Is It Safe to Perform an Early Arthroscopy After a Traumatic Hip Dislocation With an Associated Pelvic Ring Injury? Report of Our Technique

Geada, Nuno; Dantas, Pedro; Mascarenhas, Vasco; Campos, Vicente; Gonçalves, Sérgio

doi:10.1016/j.eats.2018.02.016

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…Also, access to the CC under arthroscopic control decreases the risk of iatrogenic labral perforation and full‐thickness chondral injury. Additionally, this hip arthroscopy approach is versatile and can be considered as a preferred option when the pathology is mainly located in the PC or when access to the CC is difficult [1, 4, 8, 10].…”

Section: Discussionmentioning

confidence: 99%

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients

Dantas

Gonçalves

Mascarenhas

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThis study was designed to evaluate the clinical and radiographic results of arthroscopic treatment of femoroacetabular impingement (FAI) using the technique of initial access to the peripheral compartment. It is based on a single surgeon large case series with a minimum of 2 years follow‐up. MethodsProspective longitudinal study with consecutive patients. Inclusion criteria were the presence of FAI syndrome that had failed non‐operative treatment and had a hip arthroscopy with initial access to the peripheral compartment. Exclusion criteria were previous hip surgery, patients younger than 16 or older than 60 years, Tönnis grade ≥ 2 osteoarthritis, hip dysplasia based on radiographic evidence of LCEA less than 25° and workers compensation cases. One hundred and sixty hips met the inclusion criteria, 84 were female and 70 were male patients (six bilateral cases), with a median age of 36 years (range 16–59). ResultsThe median alpha angle correction was 22.6º (range 5.9–46.7) (p < 0.01) and the average LCEA correction when acetabuloplasty was undertaken was 6.5º (range − 1.4–20.8) (p < 0.01). The mean NAHS at baseline was 56.1 (range 16–96) and improved to 83.2 at the last follow up (range 44–100) for the patients that had no additional procedure (p < 0.01). The mean average improvement was 27.7º points (range − 16–73). No iatrogenic labral perforation and no full‐thickness chondral damage were recorded during the arthroscopic procedures. ConclusionsFavourable outcomes are reported for the arthroscopic treatment of FAI with initial access to the peripheral compartment. The technique is protective against iatrogenic chondral and labral damage, more conservative to the joint capsule, but the mean traction time was relatively long when suture anchors were used. The results are comparable to the classic initial central compartment approach. Level of evidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients

Dantas

Gonçalves

Mascarenhas

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…This hip arthroscopy approach is versatile and can be used in other hip pathologies such as synovial membrane disorders, intra-articular osteochondromas, and after traumatic hip dislocation. 9 , 10 It is also preferable if the pathology is mainly located in the PC, as it allows an excellent visualization and maneuverability in the PC without wide capsulotomies ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Hip Arthroscopy With Initial Access to the Peripheral Compartment: A Detailed Step-by-Step Technique Description

Dantas

Gonçalves

Mascarenhas

et al. 2020

Arthroscopy Techniques

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Hip arthroscopy with initial access to the peripheral compartment represents a specific technique to approach the hip that can be particularly useful. This technique is suitable for both the arthroscopic treatment of femoroacetabular impingement syndrome and other pathologies that can be addressed by classic arthroscopy with central compartment initial access. Minimal capsulotomies preserve the fluid pressure in the peripheral compartment, which allows the "ballooning" of the capsule and improved joint exposure with decreased risk of fluid extravasation. In the vast majority of cases, the hip joint can be accessed by any technique depending on the surgeon preference/expertise. Interestingly, access to the central compartment under direct arthroscopic visualization decreases the risk of iatrogenic labral and chondral damage. This is particularly important when access to the central compartment is technically challenging (e.g., acetabular overcoverage, labral hypertrophy, and limited joint distraction). Such a technique is also preferable if the pathology is mainly located in the peripheral compartment. Despite several advantages, hip arthroscopy with initial access to the peripheral compartment is not a commonly performed technique. Our purpose is to perform a step-by-step explanation of a previously described technique.

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“…In the past years, these concomitant periarticular injuries (e.g., labral tears, osteochondral injuries, and loose bodies) have especially attracted further attention, as they may be addressed by arthroscopic techniques [37,[43][44][45]. However, the current data suggest that special considerations are required in many patients with associated pelvic ring or lower extremity fractures to avoid complications associated with traction, patient positioning, and fluid extravasation [46,47]. Late complications after THDs have been characterized comprehensively within the literature.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries

Weber

Lefering

Sellei

et al. 2022

JCM

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Introduction: Traumatic hip dislocations (THDs) are severe injuries associated with considerable morbidity. Delayed recognition of fracture dislocations and neurovascular deficits have been proposed to cause deleterious long-term clinical outcomes. Therefore, in this study, we aimed to identify characteristics of epidemiology, injury mechanisms, and associated injuries to identify patients at risk. Methods: For this study based on the TraumaRegister DGU® (January 2002–December 2017), the inclusion criterion was an Injury Severity Score (ISS) ≥9 points. Exclusion criteria were an isolated head injury and early transfer to another hospital. The THD group was compared to a control group without hip dislocation. The ISS and New ISS were used for injury severity and the Abbreviated Injury Scale for associated injuries classification. Univariate and logistic regression analyses were performed. Results: The final study cohort comprised n = 170,934 major trauma patients. We identified 1359 individuals (0.8%) with THD; 12 patients had sustained bilateral hip dislocations. Patients with THD were predominantly male (79.5%, mean age 43 years, mean ISS 22.4 points). Aortic injuries (2.1% vs. 0.9%, p ≤ 0.001) were observed more frequently in the THD group. Among the predictors for THDs were specific injury mechanisms, including motor vehicle accidents (odds ratio (OR) 2.98, 95% confidence interval (CI) 2.57–3.45, p ≤ 0.001), motorcycle accidents (OR 1.99, 95% CI 1.66–2.39, p ≤ 0.001), and suicide attempts (OR 1.36, 95% CI 1.06–1.75, p = 0.016). Despite a lower rate of head injuries and a comparable level of care measured by trauma center admission, both intensive care unit and total hospital stay were prolonged in patients with THD. Conclusions: Since early diagnosis, as well as timely and sufficient treatment, of THDs are of high relevance for long-term outcomes of severely injured individuals, knowledge of patients at risk for this injury pattern is of utmost importance. THDs are frequently related to high-energy mechanisms and associated with severe concomitant injuries in major trauma patients.

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Is It Safe to Perform an Early Arthroscopy After a Traumatic Hip Dislocation With an Associated Pelvic Ring Injury? Report of Our Technique

Cited by 3 publications

References 13 publications

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients

Hip arthroscopy with initial access to the peripheral compartment provides significant improvement in FAI patients

Hip Arthroscopy With Initial Access to the Peripheral Compartment: A Detailed Step-by-Step Technique Description

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries

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