Hip arthroscopy technique and complications

Abstract

Hip arthroscopy is not a new technique but the seemingly limited indications and technical challenges involved have discouraged many since Burman documented his initial experiences (Burman, 1991). The current renaissance is largely driven by the expanding indications particularly in the management of femoroacetabular impingement. The figures from our own unit illustrate this well with 40% of hip arthroscopies in 1990 being purely diagnostic as compared with less than 5% at the present time. The focus of this chapter is the technical aspects of hip arthroscopy and the potential complications that can occur.

The Effect of Traction Force and Hip Abduction Angle on Pudendal Nerve Compression in Hip Arthroscopy: A Cadaveric Model

“…15 Traction-related pudendal palsy is almost always reversible; still, it causes great distress both to patients and to surgeons. [3][4][5] It is known that compression of the pudendal nerve, in which the nerve is trapped between the perineal post and bones, causes the palsy. 8 Several articles have given recommendations for the prevention of pudendal palsy.…”

“…7,18 A well-padded perineal post with a minimum diameter of 9 cm is the most established suggestion for preventing pudendal palsy. 4,5 Most of the aforementioned recommendations are based on either clinical experience or retrospective data. From a clinical standpoint, it is critical to understand how different traction magnitudes and hip abduction angles affect the pudendal nerve.…”

“…Nearly half of the neurologic complications are cases of pudendal nerve palsy, which is accepted as being caused by compression of the nerve between the perineal post and bones, causing great distress to the patient with perineal hypoesthesia/dysesthesia or sexual dysfunction. [3][4][5] Recommendations for prevention of neurologic injury include minimizing the traction force, limiting the traction time (120 minutes), and using a wellpadded perineal post (>9 cm). [4][5][6][7] Different positioning and distraction techniques, such as using a hip distractor or arthroscopy without traction, have been described.…”

“…[3][4][5] Recommendations for prevention of neurologic injury include minimizing the traction force, limiting the traction time (120 minutes), and using a wellpadded perineal post (>9 cm). [4][5][6][7] Different positioning and distraction techniques, such as using a hip distractor or arthroscopy without traction, have been described. [8][9][10] Despite all the preventive measures, compressive neuropathy still exists.…”

The arthroscopic management of a cotyloid fossa lesion with concurrent hip dysplasia

“…9 As a treatment modality, it is increasing considerably with both labral and chondral lesions being treated. Simpson et al 10 noted that their use of arthroscopy as a purely diagnostic tool has decreased from 40% of cases to only 5% over 20 years, with treatment of femoracetabular impingement, labral tears, and iliopsoas pathology increasing.…”