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Aprato A, Giachino M, Cipolla A, Massè A. Arthroscopic assistance during open reduction and fixation for complex acetabular fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03663-2. [PMID: 37553522 DOI: 10.1007/s00590-023-03663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
Achieving an anatomical reduction in acetabular fracture is essential but may also be challenging. Most of complex fractures are treated with anterior approaches without direct visualization of the acetabular surface. In this paper, we present the surgical technique for arthroscopic assistance during open reduction and fixation for complex acetabular fractures. To our knowledge, this technique has not been described in the literature yet.
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Affiliation(s)
- Alessandro Aprato
- Department of Surgical Sciences, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy.
| | - Matteo Giachino
- Department of Orthopedics, Turin Trauma Center (CTO), Turin, Italy
| | - Alessandra Cipolla
- Department of Surgical Sciences, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
| | - Alessandro Massè
- Department of Surgical Sciences, University of Turin, Piazza Polonia, 94, 10126, Turin, TO, Italy
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Kim S, Ri HS, Kim JH, Yeom J. Intra-abdominal hypertension during hip arthroscopy: a case report. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 40:102-105. [PMID: 36137573 PMCID: PMC9946912 DOI: 10.12701/jyms.2022.00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/11/2022] [Indexed: 11/04/2022]
Abstract
Symptomatic extravasation of irrigation fluid is a rare complication of hip arthroscopy. However, depending on the amount of fluid, intra-abdominal hypertension (IAH) may occur and even develop into abdominal compartment syndrome, which can seriously alter hemodynamic circulation. Therefore, it is important for anesthesiologists to promptly recognize the abnormal signs of IAH for early diagnosis and better clinical outcomes. Nevertheless, these signs are difficult to detect because they are usually obscured when the patient is under anesthesia and masked by surgical drapes. We report a case of IAH under general anesthesia during hip arthroscopy to highlight possible symptoms and signs.
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Affiliation(s)
- Saeyoung Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea
| | - Hyun-Su Ri
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea,Corresponding author: Hyun-Su Ri, MD, PhD Department of Anesthesiology and Pain Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-200-5873 • Fax: +82-53-426-2760 • E-mail:
| | - Ji Hyun Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea
| | - Jiyong Yeom
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, Korea
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Minimally invasive removal of intra-articular hip fragments under navigation guidance. Orthop Traumatol Surg Res 2022; 108:103205. [PMID: 35074537 DOI: 10.1016/j.otsr.2022.103205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/01/2021] [Accepted: 11/09/2021] [Indexed: 02/03/2023]
Abstract
The interposition of foreign bodies between the femoral head and the acetabulum represents a danger to the articular cartilage with a definite progression to osteoarthritis. Their removal is necessary and usually involves two surgical techniques: by open arthrotomy or under arthroscopy. The present article proposes a new surgical technique allowing the removal of intra-articular foreign bodies from the hip by a minimally invasive approach and aCT-guided navigation system. This technique is a good alternative that overcomes some shortcomings of other minimally invasive techniques, which struggle to access the fragment. It can also avoid specific complications of these procedures, such as the risk of abdominal compartment syndrome with arthroscopy, in the case of an associated acetabulum fracture.
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Söylemez MS, Kemah B, Poyanli O. Arthroscopy-Assisted Reduction and Fixation of Femoral Head and Acetabulum Fractures: A Systematic Review of the Literature. Orthop Surg 2022; 14:652-662. [PMID: 35293674 PMCID: PMC9002077 DOI: 10.1111/os.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 01/28/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To perform a systematic review to determine the current arthroscopic techniques of the fixation of femoral head and acetabulum fractures and assess the radiological and functional outcomes reported in literature written in English. Methods This review was performed by searching PubMed, Cochrane Library, Scopus, and Web of Science without a filter for time limitation in line with Preferred Reporting Items for Systematic Reviews Protocols (PRISMA‐P) guidelines. Two authors took part in screening and evaluating the literature between December 2020 and January 2021. The terms acetabulum fracture, reduction, fixation, femur head fracture, fracture dislocation of the hip, hip trauma and arthroscopy or arthroscopic, and their combinations were used to search four database engines in the titles and abstracts of the reported papers. Only papers with English titles and abstracts were included. The assessment of the data related to descriptions of the techniques, indications for fracture fixation using arthroscopy, and patient‐related outcomes. Results Perfect agreement was detected between the two reviewers during all steps of the review process (κ = 0.81–1.00). Although a meta‐analysis was planned to be carried out, no randomized controlled study comparing either the radiological or functional results of different surgical techniques was detected in the literature. Nineteen studies were included in the study. Of these, 15 were retrospective case reports and four were case series. Twenty‐seven patients were operated on for acetabulum fractures (18 male/nine female). The mean age was 28.3 years (range, 15–53 years). High‐energy traumas including motor vehicle accidents were the most common reason (81%). The duration of follow‐up was a mean of 32 months (range, 12–68 months). Sixteen patients were operated on for femur fractures (12 male/three female). The mean age was 30.1 years (range, 17–50 years). Motor vehicle accident was the most common trauma (70%). Duration of follow‐up had a mean of 18 months (range, 4–60 months). Patient‐related outcomes were excellent for reported cases in both groups despite the fact that an objective scoring system was not used for most of the cases. Moreover, there was no consensus on surgical indications or the techniques. Conclusions The techniques of arthroscopic‐assisted fixation of acetabulum and femoral head fracture are so heterogeneous that conclusions cannot be made at this time, but there is potential for this method of treatment to become more popular as the devices used in the procedure develop and as exposure to and experience with hip arthroscopy improves. Further descriptions of reduction and fixation techniques and analysis of outcomes of RCTs are needed.
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Affiliation(s)
- Mehmet Salih Söylemez
- Umraniye Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Bahattin Kemah
- Umraniye Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Oguz Poyanli
- Istanbul Medeniyet University, Faculty of Medicine, Göztepe Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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Mullis BH, Figueras J, Trotter MV, Ertl JP. Arthroscopy Should be Used With Caution for Gunshot Wounds to the Hip. Arthrosc Sports Med Rehabil 2021; 3:e1395-e1400. [PMID: 34712977 PMCID: PMC8527249 DOI: 10.1016/j.asmr.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of hip arthroscopy immediately following gunshot wound (GSW) to the hip. Methods Patients who received hip arthroscopy for GSWs from 2006 to 2020 by 2 surgeons at a level I trauma center were identified by Current Procedural Terminology codes. Inclusion criteria were those patients who suffered a GSW to the hip, received hip arthroscopy for treatment, and had a minimum follow-up of 2 months. The exclusion criteria were any patients younger than 18 years of age. Medical records were reviewed for patient demographics, surgical details, clinical outcomes, and complications. Results A total of 50 hip arthroscopy cases were identified by Current Procedural Terminology codes. Of the 50 cases identified, 8 patients met the inclusion criteria. All 8 patients were male, African-American, and the mean age was 31 years (range, 19-54 years) with mean follow-up of 14 months. Five of 8 cases were noted to have poor visualization with arthroscopy. Common reasons for poor visualization were difficult access to the bullet fragments, morbid obesity, hematoma formation, and pre-existing arthritis. Of these 5 cases, 2 were converted to open procedures to retrieve the remaining bullet fragments. One patient developed abdominal compartment syndrome, most likely due to increased pulse pressure over a prolonged operative period and involvement of the acetabular fovea. Emergent exploratory laparotomy and abdominal compartment fluid release were performed, and the patient had an otherwise unremarkable hospital course. Conclusions There are risks with the use of arthroscopic methods to remove GSW fragments, which may be greater than elective hip arthroscopy. Certain factors, such as the surgeon’s arthroscopic experience, locations of bullets fragments, visual quality, length of procedure, and concomitant acetabular fractures, must be considered before proceeding with arthroscopy. Level of Evidence Therapeutic case series.
