Published 7/1/2010
Peter Pollack

Arthroscopy after traumatic hip dislocation?

Hip arthroscopy is a safe and effective subsequent procedure for patients who have sustained a traumatic hip dislocation, and loose fragments inside the joint are the clearest indication for such arthroscopy, according to data presented by Victor M. Ilizaliturri Jr., MD, at the annual meeting of the Arthroscopy Association of North America.

“Subsequent treatment is indicated for residual intra-articular fragments or for a noncongruent reduction,” explained Dr. Ilizaliturri. “Our study examined a consecutive series of patients with traumatic hip dislocation treated with closed reduction who underwent hip arthroscopy as a subsequent procedure.”

Significant improvement
The research team prospectively followed 17 patients at a single facility who underwent hip arthroscopy as a subsequent procedure after traumatic hip dislocation between January 2002 and December 2006. The average patient age was 28.5 years, and the average time between closed reduction and arthroscopy was 3 months. Overall, 14 of the patients had anterior labral tears, 6 had posterior labral tears, 16 had acetabular chondral damage, all had femoral head chondral damage, and 14 had intra-articular fragments.

“The time between dislocation and reduction was about 4.5 hours on average,” said Dr. Ilizaliturri. “One patient also had a patella fracture that was fixed at the time of reduction. Indications for arthroscopy were intra-articular fragments in 13 cases and mechanical hip symptoms in 4 cases.”

Before the end of the study period, two patients underwent total hip arthroplasty (THA), one due to osteoarthritis, and the second for osteonecrosis.

“We believe the osteonecrosis was due to the trauma, and not the arthroscopic surgery,” said Dr. Ilizaliturri.

Preoperatively, the average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for all patients was 46. At a mean follow-up of 45 months, the average WOMAC score was 87.

“The difference was statistically significant,” said Dr. Ilizaliturri.

“Other studies have reported that hip arthroscopy is valuable in the treatment of injuries after trauma,” he pointed out. “The most common cause is loose bodies and chondral damage and some labral pathology. In our series, the most common injury was femoral head cartilage damage and labral tears. Severe acetabular chondral damage seemed to be the worst prognostic factor.”

Dr. Ilizaliturri’s co-authors included Bernal Gonzalez-Gutierrez, MD; Humberto Gonzalez-Ugalde, MD; and Javier Camacho-Galindo, MD.

Disclosure information: Dr. Ilizaturri—Biomet; Smith & Nephew; Arthroscopy; AANA; International Society for Hip Arthroscopy.

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org