Summary

We describe two cases of Superior Gluteal Nerve injury after hip arthroscopy, which resolved after 4 and 8 months respectively.

Abstract

Hip arthroscopy has gained popularity in the last decade, mainly for the treatment of Femoro-Acetabular Impingement (FAI). Complication rate is between 1,3% and 23,3%. The most common complications are related to patient positioning and traction.
We report two cases of Superior Gluteal Nerve Injury After Hip Arthroscopy, performed for FAI.

CASE 1:
29 years old male patient, left Hip Arthroscopy was performed due to FAI under general anesthesia in a Maquet traction table, in supine position. Acetabular bone trimming plus labral fixation with 2 anchors was done under traction, in 70 minutes. After which, traction was released and femoral neck remodeling performed with burr. Peripheral compartment arthroscopy was performed without traction in 60 minutes.
After surgery, patient was unable to abduct or rotate his hip, when walking was authorized, he was unable to walk without assistance, presenting a Trendelemburg gait. An Electromiogram with evoked potentials was performed 45 days after Hip Arthroscopy, which reported a left superior gluteal nerve lesion, with important diminished neurophysiological activity. He received conservative treatment (neuromotor stimulation), at 3 months partial recovery was clinically visible, and electrophisiologic activity showed transmission but slower than normal. And at 8 months follow-up he regain normal function, with normal electrophysiologic potentials.

CASE 2:
27 years old male patient, left Hip Arthroscopy was performed due to FAI under general anesthesia in a Maquet traction table, in supine position. Acetabular chondroplasty, bone trimming, and labral fixation with 3 anchors was done under traction, in 75 minutes. After which, traction was released and peripheral compartment arthroscopy was performed for femoral remodeling without traction in 80 minutes.
Immediately after surgery the patient presented signs of weakness of te abductor muscles and Trendelemburg gait. An electromiogram with evoked potentials was performed, which reported acute lesion of the Superior Gluteal Nerve. He recieved early conservative treatment (neuromotor stimulation) and at 4 months he regained normal function, and normal electrophisiologic activity

Discussion

Neurological injuries are usually associated with long lasting procedures and excessive traction, but is known that they can occur even when surgery is performed within established guidelines. They are usually temporary, with full recovery in 1 to 8 months. Nerves more frequently affected are: Pudendal and Lateral Femoro-cutaneous, less frequently the Greater Sciatic nerve can also be affected. But we have never seen reports of compromise of the Superior Gluteal Nerve. Injury to this Nerve is a serious complication in hip surgery. An exact knowledge of its course may be helpful for avoiding such problems. Lateral traction due to the use of wide perineal post might be one predisposing factor, associated to distal traction.

Key Words: Hip Arthroscopy. Superior Gluteal Nerve Injury.