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Case report: Osteonecrosis of the femoral head after hip arthroscopy
Danielle L Scher1, Philip J Belmont, Brett D Owens
1Orthopaedic Surgery Service, William Beaumont Army Medical Center, 5005 N Piedras Street, El Paso, TX 79920, USA. danielle.scher@amedd.army.mil
Insights
Hip arthroscopy can lead to femoral head osteonecrosis, a rare but serious complication. This case suggests prolonged traction during the procedure may cause this condition.
Area of Science:
- Orthopaedic Surgery
- Hip Arthroscopy
- Femoral Head Osteonecrosis
Background:
- Hip arthroscopy is a common procedure with a reported complication rate of 1.3% to 23.3%.
- Major complications include traction-related injuries, fluid extravasation, and chondral damage.
- Osteonecrosis has been a theoretical concern, not a commonly reported complication.
Observation:
- A 24-year-old male presented with a 2-year history of left hip pain.
- He underwent hip arthroscopy for labral debridement and pincer lesion removal due to femoroacetabular impingement.
- Traction was applied for 90 minutes to achieve 10 mm of joint distraction.
Findings:
- Three months post-procedure, MRI revealed osteonecrosis in the subcapital region of the left femoral head.
- This is only the second reported case of femoral head osteonecrosis following hip arthroscopy.
- The previous case may have been related to the initial injury rather than the arthroscopy itself.
Implications:
- Traction duration and magnitude during hip arthroscopy may increase the risk of traction-related injuries.
- Femoral head osteonecrosis might develop secondary to increased intra-articular pressure combined with traction.
- This case highlights a potential, albeit rare, complication of hip arthroscopy requiring further investigation.
Background:
Hip arthroscopy is a common orthopaedic procedure used as a diagnostic and therapeutic tool with a multitude of surgical indications. The complication rate is reportedly between 1.3% and 23.3%. Major complications are related to traction, fluid extravasation, and iatrogenic chondral injury. Although osteonecrosis is a concern with any surgical procedure about the hip, this complication has been primarily a theoretical concern with hip arthroscopy.
Case Description:
We report the case of a 24-year-old man who presented with a 2-year history of left hip pain. He underwent hip arthroscopy to include débridement of a torn labrum and removal of a prominent pincer lesion for femoroacetabular impingement. Traction was initiated by applying manual traction to the traction bar until 10 mm of joint distraction was obtained. Traction was removed at 90 minutes. At the 3-month followup, MRI showed osteonecrosis in the subcapital region of the left femoral head.
Literature Review:
It generally is agreed the magnitude and duration of traction during hip arthroscopy increase the risk of traction-related injuries. Only one previous case of femoral head osteonecrosis associated with hip arthroscopy has been reported, and this may have resulted from the initial traumatic event. Based on anatomic studies, the use of standard arthroscopic portals would not put at risk any dominant normal vascular structures supplying the femoral head. In contrast, the literature shows that femoral head osteonecrosis may develop secondary to a combination of increased intraarticular pressure and traction.
Purposes And Clinical Relevance:
We suspect this case of femoral head osteonecrosis after hip arthroscopy was caused by traction used in the procedure.