Although arthroscopic procedures in the hip are not performed as frequently as those in the knee or shoulder, the incidence is increasing. But according to Christopher M. Larson, MD, little has been published in the orthopaedic literature on complication rates after hip arthroscopy with current techniques and indications.

Dr. Larson and his colleagues recently updated results of a prospective, multicenter study and presented their findings at the 2013 annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM).

Complications classifications
Between January 2011 and November 2012, 1,026 patients (507 males and 519 females) underwent arthroscopic hip procedures at the three institutions involved in the study. Patients had a mean age of 31.2 years (range: 12 years–73 years). Researchers recorded the diagnosis, demographic information, and type of procedure. The Clavien classification, a validated complications grading classification for hip joint surgery, was used for all patients.

Under the Clavien classification, complications are divided into the following four grades:

• Grade I—alterations from the ideal postoperative course that are non–life-threatening and result in no lasting disability
• Grade II—potentially life-threatening complications, but without residual disability
• Grade III—complications that can result in residual disability
• Grade IV—complications that can result in death

Surgeries and complications
Of the 1,026 surgeries, 951 were primary hip arthroscopies and 75 were revision hip arthroscopies, defined as arthroscopic procedures performed after a previous arthroscopic or hip preservation surgery. Reasons for hip arthroscopy included femoroacetabular impingement (936 hips), labral repair (730 hips), and labral débridement (760 hips).

Postoperative sensory disturbance adjacent to the portals or involving the distal anterolateral thigh, consistent with a disturbance of the lateral femoral cutaneous nerve (LFCN), was the most common complication (191 hips, 18.7 percent). In most cases, however, patients did not even notice the condition and it was only identified during a physical examination. The condition resolved within the first 6 months for all but seven patients; in those patients, although the thigh numbness continued, it did not limit function or require additional treatment.

Other complications noted included the following:

• iatrogenic chondral injury—20 hips (1.9 percent)
• iatrogenic labral puncture—11 hips (1.1 percent)
• superficial portal infection—6 hips (0.6 percent)
• sensory deficit about the foot—9 hips (0.9 percent)
• deep venous thrombosis—3 hips (0.3 percent)
• pulmonary embolism—1 hip (0.1 percent)
• pulmonary edema—1 hip (0.1 percent)
• wound hematoma—2 hips (0.2 percent)
• perineal numbness (pudendal nerve)—9 hips (0.9 percent)
• heterotopic ossification—4 hips (0.4 percent)
• reflex sympathetic dystrophy—1 hip (0.1 percent)
• wound/skin (traction) dehiscence—1 hip (0.1 percent)

The overall complication rate, not including temporary paresthesia of the LFCN, was 6.9 percent (71 hips). Of these complications, 88.7 percent were Grade I, 5.6 percent were Grade II, 4.2 percent were Grade III, and 1.4 percent were Grade IV. There were no femoral neck fractures, iatrogenic instability, osteonecrosis, or extra-abdominal fluid extravasation in this cohort.

Researchers found no difference in the rate of complications between males and females, or between primary and repeat arthroscopic patients. They also noted no difference between complications after labral repair and those after débridement. The patient’s body mass index had no effect on complication rate.

“The overall complication rate after hip arthroscopy was 6.9 percent,” reported Dr. Larson, “which was higher than previously reported in the literature. This rate of complications is in line with complication rates after open surgical dislocation using the same classification system.”

Dr. Larson’s coauthors for “Complications after Hip Arthroscopy: A Prospective, Multicenter Study Using a Validated Grading Classification” include John C. Clohisy, MD; Paul Beaule, MD; Bryan T. Kelly, MD; Russell Giveans, PhD; Rebecca M. Stone, MS, ATC; and Kathryn M. Samuelson, BS.

Disclosure information: Dr. Larson—Smith & Nephew; A3 Surgical. Dr. Clohisy—Biomet; Pivot Medical; Wright Medical Technology, Inc.; Zimmer; Journal of Bone and Joint Surgery – American (JBJS). Dr. Beaule—Wright Medical Technology, Inc.; Smith & Nephew; MEDACTA; Corin USA; DePuy, A Johnson & Johnson Company; JBJS. Dr. Kelly—Smith & Nephew; Pivot Medical; A-3 Surgical; Mitek; Ortholink Pty Ltd. Ms. Stone and Ms. Samuelson—no conflicts.

Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at porucznik@aaos.org

Bottom Line

• In this prospective, multicenter study, transient paresthetic LFCN postoperative sensory disturbance was the most common complication after arthroscopic hip surgery.
• Most complications after arthroscopic hip surgery are non–life-threatening and result in no lasting disability.
• The overall complication rate after arthroscopic hip surgery, however, is comparable to that of open surgery.