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Affiliation(s)
- Brian H. Mullis
- Department of Orthopaedic Surgery
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
- Address correspondence to Brian H. Mullis, M.D., Professor and Program Director, Department of Orthopaedic Surgery, Indiana University School of Medicine, 1801 N Senate Blvd., Ste 535, Indianapolis, IN 46202.
| | - Jorge Figueras
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | | | - Jan P. Ertl
- Department of Orthopaedic Surgery
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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Zhong M, Xie H, Fu Z, Lu W, Zhu W, Ouyang K. Arthroscopic Treatment of Acetabular Rim Fracture after Traumatic Posterior Hip Dislocation: A Case Series Study. Orthop Surg 2021; 13:1828-1834. [PMID: 34664415 PMCID: PMC8523759 DOI: 10.1111/os.13106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/29/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To investigate the clinical and radiographic short‐term results of arthroscopic treatment for posterior labrum tears with an attached bony fragment after traumatic posterior hip dislocation. Methods Between July 2014 and May 2019, a consecutive series of nine patients diagnosed with a posterior labrum tear with an attached bony fragment after traumatic posterior hip dislocation were treated by hip arthroscopic techniques. The patients had been injured in traffic accidents (n = 6) or high falls (n = 3). All patients were provided primary treatment at the emergency department of our institution, and then were transferred to our department for arthroscopy. Demographic data (e.g. gender, age, etc), intraoperative findings, the preoperative and postoperative multiple clinical scores and radiological results were subsequently assessed. Visual analogue scale for pain (VAS) and modified Harris hip scores (mHHSs) were measured and compared before surgery, and at the last follow‐up. Results A total of nine patients were enrolled, all of them were male, with a mean age at surgery of 32.2 ± 5.6 years (range, 22–65 years). The patients were followed‐up for an average of 26.5 ± 4.1 (range, 24 to 50 years). During the arthroscopic surgery, all patients had labral tears with posterior acetabular rim fracture. All patients had loose osteochondral fragments. Five had partial or complete tears of ligamentum teres. Two patients had osteochondral damage. Two had capsular rupture. Postoperative X‐ray films and three dimension computed tomography (3D‐CT) showed satisfactory reduction of posterior acetabular wall fractures. The mHHS before surgery and at 1 year and 2 years after surgery were 51.8 ± 4.3, 81.8 ± 2.0 and 87.5 ± 1.9 respectively; VAS scores were 5.6 ± 0.5, 1.3 ± 0.3 and 0.7 ± 0.3 respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS and VAS scores at 1 year and 2 years after surgery (P < 0.01). There was no significant improvement in the mHHS and VAS scores between 1 year and 2 years after surgery (P < 0.05). At the final follow‐up, all patients had regained full range of motion (ROM) and were satisfied with the results. None of the patients showed signs of heterotopic ossification, avascular necrosis or progression of osteoarthritis of the hip joint. Conclusion Traumatic dislocation is accompanied by a variety of intra‐articular hip joint pathologies. Managing posterior acetabular rim fracture after traumatic posterior hip dislocation using arthroscopic reduction and fixation with anchors is a safe and minimally invasive option and delays the progression of traumatic osteoarthritis.
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Affiliation(s)
- Mingjin Zhong
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People's Hospital, Shenzhen, China
| | - Huanyu Xie
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People's Hospital, Shenzhen, China
| | - Zicai Fu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei Lu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People's Hospital, Shenzhen, China
| | - Weimin Zhu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People's Hospital, Shenzhen, China
| | - Kan Ouyang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Health Science Center; Shenzhen Second People's Hospital, Shenzhen, China
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Fundamentals of Arthroscopy Fluid Management and Strategies to Safely Improve Visualization. J Am Acad Orthop Surg 2021; 29:862-871. [PMID: 34623341 DOI: 10.5435/jaaos-d-20-01057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/18/2021] [Indexed: 02/01/2023] Open
Abstract
Arthroscopy has become increasingly relevant to various subspecialties within the orthopaedic surgery. From a patient safety standpoint and surgical efficiency standpoint, it is critical to know the fundamental concepts of fluid management such as those related to the fluid, pressure, and flow. A satisfactory field of view during arthroscopy can be achieved with the use of gravity-dependent or automated fluid management systems. Fluid management parameters and their physiological impact on the patient should be continuously monitored to avoid morbidity or delayed recovery. Local and systemic complications can occur from careless use of techniques that improve visualization such as tourniquet, epinephrine-diluted irrigation, and controlled hypotensive anesthesia. The purpose of this article is to review the fundamental concepts of fluid management in arthroscopy and the techniques to safely improve arthroscopic visualization.
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Abdominal compartment syndrome after hip arthroscopy. Anaesthesist 2021; 70:398-400. [PMID: 33416912 PMCID: PMC7791902 DOI: 10.1007/s00101-020-00909-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 10/25/2022]
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Hsu SL, Chen CY, Ko JY, Hsu CH, Liu HC, Lu YD. Hip arthroscopy-assisted reduction and fixation for femoral head fracture dislocations: Clinical and radiographic short-term results of seven cases. J Orthop Surg (Hong Kong) 2020; 27:2309499019881865. [PMID: 31640467 DOI: 10.1177/2309499019881865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Femoral head fracture dislocations are serious articular fractures that are associated with soft tissue injuries and are challenging to treat. Arthroscopic surgery may be a way to treat fracture reduction and fixation, thereby avoiding the need for extensive arthrotomy. METHODS We followed up a consecutive series of seven patients with femoral head fracture dislocation via a scope-assisted percutaneous headless screw fixation between 2016 and 2017. The clinical and radiological results were assessed. RESULTS The locations of the fracture were all involving infra-foveal area. The mean follow-up duration was 18 (range 12-24) months. The mean Harris hip score was 90.8 (range 88-93) at the latest follow-up. None of the patients showed early osteoarthritis, heterotopic ossification, or avascular necrosis. The average maximal displacement of the fracture site was improved from preoperative 6.79 mm (range 4.21-12.32) to postoperative 2.76 mm (range 0.97-3.97). Concomitant intra-articular hip lesions secondary to traumatic hip dislocation can also be treated. CONCLUSION Managing the infra-foveal fracture of the femoral head using arthroscopic reduction and fixation with headless screws can be a safe and minimally invasive option. More patients and longer follow-up are needed for a definite conclusion.
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Affiliation(s)
- Shan-Ling Hsu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
- Department of Nursing, Fooyin University, Kaohsiung
| | - Chung-Yang Chen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Jih-Yang Ko
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Chi-Hsiang Hsu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Hao-Chen Liu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Yu-Der Lu
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
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Chawla S, Githens MF, Hagen MS. Safe Distraction Technique for Hip Arthroscopy in a Polytraumatized Patient with Pelvic, Acetabular, and Ankle Fractures: A Case Report. JBJS Case Connect 2020; 10:e2000111. [PMID: 32910615 DOI: 10.2106/jbjs.cc.20.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A healthy 41-year-old man presented after a motorcycle collision resulting in polytrauma and underwent hip arthroscopy for removal of loose bodies after initial stabilization of pelvic, acetabular, and ipsilateral ankle fractures. Given these injuries, a novel hip distraction technique with a combination of postless traction and skeletal traction was used. CONCLUSION Specific considerations for hip arthroscopy with concomitant acetabular fracture include alternate techniques for joint distraction, maintenance of low pump pressures, and technical pearls for clearing hemarthrosis. Orthopaedic surgeons familiar with hip arthroscopy can use these methods.
