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Complications following arthroscopic surgery of the hip: a systematic review of 36 761 cases
N Nakano1, L Lisenda1, T L Jones2
1Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
Insights
Hip arthroscopy is a common procedure with a low overall complication rate of 3.3%. Nerve injury and iatrogenic damage are the most frequent issues, but major complications remain rare.
Area of Science:
- Orthopedic Surgery
- Minimally Invasive Procedures
- Patient Safety
Background:
- Hip arthroscopy is increasingly performed for intra- and extra-articular hip conditions.
- The procedure has a steep learning curve and potential for complications.
Purpose of the Study:
- To systematically review and determine the prevalence of complications associated with hip arthroscopy.
Main Methods:
- Systematic literature search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Data abstraction and analysis of complications from eligible studies.
Main Results:
- Analysis of 36,761 hip arthroscopies from 276 studies revealed a 3.3% complication rate.
- Nerve injury (0.9%) and iatrogenic chondral/labral injury (0.7%) were most common.
- Major complications occurred in 0.2% of cases, including three deaths (0.008%).
Conclusions:
- Hip arthroscopy demonstrates a relatively low complication rate.
- While generally safe, certain complications can be significant for the patient population.
Aims:
The number of patients undergoing arthroscopic surgery of the hip has increased significantly during the past decade. It has now become an established technique for the treatment of many intra- and extra-articular conditions affecting the hip. However, it has a steep learning curve and is not without the risk of complications. The purpose of this systematic review was to determine the prevalence of complications during and following this procedure.
Materials And Methods:
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in designing this study. Two reviewers systematically searched the literature for complications related to arthroscopy of the hip. The research question and eligibility criteria were established a priori. Pertinent data were abstracted and analysed.
Results:
We found 276 relevant studies with a total of 36 761 arthroscopies that met the inclusion criteria. The mean age of the patients was 36.7 years (1.7 to 70) and the mean body mass index was 25.7 kg/m2 (20.2 to 29.2). Femoroacetabular impingement and labral tears were the most common indications for the procedure. The total number of complications was 1222 (3.3%). Nerve injury (0.9%), mainly involving the pudendal and lateral femoral cutaneous nerves, and iatrogenic chondral and labral injury (0.7%), were the two most common complications. There were 58 major complications (0.2%), the most common being intra-abdominal extravasation of fluid, which was found in 13 cases (0.04%). There were three deaths (0.008%).
Conclusion:
Arthroscopic surgery of the hip is a procedure with a relatively low rate of complications, although some may be significant in this young cohort of patients. This study relied on the reported complications only and the results should be interpreted with caution. Cite this article: Bone Joint J 2017;99-B:1577-83.
