Summary

Hip arthroscopy appears effective and safe in the setting of trauma. This data should be interpreted with caution due to very low quality evidence of included studies. Hip arthroscopists must remain vigilant for abdominal compartment syndrome.

Abstract

Introduction

Treatment of traumatic hip pathology has historically required extensile exposure and occasional surgical hip dislocation. However, this carries with it substantial morbidity, including risk of avascular necrosis, heterotopic ossification and nerve injury. Hip arthroscopy indications have continued to grow, with expanding utilization in the setting of trauma. This systematic review explores the indications, efficacy and complications of hip arthroscopy in the setting of trauma.

Methods

Databases (Pubmed, MEDLINE, EMBASE, WoS) were searched from inception to March 2015 for studies employing hip arthroscopy in trauma treatment. Systematic screening of eligible studies was undertaken in duplicate. Inclusion criteria included studies pertaining to arthroscopic intervention of all traumatic hip injuries. Exclusion criteria included review articles and studies without outcomes and/or complications data. Abstracted data was organized in table format and descriptive statistics presented.

Results

From an initial search yield of 2809 studies, 32 studies (25 case reports, 7 case series) satisfied criteria for inclusion. A total of 145 (age range, 10-53) patients underwent hip arthroscopy for six indications associated with trauma - 8 for bullet extraction, 6 for femoral head fixation, 82 for loose body removal, 6 for acetabular fracture fixation, 20 for labral treatment, and 23 for debridement of ligamentum teres avulsion. Followup was 2.9 years (range, 8 days to 16 years). Successful surgery was accomplished in 96% of patients, with 5 failures for retained loose bodies and 1 for irretrievable bullet fragments. Rate of major complication - fatal pulmonary embolism and abdominal compartment syndrome - was 1.4% (2/145), 1.4% (2/145) for avascular necrosis, 0.7% (1/145) for nerve palsy and 0% for heterotopic ossification.

Conclusion

Hip arthroscopy appears effective and safe in the setting of trauma. This data should be interpreted with caution due to very low quality evidence of included studies. Hip arthroscopists must remain vigilant for abdominal compartment syndrome.