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Affiliation(s)
- Sagar Chawla
- 1Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington 2Harborview Medical Center, Seattle, Washington
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Intra-abdominal Pressure Changes During Hip Arthroscopy: A Prospective Multicenter Study. Arthroscopy 2020; 36:1053-1060. [PMID: 31805384 DOI: 10.1016/j.arthro.2019.11.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 11/10/2019] [Accepted: 11/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate intra-abdominal pressure changes during hip arthroscopy and define its relationship with other patient related variables. METHODS A prospective multicenter study evaluating intra-abdominal pressure (IAP) in patients undergoing arthroscopic treatment of femoroacetabular impingement was performed. The IAP was measured indirectly by a bladder catheter (AbViser Autovalve Intra-abdominal pressure monitor) and documented every 30 minutes during the entire procedure. The following risk factors were analyzed: traction time, duration surgery, previous abdominal surgery, capsule repair, psoas tenotomy, and surgical approach. RESULTS One hundred and five patients with symptomatic femoroacetabular impingement that underwent hip arthroscopy met the inclusion criteria. There were significant differences in the IAP between the preoperative measurement of IAP and the IAP at different time points during surgery (P < .01). The IAP increased continuously from the commencement of surgery (considered as time point from portal establishment) until the first 60 minutes. After first 60 minutes of surgery, the IAP did not increase significantly. There were no significant associations between increased IAP and the risk factors analyzed. CONCLUSIONS IAP increases significantly during the first 60 minutes of hip arthroscopy; it then stabilizes for the duration of surgery before decreasing just after the completion of surgery. The highest recorded IAP was not associated with additional complications. No symptomatic intra-abdominal hypertension was documented. Finally, patient- and procedure-specific risk factors did not predict changes in IAP. Systemic monitoring of IAP during the hip arthroscopy procedure can easily and effectively be done, allowing the surgeon to early detect any significant change. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Gürpınar T, Polat B, Kanay E, Polat A, Öztürkmen Y. Arthroscopic Fixation of a Posterior Acetabular Wall Fracture: A Case Report. Cureus 2019; 11:e6264. [PMID: 31893189 PMCID: PMC6937468 DOI: 10.7759/cureus.6264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to present the results of an unusual surgical technique for the treatment of posterior wall acetabular fractures. A 49-year-old man presented to the emergency department after a fall from three meters. His X-rays revealed a right acetabular posterior wall fracture. He was treated with arthroscopic reduction and fixation using a cannulated screw through arthroscopic portals. The patient was allowed partial weight-bearing immediately and had a satisfactory outcome. In selected cases, arthroscopic reduction and fixation in acetabular posterior wall fractures could be a good surgical option with the advantages of simultaneous labral treatments and loose body removal.
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Affiliation(s)
- Tahsin Gürpınar
- Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, TUR
| | - Barış Polat
- Orthopaedics and Traumatology, University of Kyrenia, Kyrenia, CYP
| | - Enes Kanay
- Orthopaedics and Traumatology, Beykoz State Hospital, Istanbul, TUR
| | - Ayşe Polat
- Orthopaedics and Traumatology, Dr. Akçiçek State Hospital, Kyrenia, CYP
| | - Yusuf Öztürkmen
- Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, TUR
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Heimer J, Gascho D, Tappero C, Thali MJ, Zoelch N. Noninvasive analysis and identification of an intramuscular fluid collection by postmortem 1H-MRS in a case of a fatal motor vehicle accident. Int J Legal Med 2019; 134:1167-1174. [PMID: 31713679 DOI: 10.1007/s00414-019-02190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
In a case of a fatal traffic accident, a suspicious finding was identified in the muscular tissue of the left thigh by whole-body postmortem computed tomography. To better interpret the finding, the lower extremities were investigated by magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS). MRI revealed the presence of an evenly distributed intramuscular fluid and 1H-MRS of a volume within the fluid detected concentrations of acetate and lactate. The fluid was assumed to be an extravasation of an intraosseous infusion, erroneously administered to the intermediate vastus of the left thigh during resuscitation, which was later confirmed when access to resuscitation protocols was granted. Further ex situ 1H-MRS investigations of five different infusion fluids showed the possible discrimination of the fluids and further indicated the unknown fluid to be a Ringer's acetate solution. This paper presents the case-based application of postmortem intramuscular 1H-MRS and introduces the possibility of its use to differentiate exo- and endogenic fluids for forensic interpretation. Further research for this method regarding problems in forensic pathology is needed.
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Affiliation(s)
- Jakob Heimer
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.
| | - Dominic Gascho
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland
| | - Carlo Tappero
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.,Department of Radiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Michael J Thali
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland
| | - Niklaus Zoelch
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Zurich, Switzerland.,Hospital of Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
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Hip Arthroscopy Technique for Acetabular Osteochondral Loose Bodies After Combined Lower Extremity Trauma. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hüftgelenkarthroskopie bei Frakturen und Frakturfolgen. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Do Arthroscopic Fluid Pumps Display True Surgical Site Pressure During Hip Arthroscopy? Arthroscopy 2018; 34:126-132. [PMID: 29103841 DOI: 10.1016/j.arthro.2017.08.290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To report on the accuracy of 5 commercially available arthroscopic fluid pumps to measure fluid pressure at the surgical site during hip arthroscopy. METHODS Patients undergoing hip arthroscopy for femoroacetabular impingement were block randomized to the use of 1 of 5 arthroscopic fluid pumps. A spinal needle inserted into the operative field was used to measure surgical site pressure. Displayed pump pressures and surgical site pressures were recorded at 30-second intervals for the duration of the case. Mean differences between displayed pump pressures and surgical site pressures were obtained for each pump group. RESULTS Of the 5 pumps studied, 3 (Crossflow, 24K, and Continuous Wave III) reflected the operative field fluid pressure within 11 mm Hg of the pressure readout. In contrast, 2 of the 5 pumps (Double Pump RF and FMS/DUO+) showed a difference of greater than 59 mm Hg between the operative field fluid pressure and the pressure readout. CONCLUSIONS Joint-calibrated pumps more closely reflect true surgical site pressure than gravity-equivalent pumps. With a basic understanding of pump design, either type of pump can be used safely and efficiently. The risk of unfamiliarity with these differences is, on one end, the possibility of pump underperformance and, on the other, potentially dangerously high operating pressures. LEVEL OF EVIDENCE Level II, prospective block-randomized study.
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Shakuo T, Bito K, Yasuda S, Asagi C. Abdominal compartment syndrome during hip arthroscopy for an acetabular fracture: a case report. JA Clin Rep 2017; 3:24. [PMID: 29457068 PMCID: PMC5804609 DOI: 10.1186/s40981-017-0100-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background We encountered a case of abdominal compartment syndrome during hip arthroscopic surgery, caused by the irrigation fluid flowing into the peritoneal cavity. Case presentation A 47-year-old male patient with the acetabulum fracture underwent open reduction and internal fixation with hip arthroscopy. Hypothermia, increased airway pressure (under volume-controlled ventilation) and oliguria were observed during the operation, and arterial blood gas analysis showed decreased oxygenation and metabolic acidosis. Abdominal distention was observed, and a postoperative CT revealed accumulation of a large volume of irrigation fluid in the peritoneal cavity and retroperitoneum. The patient was diagnosed as having abdominal compartment syndrome and treated by percutaneous peritoneal drainage. His subsequent course was uneventful, and he was discharged 8 weeks after the operation. Intraperitoneal extravasation of irrigation fluid may occur during hip arthroscopic surgery, and is more likely to occur in the presence of an injury. Conclusion Anesthesiologists should be aware of the possible occurrence of the abdominal compartment syndrome during hip arthroscopic surgery and ensure that it is detected early.
