Thursday, May 2, 2013

Study Reveals Higher Rate of Hip Arthroscopy Complications than Previously Thought

If you are one of all hip FAI patients considering surgery, you might wonder about the complication rates hip arthroscopy. A recent case study on more than 500 hip procedures revealed that complication rates may be higher than previously thought. The researchers – led by Dr. Christopher Larson, MD, of the Minnesota Orthopaedic Sports Medicine Institute in Minneapolis – presented the study results at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Specialty Day in Chicago, IL.


Previously, literature had reported the overall complication rate of hip arthroscopy at 1.5 percent. The new study showed a complication of rate 7.2 percent. The multicenter research study evaluated complication rates for all arthroscopic hip procedures using a grading scheme that assessed the possibility of complications based on demographic and surgical data. During the presentation, Dr. Larson stated that previous reports on complications were prior to new surgical techniques such as labral repair and treatment of femoroacetabular impingement (FAI) or were not comprehensive.

The study was conducted between January 2011 and April 2012 and consisted of 573 individuals (287 males, 286 females) with a mean age of 32.3 years who underwent hip arthroscopy at three institutions. The most common adverse event after surgery (22.7% of hips) was post-operative sensory disturbance in the leg. It only persisted beyond six months in four hips. The researchers called the sensory nerve disturbance a sequelae (a condition that is the consequence of a previous disease or injury) rather than a complication. Notably, there was no difference in complications between males vs. females, primary surgery vs. revision, labral repair vs. debridement and BMI.

I wanted to dig a little deeper for my readers, so I managed to find more detailed results presented at a prior hip arthroscopy conference, not the watered down press release statistics. Are you ready?

There were 532 primary hip arthroscopies and 41 revision hip arthroscopies. Arthroscopy was performed for FAI in 530 hips (92.5%), and 415 hips (72.4%) had a labral repair and 140 hips (24.4%) had a labral debridement.

The sensory disturbance mentioned above was directly related to the surgery portals in the side/front of the thigh and involved the lateral femoral cutaneous nerve. The disturbance was typically not noted by patients but found on physical examination. Recall from above? This nerve disturbance went away on its own in all but four hips.

Apart from the sensory disturbance, which was not included in the complication rate number, the following were the complications recorded in the study:
  • Iatrogenic chondral injury was noted for ten hips (1.7%). Iatrogenic means an injury resulting from an activity by a physician, so in this case simply something that was not present before the surgery. Chondral refers to cartilage. = cartilage injury as a result of surgery
  • Iatrogenic labral puncture occurred in five hips (0.9%). = puncturing of labral cartilage
  • Superficial portal infection in four hips (0.7%)
  • Sensory deficit about the foot in eight hips (1.4%)
  • Deep venous thrombosis in three hips (0.5%)
  • Pulmonary embolism in one hip (0.2%)
  • Pulmonary edema in one hip (0.2%)
  • Wound hematoma in two hips (0.3%)
  • Perineal numbness in three hips (0.5%)
  • Major nerve neuropraxia (loss of impulses from a nerve) in two hips (0.3%).
There were no femoral neck fractures, iatrogenic instability, avascular necrosis (loss of blood supply to bone tissue resulting in bone collapse) or extra‐abdominal fluid extravasation in this patient group.
Intereresting: compared to open hip surgery with dislocation the complication rate is in the same range using the same classification system.

Using a grading system designed and validated for hip surgery, the study authors noted that 5.8 percent of patients had a grade 1 complication that required no change of postoperative management. About 0.7 percent of patients experienced grade 2 complications requiring a change in postoperative treatment. Another 0.35 percent each had either grade 3 (requiring surgical or radiologic intervention) or grade 4 (long-term morbidity) complications.

In conclusion, life-threatening complications of hip arthroscopy are rare, but as after any surgery, serious. Non-resolving nerve injuries are also rare, but nonetheless impacting for those affected. Any surgery has complication risks. I hope this blog post contributes to your own risk-benefit-analysis. On a personal note, I have had three hip arthroscopies without any complications.

Sources:

American Orthopedic Society for Sports Medicine, Press Release, March 23, 2013.

Paper #35: Complications after Hip Arthroscopy: A Prospective, Multicenter Study Using A Validated Grading Classification. International Society of Hip Arthroscopy Annual Meeting 2012. Presenting author: Christopher M. Larson, MD.

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