2017 ISAKOS Biennial Congress ePoster #714
Fluid Extravasation In Hip Arthroscopy: A Systematic Review
Seper Ekhtiari, MD, Hamilton, ON CANADA
Chloe Emma Haldane, BHSc, MScPT, Hamilton, ON CANADA
Darren L. de SA, MBA(c), MD FRCSC, Hamilton, Ontario CANADA
Nicole Simunovic, MSc, Hamilton, ON CANADA
Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, Hamilton, ON CANADA
McMaster University, Hamilton, ON, CANADA
FDA Status Not Applicable
Summary
Fluid extravasation is a rare but serious complication of hip arthroscopy that often requires surgical management including emergent laparotomy. It is important for physicians to be aware of this complication as early recognition may prevent the need for invasive intervention. This study examines risk factors, management strategies, and outcomes following symptomatic fluid extravasation.
ePosters will be available shortly before Congress
Abstract
Background
Arthroscopic procedures of the hip have developed rapidly in the early 21st century. Case reports of fluid extravasation leading to complications such as abdominal compartment syndrome and cardiac arrest have been published. The risk factors and management strategies of this complication remain unclear. The purpose of this systematic review was to (1) characterize cases of fluid extravasation during hip arthroscopy and explore common factors amongst them, and (2) describe management strategies and outcomes of this complication.
Methods
The databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data regarding patient demographics, fluid management, presentation, management, and outcomes were collected. Study quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies Criteria.
Results
Fourteen studies (1286 patients) were included. Twenty-two occurrences of symptomatic fluid extravasation were reported in 21 patients (1.6% of total patients; one patient had fluid extravasation during two separate hip arthroscopies). Two studies of normal fluid extravasation in asymptomatic patients reported 1.13 to 3.06L of extravasated fluid observed on computed tomography. Nine case studies were included which provided detailed patient and surgical information. Of these nine patients (ten cases) with a mean age of 38.2 years old (range = 15-55 years), six were female. Signs of fluid extravasation included abdominal distension (89%), hypothermia (56%), hypotension and metabolic acidosis (33% each). Four patients required surgical intervention, while three underwent paracentesis. Two patients were managed conservatively. All patients stabilized and were discharged, with one patient reporting abdominal complaints at latest follow-up (length of follow-up unspecified).
Conclusions
Fluid extravasation is a rare but potentially life-threatening complication of hip arthroscopy. It is important for surgeons and anaesthesiologists to be aware of its existence in order to recognize and manage it promptly. Most patients require interventional management by surgery or paracentesis, but some stabilize with conservative management.