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Affiliation(s)
- Tomoharu Shakuo
- 1Department of Anesthesiology, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuou, Tsuzuki-ku, Yokohama-shi, Kanagawa 224-8503 Japan
| | - Kiyoko Bito
- 2Department of Anesthesiology, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Seiichi Yasuda
- 3Nissan Tamagawa Hospital, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095 Japan
| | - Chie Asagi
- 3Nissan Tamagawa Hospital, 4-8-1 Seta, Setagaya-ku, Tokyo, 158-0095 Japan
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18
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Ekhtiari S, Haldane CE, de Sa D, Simunovic N, Ayeni OR. Fluid Extravasation in Hip Arthroscopy: A Systematic Review. Arthroscopy 2017; 33:873-880. [PMID: 28109644 DOI: 10.1016/j.arthro.2016.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review was to (1) characterize cases of fluid extravasation during hip arthroscopy and explore common factors among them and (2) describe management strategies and outcomes of this complication. METHODS The databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data regarding patient demographics, fluid management, presentation, management, and outcomes were collected. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies Criteria. RESULTS Fourteen studies (1,286 patients) were included. Twenty-two occurrences of symptomatic fluid extravasation were reported in 21 patients (1.6% of total patients; one patient had fluid extravasation during 2 separate hip arthroscopies). Two studies of normal fluid extravasation in asymptomatic patients reported 1.13 to 3.06 L of extravasated fluid observed on computed tomography. Nine case studies were included, which provided detailed patient and surgical information. Of these 9 patients (10 cases) with a mean age of 38.2 years old (range, 15 to 55 years), 6 were female. Signs of fluid extravasation included abdominal distension (89%), hypothermia (56%), hypotension. and metabolic acidosis (33% each). Four patients required surgical intervention, while 3 underwent paracentesis. Two patients were managed conservatively. All patients stabilized and were discharged, with one patient reporting abdominal complaints at latest follow-up (length of follow-up unspecified). CONCLUSIONS Fluid extravasation is a rare but potentially life-threatening complication of hip arthroscopy. It is important for surgeons and anaesthesiologists to be aware of its existence in order to recognize and manage it promptly. Most patients require interventional management by surgery or paracentesis, but some stabilize with conservative management. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Seper Ekhtiari
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chloe E Haldane
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Centre for Evidence Based Orthopaedics, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Abstract
BACKGROUND Recent developments in hip arthroscopic techniques and technology have made it possible in many cases to avoid open surgical dislocation for treating a variety of pathology in the hip. Although early reports suggest favourable results' using hip arthroscopy and it has been shown to be a relatively safe procedure, complications do exist and can sometimes lead to significant morbidity. METHODS This is a review article. The aim of this manuscript is to present the most frequent and/or serious complications that could occur at or following hip arthroscopy and some guidelines to avoid these complications. CONCLUSION Most complications of hip arthroscopy are minor or transient but serious complications can occur as well. A lot of complication e.g. acetabular labral puncture go unreported. Appropriate education and training, precise and meticulous surgical technique with correct instrumentation, the right indication in the right patient and adherence to advice from mentors and experienced colleagues are all essential factors for a successful outcome. Level of evidence: V.
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Affiliation(s)
- Naoki Nakano
- Department of Trauma and Orthopaedics, Addenbrooke's, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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20
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Seijas R, Ares O, Sallent A, Cuscó X, Álvarez-Díaz P, Tejedor R, Cugat R. Hip arthroscopy complications regarding surgery and early postoperative care: retrospective study and review of literature. Musculoskelet Surg 2016; 101:119-131. [PMID: 27928731 DOI: 10.1007/s12306-016-0444-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/27/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose is to describe the rate of complications in a series of hip arthroscopies performed at our center, as well as perform a systematic review of the current literature in order to compare our outcomes. METHODS Two hundred and fifty-eight patients affected of femoroacetabular impingement and treated with hip arthroscopy have been studied. All minor and major complications were studied during the first postsurgery year. Furthermore, a systematic review was performed comparing major and minor complications with our series. Two attending orthopedic surgeons selected the different studies with the same inclusion and exclusion criteria, remaining with 48 studies that have been reviewed and included in the present study. RESULTS Mean age was 36.6 years old (SD 17.45), and the ratio men:women was 137:121. The mean complication rate observed was 14.34% (37/258) of global complications. Only three patients showed major complications: femoral neck fracture, septic arthritis and avascular necrosis of the femoral head. Any of these patients had permanent side effects. CONCLUSIONS Hip arthroscopy has a low rate of major complications, but a higher number of minor complications that could be avoided with certain preventive measures.
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Affiliation(s)
- R Seijas
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - O Ares
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - A Sallent
- Department of Orthopaedic Surgery, Hospital Vall d'Hebron, Paseo Vall d'Hebron, 119-129, Barcelona, Spain.
| | - X Cuscó
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - P Álvarez-Díaz
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain.,Mutualitat Catalana de Futbolistes of Spanish Soccer Federation, Barcelona, Spain
| | - R Tejedor
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,School of Medicine, Hospital Clínic Barcelona, University of Barcelone, Barcelone, Spain
| | - R Cugat
- Department of Orthopaedic Surgery, Artroscopia GC - Fundación García Cugat, Hospital Quirón Barcelona, Barcelona, Spain.,Mutualitat Catalana de Futbolistes of Spanish Soccer Federation, Barcelona, Spain
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21
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Çatma MF, Ünlü S, Ersan Ö, Öztürk A. Treatment of the Bullet, Traversing Femoral Neck, Lodged in Hip Joint: Initial Arthroscopic Removal and Subsequent Cartilage Repair. J Orthop Case Rep 2016; 6:13-16. [PMID: 28164046 PMCID: PMC5288614 DOI: 10.13107/jocr.2250-0685.548] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION There have been several reports on arthroscopically assisted removal of the bullet imbedded in hip joint in the literature. Similarly, in this case, a bullet lodged in acetabulum was extracted with arthroscopic technique. What makes this case unique in the literature is that the bullet removed from the acetabulum traversed the femoral neck. CASE REPORT Male patient aged 32 years with a low-velocity gunshot wound was referred to the emergency room on August 28, 2012. The projectile was lodged in acetabular side of the hip joint transversing through the femoral neck. A hip arthroscopy was performed for bullet removal. Two years after surgery, the patient had groin pain and underwent a safe dislocation for femoral chondral injury. In the last follow-up in the second post-operative year, the patient had no clinical complaint. CONCLUSION Hip arthroscopy is a minimally invasive and proper procedure for removal of foreign materials such as a bullet in the hip joint. Arthrotomy can be reserved for further complications such as chondral injury as in this case.
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Affiliation(s)
- Mehmet Faruk Çatma
- Department of Orthopaedics and Traumatology, Diskapi Training and Research Hospital, Ankara, Turkey
| | - Serhan Ünlü
- Department of Orthopaedics and Traumatology, Diskapi Training and Research Hospital, Ankara, Turkey
| | - Önder Ersan
- Department of Orthopaedics and Traumatology, Diskapi Training and Research Hospital, Ankara, Turkey
| | - Alper Öztürk
- Department of Orthopaedics and Traumatology, Diskapi Training and Research Hospital, Ankara, Turkey
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22
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Complications in Hip Arthroscopy: A Systematic Review and Strategies for Prevention. Sports Med Arthrosc Rev 2016; 23:187-93. [PMID: 26524553 DOI: 10.1097/jsa.0000000000000084] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary objective of this study was to determine the minor and major complication rate of hip arthroscopy. The secondary objective was to provide strategies for avoiding complications. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Therapeutic hip arthroscopy investigations that reported on adverse events or complications were included. Narrative and other systematic reviews, meta-analyses, conference abstracts or proceedings, and level V evidence studies were excluded. No follow-up minimum was imposed. The results yielded 53 studies (8189 hip arthroscopies in 8071 subjects). Most studies were level IV evidence (74%) with a mean of 2.2±2.1 years follow-up. Femoroacetabular impingement (FAI) and labral pathology were the 2 most common indications for surgery, and osteochondroplasty for FAI and labral treatment were the 2 most common procedures performed. The minor and major complication rates were 7.9% and 0.45%, respectively. Iatrogenic chondrolabral damage and temporary nerve injury were the 2 most common minor complications. Extra-articular fluid extravasation was the most common major complication encountered. Minor complications associated with hip arthroscopy are generally technical in nature and may be related to the learning curve associated with hip arthroscopy. As surgeon experience increases and patient selection improves, a corresponding decline should be observed in minor complications. Strategies to prevent complications include careful preoperative planning, appropriate surgical indications, attention to detail in the operating room, and proper postoperative rehabilitation.
