Page 30 - ISAKOS 2021 Newsletter Volume 1

CURRENT CONCEPTS
Complications Following Arthroscopic Surgery of the Hip
Review of 36,761 Arthroscopies
Our systematic review encompassed a literature search, based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the PubMed (MEDLINE), EMBASE, and Google Scholar databases2. This review was conducted on December 11, 2016. The inclusion criteria were (1) studies evaluating hip arthroscopy only, (2) studies with all levels of evidence, (3) studies evaluating all outcomes, not just complications, and (4) studies published in English. The exclusion criteria were (1) studies evaluating combined arthroscopic and open or mini-open surgery, (2) studies consisting of the abstract only, (3) review studies, and (4) cadaveric studies.
The initial literature search identified a total of 2,381 articles. Of those, 276 relevant studies involving 35,916 patients (36,761 hips) met the inclusion and exclusion criteria. The mean age of the patients was 36.7 years (range, 1.7 to 70 years), and the mean body mass index was 25.7 kg / m2 (range, 20.2 to 29.2 kg / m2). The four most common indications for the procedure were femoroacetabular impingement (43.5%), labral tears (32.9%), chondral defects (8.9%), and osteoarthritis (7.1%).
A total of 1,222 complications occurred during or after arthroscopy, for an overall rate of complication of 3.3% (Table I). Neuropraxia (0.9%), iatrogenic chondral and labral injuries (0.7%), and heterotopic ossification (0.6%) were the three most common complications. There were 58 major complications (0.2%), the most common being intra- abdominal extravasation of fluid, which was found in 13 cases (0.04%). There were three deaths (0.008%).
Nerve Injury
Nerve injury was the most common complication (0.9%) in our analysis. Most cases of neuropraxia were related to traction or compression because of the perineal post, and almost all cases resolved within 3 months. Following the publication of our systematic review, there were three further reports on nerve injuries following arthroscopic surgery of the hip. Those three studies demonstrated a higher rate of postoperative nerve injury than the rate of 0.9% reported in our review (Table I). Frandsen et al.3, in a study in which 100 patients completed a questionnaire with 25 questions related to the perception of traction-related problems, reported that 22% of the patients experienced numbness in the groin area. Reda et al.4, in a retrospective study in which 221 patients responded to a telephone survey with four questions, reported that 37% of the patients had postoperative numbness. The authors reported the duration of surgery was a risk factor for numbness, with an odds ratio of 2.18 if the surgery took >50 minutes. Finally, Mas Martinez et al.5 , in a study of 110 patients who were evaluated with specific questions and physical examination after hip arthroscopy, found that 62.7% of the patients reported symptoms of nerve dysfunction 24 hours after the procedure.
Introduction
Masayoshi Saito, MD
Addenbrooke’s - Cambridge University Hospitals NHS, Tokyo, JAPAN
Yuichi Kuroda, MD, PhD
Addenbrooke’s - Cambridge University Hospitals NHS, Kobe, JAPAN
Vikas Khanduja, MA (Vantab), MSc, FRCS (Orth)
Addenbrooke’s - Cambridge University Hospitals NHS
Hip arthroscopy was first described by Burman et al. in 1931, and its therapeutic use commenced in 19391. Since the description of femoroacetabular impingement by Ganz et al. in the late 1990s, the number of hip arthroscopies performed each year has increased dramatically and is projected to continue to rise. Hip arthroscopy has been associated with reliable improvements in both patient satisfaction and function, and the indications for this procedure now also include extra-articular pathology (e.g. external snapping hip and abductor pathology). However, hip arthroscopy remains a technically demanding procedure that is associated with a steep learning curve and the potential for complications. As such, it is not for the occasional operator.
The aim of this article is to provide a synopsis of our systematic review of the available literature on complications during and following arthroscopic surgery of the hip. We hope that this information will be of immense value to all surgeons undertaking this procedure, especially during the process of obtaining informed consent.
28 ISAKOS NEWSLETTER 2021: VOLUME I