Emergent Hip Arthroscopy: Life-saving Intervention for Septic Hip and Secondary Multiorgan Failure

Abstract

This article describes the case of a 27-year-old female athletic trainer who presented to the emergency department in acute renal failure with rhabdomyolysis and disseminated intravascular coagulation following a brief onset of right hip pain and staphylococcal facial infection. Despite the absence of fever, peripheral leukocytosis, or organisms on gram stain from emergent joint aspiration, magnetic resonance imaging revealed a large hip effusion; a presumptive diagnosis of septic hip was made. Emergent hip arthroscopy was performed in the middle of the night within 3 hours of presentation. Minimally invasive, high-volume irrigation and debridement was rapidly performed using dual-portal arthroscopy. Although this approach required prolonged critical respiratory and hemodynamic support, the patient recovered from a life-threatening situation not often seen by arthroscopic or sports medicine surgeons. The unusual diagnosis of staphylococcal hip sepsis with multifocal dissemination was established, as was an atypical but important indication for emergent hip arthroscopy. Although generally implemented to improve quality of life, this case represents the use of hip arthroscopy to increase its quantity as well. Hip arthroscopy may have an emergent indication with life-saving potential.

Arthroscopic Removal of Proximal Femoral Locking Screws: A Novel Application of Hip Arthroscopy

“…[13][14][15] Indications for hip arthroscopy include femoroacetabular impingement, labral tears, chon-dral and osteochondral lesions or defects, synovial disease, ligamentum teres pathology, loose body retrieval, and septic arthritis. [14][15][16] In hip arthroscopy, 3 compartments have been identified: the central compartment, which is intracapsular and intra-articular (as defined by the edges of the acetabular labrum); the peripheral compartment, which is intracapsular and extra-articular; and the extracapsular peritrochanteric or lateral compartment, which is a potential space that extends from the femur to the tensor fascia lata. 13 Within the peritrochanteric compartment, proximal screw heads can be found and bursal scarring and gluteus medius tendinopathy can be evaluated.…”

Peri-articular diseases of the hip: emerging frontiers in arthroscopic and endoscopic treatments

“…Larson published two papers describing three and ten cases, respectively, of AIIS or subspine impingement that he managed with arthroscopic decompression [19, 20]. Matsuda [21] has also described arthroscopic management in a case of secondary symptomatic femoroacetabular impingement arising from an inferiorly malunited AIIS avulsion fracture.

Fig. 6Arthroscopic view at excision of anteroinferior iliac spine impingement lesion (IL)

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Microbial Colonization of Capsular Traction Sutures in Hip Arthroscopic Surgery

“…§ Multiple independent risk factors have been identified including smoking, obesity, inflammatory arthritis, chronic kidney disease, and preoperative joint injections. 23 Although septic arthritis after hip arthroscopic surgery is relatively uncommon, the potential for significant morbidity, such as irreversible chondral damage, 17,21 warrants an investigation of all potential endogenous and exogenous sources of an infection.…”