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23
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Yu HC, Al-Shehri M, Johnston KD, Endersby R, Baghirzada L. Anesthesia for hip arthroscopy: a narrative review. Can J Anaesth 2016; 63:1277-90. [PMID: 27530361 DOI: 10.1007/s12630-016-0718-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/19/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Hip arthroscopy is a minimally invasive surgical procedure indicated for the treatment of specific hip disorders. In this narrative review, we aim to examine the key components in providing anesthesia for this procedure. SOURCE MEDLINE(®), PubMed, and EMBASE™ databases were searched for peer-reviewed articles discussing the anesthetic management of patients undergoing hip arthroscopy. PRINCIPAL FINDINGS The primary anesthetic regimen used for hip arthroscopy should balance patient factors, preferences of the surgeon, and the demands of the procedure itself. Both general and neuraxial anesthetic techniques are well suited for this mostly ambulatory surgical procedure. There is a lack of current literature specifically comparing the benefits and risks of the two techniques in this setting. Postoperative pain management consists mainly of intravenous and oral opioids; however, a variety of regional anesthesia techniques, such as lumbar plexus block and fascia iliaca block, can be performed pre- or postoperatively. Overall, hip arthroscopy is safe, although positioning-related difficulties, extravasation of irrigation fluid, hypothermia, infections, and thromboembolic events are potential perioperative complications that warrant specific monitoring and prompt treatment. CONCLUSIONS Until now, the anesthetic technique for hip arthroscopy has not been well studied. Thus, increasing emphasis should be directed towards examining relevant clinical outcomes that can better inform evidence-based decision-making in the anesthetic management of hip arthroscopy patients. In the meantime, awareness of potential complications and vigilant monitoring are paramount in providing safe anesthetic care for patients undergoing hip arthroscopy.
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Affiliation(s)
- Hai Chuan Yu
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mohammed Al-Shehri
- Division of Orthopedics, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Kelly D Johnston
- Division of Hip & Knee Reconstruction, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Ryan Endersby
- Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Leyla Baghirzada
- Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada. .,Department of Anesthesia, South Health Campus, 4448 Front Street, SE, Calgary, AB, T3M 1M4, Canada.
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24
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Burrus MT, Cowan JB, Bedi A. Avoiding Failure in Hip Arthroscopy: Complications, Pearls, and Pitfalls. Clin Sports Med 2016; 35:487-501. [PMID: 27343398 DOI: 10.1016/j.csm.2016.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although most patients have successful outcomes after hip arthroscopy, a minority of patients experience complications that may impact their recovery and long-term benefit. As most of these complications can be minimized by appropriate surgical technique, many tips have been recommended. Additionally, the reasons behind clinical failure postoperatively have been scrutinized, which include, most commonly, incomplete correction of osseous pathomorphology, underappreciated preexisting hip osteoarthritis, and/or an incorrect preoperative diagnosis. Meticulous preoperative planning, evaluation of advanced imaging studies, and proper patient selection will help to reduce the number of postoperative failures and increase the chance of a successful outcome following hip arthroscopy.
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Affiliation(s)
- Matthew Tyrrell Burrus
- Department of Orthopaedic Surgery, University of Virginia Health System, PO Box 801016, Charlottesville, VA 22911, USA
| | - James B Cowan
- Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, PO Box 391, Ann Arbor, MI 48106, USA
| | - Asheesh Bedi
- Sports Medicine, Orthopaedic Surgery, MedSport, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, PO Box 391, Ann Arbor, MI 48106, USA.
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Abstract
Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation.
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26
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Niroopan G, de Sa D, MacDonald A, Burrow S, Larson CM, Ayeni OR. Hip Arthroscopy in Trauma: A Systematic Review of Indications, Efficacy, and Complications. Arthroscopy 2016; 32:692-703.e1. [PMID: 26935573 DOI: 10.1016/j.arthro.2015.12.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This systematic review explored the indications, efficacy, and complications of hip arthroscopy in the setting of trauma. METHODS Databases (PubMed, Medline, Embase, and Web of Science) were searched from database inception to March 2015 for studies using hip arthroscopy in trauma treatment. Systematic screening of eligible studies was undertaken in duplicate. The inclusion criteria included studies pertaining to arthroscopic intervention of all traumatic hip injuries. Abstracted data were organized in table format with descriptive statistics presented. RESULTS From an initial search yield of 2,809 studies, 32 studies (25 case reports and 7 case series) satisfied the criteria for inclusion. A total of 144 patients (age range, 10 to 53 years) underwent hip arthroscopy for 6 indications associated with trauma: 8 patients for bullet extraction, 6 for femoral head fixation, 82 for loose body removal, 6 for acetabular fracture fixation, 20 for labral intervention, and 23 for ligamentum teres debridement. Patients were followed up postoperatively for a mean of 2.9 years (range, 8 days to 16 years). Successful surgery was achieved in 96% of patients. The rate of major complications (i.e., pulmonary embolism and abdominal compartment syndrome) was 1.4% (2 of 144); avascular necrosis, 1.4% (2 of 144); and nerve palsy, 0.7% (1 of 144). CONCLUSIONS Hip arthroscopy appears effective and safe in the setting of trauma. These data should be interpreted with caution because of the low-quality evidence of the included studies. Surgeons should be aware of the potential complications such as abdominal compartment syndrome and thromboembolic events when performing hip arthroscopy in the setting of trauma. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Gavinn Niroopan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Austin MacDonald
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Burrow
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, Hamilton, Ontario, Canada.
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27
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de Sa D, Stephens K, Parmar D, Simunovic N, Philippon MJ, Karlsson J, Ayeni OR. A Comparison of Supine and Lateral Decubitus Positions for Hip Arthroscopy: A Systematic Review of Outcomes and Complications. Arthroscopy 2016; 32:716-25.e8. [PMID: 26947742 DOI: 10.1016/j.arthro.2015.12.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/08/2015] [Accepted: 12/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This systematic review examines outcomes and risk profiles of the hip arthroscopy in the supine versus lateral decubitus positions to elucidate any superiority of one approach over the other. METHODS Three databases (Embase, PubMed, and Medline) were searched for studies that addressed hip arthroscopy performed in either position, and were subsequently screened by two reviewers with data abstracted in duplicate. RESULTS Similar outcomes were observed. Supine studies showed a greater mean postoperative improvement for modified Harris hip score (33.74), visual analog scale (-3.99), nonarthritic hip score (29.61), Harris hip score (35.73), and hip outcome score (31.4). Lateral decubitus studies showed greater improvement using the Western Ontario and McMaster University Osteoarthritis (14.76) score. Supine studies reported more neuropraxic injuries (2.06% v 0.47%), labral penetration (0.65% v 0%), and heterotopic ossification (0.21% v 0%). Lateral decubitus studies reported more fluid extravasation (0.21% v 0.05%) and missed loose bodies (0.08% v 0.01%). Similar rates of revision (1.8% lateral, 1.4% supine) and conversion to open procedures (2.6% in lateral, 2.0% in supine) were also identified. CONCLUSIONS Because of quality of evidence, direct comparisons are currently limited; however, the supine position is associated with more neuropraxic injuries, labral penetration, and heterotopic ossification, whereas lateral decubitus has increased risk of fluid extravasation and missed loose bodies. At this time, no evidence exists to establish superiority of one position. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Kellee Stephens
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Parmar
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada.
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28
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Howse EA, Rogers JP, Stone AV, Mannava S, Stubbs AJ. Arthroscopic Bullet Removal From the Central and Peripheral Compartments of the Hip Joint. Arthrosc Tech 2016; 5:e217-21. [PMID: 27489755 PMCID: PMC4962620 DOI: 10.1016/j.eats.2015.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/06/2015] [Indexed: 02/03/2023] Open
Abstract
Recent advances in hip arthroscopy offer an approach for treating an uncommon but highly disabling injury from intra-articular missile injury to the hip. Hip arthroscopy affords the patient the benefit of minimally invasive surgery while allowing for the diagnosis and treatment of concomitant pathology, which may be either acute, from the trauma of the missile, or chronic. We present a technique for the removal of projectiles from the central and peripheral compartments of the hip joint. Through a surgical series of a variety of gunshot wounds, we detail the unique aspects of retrieval for the various missile endpoints. We describe this technique for bullets or pieces of bullets lodged within the hip joint space, bone of the acetabulum, or femoral head. Furthermore, we provide an example in which hip arthroscopy is not a suitable option for treatment because of the resulting fracture pattern, which necessitates open reduction along with internal fixation.
