and the potential for unexplained hypotension or hypothermia; and, if an iliopsoas release is indicated, performing the procedure at the end of the surgical case.…”

Complications of arthroscopic surgery of the hip

“…Early literature on hip arthroscopy suggested that some fluid inevitably escapes into the abdomen to be subsequently resorbed. 7 Stafford, Malviya and Villar 49 recently reported a mean extravasation of 1132 ml (95% confidence interval (CI) 808 to 1456) of irrigation fluid into peri-articular tissues. The surgeon should always be aware of the ingress–egress balance of irrigation fluid during the procedure.…”

Clinical Issues‐May 2017

“…Stafford et al 7 reviewed 36 patients undergoing hip arthroscopy performed by one physician in one facility. Researchers measured the volume of irrigation fluid infused, operating time, fluid pressures, and volumes of fluid recovered during all 36 procedures.…”

“…There was a correlation between the volume of extravasated fluid and both the length of surgery and the volume of infused fluid used. The authors concluded that reduced operative times (ie, <90 minutes) and fluid pressure at low rates (ie, <50 mm Hg) reduced the risk of fluid extravasation 7 …”