Monday, February 11, 2013

Perspective on Nerve Injury from Hip Arthroscopy


In my previous blog post, I had cited an article from the Journal of Bone and Joint Surgeons about a study on the relationship between traction weight and sciatic nerve injury during hip arthroscopy. In a subsequent issue of the same journal (November 21, 2012), Dr. Patrick Birmingham, MD, published a commentary on the article called “Risk of Sciatic Nerve Traction Injury During Hip Arthroscopy – Is It the Amount or Duration? An Intraoperative Nerve Monitoring Study” (by Dr. Jessica Telleria, MD).

I wanted to share the commentary with you as it provides some perspective on the topic of potential nerve injury from hip arthroscopy. Dr. Birmingham states
that in the majority of the papers reporting nerve injuries during hip arthroscopy, the range has been 2% to 10%, with the sciatic nerve and the pudendal nerve being the most commonly involved. He also states that Dr. Telleria’s study only included patients who were operated in side-lying (lateral) position.
According to Dr. Birmingham, sciatic nerve injury has been almost exclusively reported during hip arthroscopy done with the patient in the lateral position whereas hip arthroscopy done with the patient supine (on back) has been associated with pudendal nerve injury instead of sciatic nerve injury. With hip arthroscopy in the supine position, the majority of pudendal nerve injuries resolve between two and twelve weeks after injury.

Dr. Birmingham draws the conclusion that, since side-lying hip arthroscopy seems to be more highly correlated with sciatic nerve injury, total traction weight should be carefully monitored when patients are in the side-lying position. He also cautions physicians to apply the findings of Dr. Tellaria’s study to hip arthroscopy with the patient in the supine position since sciatic nerve injury is much less common in that position. In addition, Dr. Birmingham concludes that because hip arthroscopy with the patient in the supine position is associated with a higher incidence of pudendal nerve injury, which is more likely to be a compression-type injury, physicians should carefully monitor the total traction time. 

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