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Affiliation(s)
- Elizabeth A. Howse
- Department of Emergency Medicine, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, U.S.A
| | - Jason P. Rogers
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Austin V. Stone
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Allston J. Stubbs
- Department of Orthopaedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.,Address correspondence to Allston J. Stubbs, M.D., M.B.A., Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, U.S.A.Department of Orthopaedic SurgeryWake Forest University School of MedicineMedical Center BoulevardWinston-SalemNC27157U.S.A.
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29
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Michel AJ, Brandner J, Cotofana S, Ardelean M, Metzger R. Infusoabdomen with abdominal compartment in extremely low birth weight neonates. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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30
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Kuhns BD, Frank RM, Pulido L. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement. Front Surg 2015; 2:63. [PMID: 26697431 PMCID: PMC4667034 DOI: 10.3389/fsurg.2015.00063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/12/2015] [Indexed: 12/22/2022] Open
Abstract
Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI.
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Affiliation(s)
- Benjamin D Kuhns
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center , Chicago, IL , USA
| | - Rachel M Frank
- Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center , Chicago, IL , USA
| | - Luis Pulido
- Houston Methodist Orthopedics & Sports Medicine , Houston, TX , USA
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31
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Abstract
Objectives: To determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the sample through a learning curve; and to recognize the causes of complications in arthroscopic hip operations. Method: 150 consecutive cases that underwent hip arthroscopy between May 2004 and December 2008 were evaluated. The complications encountered were classified in three ways: organic system affected, severity and groups of 50 consecutive cases. The data were analyzed by means of descriptive statistics and Fisher's exact test. Results: We observed 15 complications in this study (10%): ten were neurological, two were osteoarticular, one was vascular-ischemic and two were cutaneous. In the classification of severity, three were classified as major, 12 as intermediate and none as minor. The incidence of complications over the course of the learning curve did not present any statistically significant difference (p = 0.16). Conclusions: Hip arthroscopy is a surgical procedure that involves low morbidity, but which presents complications in some cases. These complications are frequently neurological and transitory, and mainly occur because of joint traction. The complication rate did not decrease with progression of our sample.
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Affiliation(s)
- Marcos Emílio Kuschnaroff Contreras
- MSc in Human Movement Science/Biomechanics (Udesc). Postgraduate (doctoral) student of High Sports Yield, Pablo de Olavide University, Seville, Spain. Head of the Hip Group, Orthopedics Service, Hospital Governor Celso Ramos, Florianópolis, SC
| | | | | | | | - Francisco José Berral
- PhD in Medicine and Surgery, Head of the Department of Sport and Information Technology. Director of the Doctoral Program on High Sports Yield. Pablo de Olavide University, Seville, Spain
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Whiting DR, Moya-Angeler J, Sierra RJ. Iliopsoas Bursa-Hip Capsule Connection Leading to Intra-abdominal Fluid Extravasation. Orthopedics 2015; 38:e1055-8. [PMID: 26558672 DOI: 10.3928/01477447-20151020-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/23/2015] [Indexed: 02/03/2023]
Abstract
Intra-abdominal fluid extravasation is a rare complication of hip arthroscopy, with a reported incidence of 0.16%. Associated risk factors include recent acetabular fracture, extra-articular procedures, iliopsoas tenotomy, and high fluid pump pressure. These previously reported risk factors were not present in the 48-year-old woman reported in this article. The patient elected to undergo hip arthroscopy for mechanical hip pain that persisted for 18 months. Preoperative magnetic resonance imaging scan showed a "normal variant communication [between] the iliopsoas bursa" and the hip capsule. Postoperative examination showed a tense, distended abdomen. After extubation, the patient had severe abdominal and pleuritic chest pain. Postoperative imaging showed significant retro- and intraperitoneal fluid extravasation. Ultrasound-guided paracentesis was used to drain the intraperitoneal fluid collection, with a significant decrease in pain. The patient returned home less than 24 hours later, with no further complications. The authors believe that the preexisting connection between the hip capsule and the iliopsoas bursa allowed the arthroscopy fluid to easily track proximally within the tendon sheath, despite relatively low fluid pump pressure. Surgeons should be aware of this possible "normal variant communication," which may be considered a relative contraindication to hip arthroscopy, especially in patients with arthritic changes on preoperative imaging. This must be addressed with the patient preoperatively, with proper counseling and patient selection. If arthroscopy is pursued, the surgical and anesthesia teams must be vigilant for signs of intra-abdominal fluid extravasation and must be prepared to treat this potentially serious complication.
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Newman JT, Saroki AJ, Philippon MJ. Hip arthroscopy for the management of trauma: a literature review. J Hip Preserv Surg 2015; 2:242-8. [PMID: 27011845 PMCID: PMC4765307 DOI: 10.1093/jhps/hnv047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/07/2015] [Accepted: 05/19/2015] [Indexed: 12/21/2022] Open
Abstract
The first descriptions of the use of hip arthroscopy for traumatic injuries were presented in 1980. One paper described arthroscopy for the removal of a bullet fragment while others reported using hip arthroscopy to remove fragments following total hip arthroplasty. With the application of traction and modification of arthroscopic instruments, hip arthroscopy has become a useful tool in treating trauma to the hip. Most of the literature describes traumatic hip dislocation. Several studies have documented the successful use of arthroscopy for removal of loose bodies, but it has also been used to treat labral tears, chondral defects and acetabular rim fractures. Complications reported include fluid extravasation, the lowering of the patient's body temperature using cool saline irrigation and further injury due to unrecognized concomitant pathology.
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Affiliation(s)
- Justin T Newman
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, CO, USA
| | - Adriana J Saroki
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, CO, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, 181 W. Meadow Dr. Suite 1000, Vail, CO, USA
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Hinzpeter J, Barrientos C, Barahona M, Diaz J, Zamorano A, Salazar A, Catalan J. Fluid Extravasation Related to Hip Arthroscopy: A Prospective Computed Tomography-Based Study. Orthop J Sports Med 2015; 3:2325967115573222. [PMID: 26665027 PMCID: PMC4622354 DOI: 10.1177/2325967115573222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Complications related to hip arthroscopy are rare, with a current rate of <2%. Some complications are related to fluid extravasation, which has been associated with life-threatening conditions such as abdominal compartment syndrome, cardiopulmonary arrest, hypothermia, and atelectasis. Purpose: To identify risk factors for fluid volume extravasation in hip arthroscopy and to determine the relationship between anatomical location on computed tomography (CT) and extravasated volume. Study Design: Case series; Level of evidence, 4. Methods: We performed a prospective cohort study of 40 consecutive arthroscopies for femoroacetabular impingement. Patient demographics and procedures performed (ie, acetabuloplasty and its size, femoral osteoplasty, and psoas tenotomy) were recorded. The extravasated volume was estimated by the difference between the infused volume and the intraoperatively collected volume. Within 12 hours after the procedure, the pelvis was scanned by CT. We created a 3-stage radiological classification based on progressive involvement of anatomical structures attributed to liquid extravasation. Statistical analyses were performed with a 95% CI and a significance level of 5%. Results: No relevant clinical symptoms related to fluid extravasation were recorded. The mean extravasated volume was 3.06 L at a rate of 1.05 L/h, corresponding to nearly 10% of the infused volume. There was a trend toward greater extravasated volume with longer operative time and longer time in the peripheral compartment (without axial traction); however, there was no statistical significance. The anatomical classification on CT imaging was directly related to the extravasated volume and compromised the thigh, gluteus, and retroperitoneum and intraperitoneal spaces. There was a 6-fold greater probability of female patients having an advanced stage extravasation on CT classification. Conclusion: In our series, 10% of the infused volume was extravasated in uncomplicated hip arthroscopy. Risk factors for extravasation were related to operative time, particularly during peripheral compartment intervention (ie, without traction). The anatomical classification proposed in this study reflects the progressive involvement of the thigh, gluteus, iliopsoas, and retroperitoneal and intraperitoneal spaces after increase in extravasated volume. Compared with males, females were associated with more severe anatomical compromise for the same extravasated volume.
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Affiliation(s)
- Jaime Hinzpeter
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independence, Chile
| | - Cristián Barrientos
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independence, Chile
| | - Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independence, Chile
| | - Jorge Diaz
- Department of Imaging, Musculoskeletal Radiology Unit, Hospital Clínico Universidad de Chile, Independence, Chile
| | - Alvaro Zamorano
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independence, Chile
| | - Alfonso Salazar
- Department of Imaging, Musculoskeletal Radiology Unit, Hospital Clínico Universidad de Chile, Independence, Chile
| | - Jaime Catalan
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Independence, Chile
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Kaya I, Ugras A, Saglam N, Sungur I, Cetinus E. Bullet in hip joint. Eurasian J Med 2015; 45:141-2. [PMID: 25610269 DOI: 10.5152/eajm.2013.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/19/2013] [Indexed: 11/22/2022] Open
Abstract
Recently, hip arthroscopy has become more popular in the diagnosis and extraction of intraarticular foreign bodies compared to open surgery. If a foreign object such as a bullet is not extracted from the hip joint, it may cause mechanical arthritis, infection and systemic lead toxicity. We present the arthroscopic excision of a bullet from the hip joint of a 33-year-old male patient who sustained a gunshot injury.
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Affiliation(s)
- Ibrahim Kaya
- Clinic of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Akin Ugras
- Clinic of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Necdet Saglam
- Clinic of Orthopedics and Traumatology, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Ibrahim Sungur
- Clinic of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Ercan Cetinus
- Clinic of Orthopedics and Traumatology, Haseki Training and Research Hospital, İstanbul, Turkey
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Ciemniewska-Gorzela K, Piontek T, Szulc A. Abdominal compartment syndrome--the prevention and treatment of possible lethal complications following hip arthroscopy: a case report. J Med Case Rep 2014; 8:368. [PMID: 25394557 PMCID: PMC4244098 DOI: 10.1186/1752-1947-8-368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/16/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Intra-abdominal hypertension and abdominal compartment syndrome have been increasingly recognized as a hip arthroscopy complication over the past decade. In the absence of consensus definitions and treatment guidelines, the diagnosis and management of intra-abdominal hypertension and abdominal compartment syndrome remains variable from institution to institution. CASE PRESENTATION We report the occurrence of the extravasation of fluid into the abdomen during arthroscopic treatment of femoroacetabular impingement combined with resection of trochanteric bursa and our management of the condition in a 55-year old Caucasian woman. CONCLUSIONS We present an algorithm of treatment of abdominal compartment syndrome, as a hip arthroscopy complication, according to the consensus definitions and recommendations of the World Society of the Abdominal Compartment Syndrome. In the algorithm options, we have included paracentesis and percutaneous catheter decompression as the main point of treatment. Our algorithm will have a broader clinical impact on orthopedic surgery, anesthesiology and emergency medicine.
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Affiliation(s)
- Kinga Ciemniewska-Gorzela
- Rehasport Clinic Poznan, Clinic of Pediatric Orthopedic Surgery UM in Poznan, Rehasport Clinic, ul. Górecka 30, 60-201 Poznań, Poland
| | - Tomasz Piontek
- Rehasport Clinic Poznan, Clinic of Pediatric Orthopedic Surgery UM in Poznan, Rehasport Clinic, ul. Górecka 30, 60-201 Poznań, Poland
| | - Andrzej Szulc
- Clinic of Pediatric Orthopedic Surgery UM in Poznan, Clinic of Pediatric Orthopedic Surgery, ul 28 czerwca 1956 r. 134/145, 61-495 Poznań, Poland
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Gupta A, Redmond JM, Hammarstedt JE, Schwindel L, Domb BG. Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence. Arthroscopy 2014; 30:1342-8. [PMID: 25017649 DOI: 10.1016/j.arthro.2014.04.103] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/09/2014] [Accepted: 04/23/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. METHODS Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. RESULTS We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m(2). Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. CONCLUSIONS Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. LEVEL OF EVIDENCE Level IV, systematic review of Level II to V studies.
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Affiliation(s)
| | | | | | - Leslie Schwindel
- University of Illinois-Chicago, Department of Orthopaedics, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois, U.S.A.; Loyola University Stritch School of Medicine, Maywood, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A..
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Marecek GS, Routt MLC. Percutaneous manipulation of intra-articular debris after fracture-dislocation of the femoral head or acetabulum. Orthopedics 2014; 37:603-6. [PMID: 25350613 DOI: 10.3928/01477447-20140825-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/02/2013] [Indexed: 02/03/2023]
Abstract
Traumatic fracture-dislocation of the hip usually warrants prompt management by closed manipulative reduction. In some patients, debris malpositioned between the femoral head and the acetabular dome obstructs a completely concentric reduction of the injured hip. To avoid damage to the articular surfaces, the debris between them should be removed in a timely fashion. Techniques for removal include open approaches with or without fracture fixation or hip arthroscopy. Fracture fixation and hip arthroscopy have associated risks and potential complications, may require special equipment, and may not be familiar to all surgeons. The authors present a simple fluoroscopically guided technique for the percutaneous removal of intra-articular debris between the femoral head and the acetabular dome after traumatic femoral head or acetabular fracture-dislocation.
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40
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Park MS, Yoon SJ, Kim YJ, Chung WC. Hip arthroscopy for femoroacetabular impingement: the changing nature and severity of associated complications over time. Arthroscopy 2014; 30:957-63. [PMID: 24835839 DOI: 10.1016/j.arthro.2014.03.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to assess complications related to arthroscopy for femoroacetabular impingement (FAI) and how these complications have changed as we have gained more experience with this procedure. METHODS The authors reviewed 200 hips (197 patients). The average patient age was 44.64 years and the mean follow-up time was 28.2 months. All patients underwent hip arthroscopy in the supine position. Clinically, Modified Harris Hip Scores (MHHS) and patient satisfaction with outcome were used. We divided complications into 3 groups: Group 1 related to traction, group 2 related to surgical technique or implant failure, and group 3 related to outcomes. RESULTS Clinically, the MHHS improved from 69.96 (±6.10) to 80.45 (±7.00), and patient satisfaction with the achieved outcome increased to 8.87 (±0.76). The overall complication rate was 15% (30 of 200 hips). Group 1 consisted of 4 patients with pudendal neuropraxia and 2 patients with ankle joint pain (P = .013). Group 2 consisted of 2 patients with lateral femoral cutaneous neuropraxia, 2 patients with iatrogenic labral perforations, one patient with a labral tear, and 4 patients with femoral head scuffs. There were 4 incidents of instrument breakage. Furthermore, 3 suture anchors failed, a second-degree burn occurred in one patient, and there was incomplete reshaping in 5 hips (P = .045). Group 3 included one patient with a snapping sound and heterotopic ossification. Second-look arthroscopy was performed for 5 hips. All the complications outlined in groups 1 and 2 are related to the learning curve and have statistical significance (P < .05). CONCLUSIONS Complications relating to hip arthroscopy took different forms during the early learning period, but overall complication rates decreased along the learning curve. Surgical technique-related complications such as problems with suture anchors and the reshaping of cam impingements were also considered during the later stage. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Myung-Sik Park
- Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Jeonju, Korea.
| | - Sun-Jung Yoon
- Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Jeonju, Korea
| | - Yong-Jin Kim
- Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Jeonju, Korea
| | - Woo-Chul Chung
- Department of Orthopedic Surgery, Carollo Hospital, Sunchun, Korea
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41
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Abstract
Displaced femoral head fractures often require open reduction and internal fixation. This article describes 3 cases of displaced large-fragment femoral head fractures (OTA 31-C1.3) that were treated by arthroscopic reduction and internal fixation, which was accomplished using an anterolateral viewing portal, an anterior portal, and an accessory distal anterior working portal. By 3 months postoperatively, all 3 patients had returned to full function. Therefore, we conclude that an arthroscopic approach results in stable fixation and early joint motion, thereby effectively treating displaced femoral head fractures in a minimally invasive manner.
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42
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Hari Krishnan B, Joshi GR, Pushkar A. Arthroscopic removal of intraarticular fracture fragment after fracture dislocation of hip. Med J Armed Forces India 2014; 71:S208-10. [PMID: 26265834 DOI: 10.1016/j.mjafi.2014.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/21/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- B Hari Krishnan
- Associate Professor, Dept of Orthopaedics, Armed Forces Medical College, Pune 411040, India
| | - G R Joshi
- Professor & Head, Dept of Orthopaedics, Armed Forces Medical College, Pune 411040, India
| | - Akshay Pushkar
- Resident (Orthopaedics), Command Hospital (Southern Command), Pune 411040, India
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43
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Stabile KJ, Neumann JA, Mannava S, Howse EA, Stubbs AJ. Arthroscopic treatment of bucket-handle labral tear and acetabular fracture. Arthrosc Tech 2014; 3:e283-7. [PMID: 24904778 PMCID: PMC4044544 DOI: 10.1016/j.eats.2014.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/08/2014] [Indexed: 02/03/2023] Open
Abstract
Traumatic hip dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the joint. These types of injury often lead to traumatic arthritis. In some cases an osseo-labral fragment may become incarcerated in the joint that is not readily visualized preoperatively. In place of open surgery, hip arthroscopy permits a technique to remove loose bodies and repair labral tears to restore joint congruity and achieve fracture reduction and fixation.
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Affiliation(s)
- Kathryne J. Stabile
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Julie A. Neumann
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.,Address correspondence to Julie A. Neumann, M.D., Department of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Dr, Box 3000, Room 5309, Orange Zone, Durham, NC 27710, U.S.A.
| | - Sandeep Mannava
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Elizabeth A. Howse
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, U.S.A
| | - Allston J. Stubbs
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
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44
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Matsuda DK, Gupta N, Hanami D. Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement. Arthrosc Tech 2014; 3:e197-204. [PMID: 24904760 PMCID: PMC4044509 DOI: 10.1016/j.eats.2013.09.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/24/2013] [Indexed: 02/03/2023] Open
Abstract
Pincer femoroacetabular impingement occurs in focal or global forms, the latter having more generalized and typically more extreme acetabular overcoverage. Severe global deformities are often treated with open surgical dislocation of the hip. Arthroscopic technical challenges relate to difficulties with hip distraction; central-compartment access; and instrument navigation, acetabuloplasty, and chondrolabral surgery of the posterior acetabulum. Techniques addressing these challenges are introduced permitting dual-portal hip arthroscopy with central-compartment access, subtotal acetabuloplasty, and circumferential chondrolabral surgery. The modified midanterior portal in combination with a zone-specific sequence of acetabular rim reduction monitored with fluoroscopic templating enables precision subtotal acetabuloplasty. Guidelines for acetabular rim reduction include the following suggested radiographic endpoints: postoperative center-edge angle of 35°, a neutral posterior wall sign, and an anterior margin ratio of 0.5. Arthroscopic zone-specific chondrophobic rim preparation and circumferential labral reparative and reconstructive techniques and tools permit the arthroscopic treatment of these challenging deformities.
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Affiliation(s)
- Dean K. Matsuda
- Kaiser West Los Angeles Medical Center, Los Angeles, California, U.S.A
| | - Nikhil Gupta
- Jefferson Medical School, Philadelphia, Pennsylvania, U.S.A
| | - Dylan Hanami
- Saint Louis University Medical School, St. Louis, Missouri, U.S.A
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Glick JM, Valone F, Safran MR. Hip arthroscopy: from the beginning to the future--an innovator's perspective. Knee Surg Sports Traumatol Arthrosc 2014; 22:714-21. [PMID: 24482213 DOI: 10.1007/s00167-014-2859-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
Abstract
Hip arthroscopy is one of the fastest-growing areas of orthopaedic surgery. There are many reasons for this, including a better understanding of the pathophysiology of damage to the hip joint, improvements in imaging and technology advancements in arthroscopic instrumentation. This manuscript documents the historical development of hip arthroscopy, in general, as well as advances and ideas that have led to common techniques with regard to portal placement, traction and instrumentation. These advances have led to expanding indications for hip arthroscopy. This manuscript ends with some thoughts about the future of hip arthroscopy from the perspective of one of the leaders who helped shape hip arthroscopy, as it is performed today.
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Affiliation(s)
- James M Glick
- Department of Orthopaedic Surgery, University of California, San Francisco, 2705 Ralston Ave., Hillsborough, San Francisco, CA, 94010, USA,
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46
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Grand JG, Roig JA, de Swarte M. Instrument breakage as a complication of elbow arthroscopy in a dog. Aust Vet J 2014; 92:128-31. [DOI: 10.1111/avj.12153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- JG Grand
- Section of Veterinary Clinical Sciences, School of Veterinary Medicine; University College Dublin; Belfield Dublin Ireland
| | - JA Roig
- Section of Veterinary Clinical Sciences, School of Veterinary Medicine; University College Dublin; Belfield Dublin Ireland
| | - M de Swarte
- Section of Veterinary Clinical Sciences, School of Veterinary Medicine; University College Dublin; Belfield Dublin Ireland
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47
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[Rare complication after endoscopic discectomy]. Anaesthesist 2014; 63:41-6. [PMID: 24402511 DOI: 10.1007/s00101-013-2279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/23/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
Surgical treatment of the lumbar spine is a standard procedure in orthopedic and neurosurgery. After endoscopic discectomy an otherwise healthy patient developed massive dyspnea in combination with severe abdominal pain. Sonography revealed a large volume of free fluid in the abdominal cavity which proved to be surgical irrigation solution after computed tomography (CT) guided puncture. After insertion of a drainage channel fluid could be removed and the patient was transferred to a peripheral ward after a 24 h monitoring period. This review reports on the complications and anesthetic characteristics of percutaneous spinal interventions and presents differential diagnoses of postoperative dyspnea.
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48
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Komplikationen bei der Arthroskopie des Hüftgelenks und deren Therapie. DER ORTHOPADE 2014; 43:6-15. [DOI: 10.1007/s00132-013-2119-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Abstract
This article discusses contemporary management strategies for gunshot-related fractures with special attention paid to the initial evaluation, role of debridement, principles of fixation, need and duration of antibiotic therapy, and management of sequelae. Pertinent sequelae detailed are fractures associated with vascular injury, compartment syndrome, massive loss of soft tissue and bone, nerve injury, and lead toxicity.
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Affiliation(s)
- Rick Tosti
- Department of Orthopaedic Surgery and Sports Medicine, School of Medicine, Temple University, 3401 N Broad St, Philadelphia, PA 19140, USA.
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50
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Park MS, Yoon SJ, Choi SM. Hip Arthroscopic Management for Femoral Head Fractures and Posterior Acetabular Wall Fractures (Pipkin Type IV). Arthrosc Tech 2013; 2:e221-5. [PMID: 24265988 PMCID: PMC3834644 DOI: 10.1016/j.eats.2013.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 02/14/2013] [Indexed: 02/03/2023] Open
Abstract
Femoral head fractures associated with acetabular fractures are usually treated by an open method. After a closed reduction of a hip dislocation, open reduction and internal fixation of acetabular fractures usually depend on the type of acetabular fracture. Acetabular fractures associated with femoral head fractures, torn labrums, or osteochondral fractures are often managed simultaneously by a posterior approach. The patient in this study was referred to us because of pain and limited motion after open reduction and internal fixation of an acetabular fracture. Postoperative computed tomography showed remnant osteochondral fragments located in the cotyloid fossa. Using hip arthroscopy, we found a torn labrum and multiple osteochondral fragments in the cotyloid fossa. The avulsed torn labrum was reattached with 2 anchors through the midanterior portal. Osteochondral fragments were curetted and removed. This article reviews the treatment of the torn labrum and multiple fragments after acetabular fracture reduction. The patient recovered immediately and had a satisfactory outcome. We conclude that hip arthroscopy is a valuable option for treating femoral head fracture dislocations associated with acetabular fractures.
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Affiliation(s)
- Myung-Sik Park
- Department of Orthopedic Surgery, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea
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