Methods: All hip arthroscopies were performed by two surgeons from 2006-2020 at a level 1 trauma center with a 30% penetrating trauma rate. A total of 60 hip arthroscopy cases were identified by Current Procedural Terminology (CPT) codes. Of the 60 cases identified, eleven patients met the inclusion criteria. The eleven cases identified consisted of patients who suffered a gunshot wound (GSW) to the hip and had arthroscopy performed with a minimum follow up of two months. The main outcome measurements were successful bullet removal, blood loss, surgical time, operative complications, and short-term outcomes.
All 11 patients were male with a mean age of 31 years (range, 19 to 54 years) with a mean follow-up of 14 months. All 11 patients had their procedures performed between 2006 to 2020. Two patients were lost to follow-up. The most common complications such as traction injuries, peripheral nerve injuries (i.e. peroneal, sciatic, femoral nerve injuries, lateral femoral cutaneous nerve transection) and pressure wounds to the sacrum, were not seen in these patients. However, 5 of 11 cases were noted to have poor visualization with arthroscopy. Common reasons for poor visualization were difficult access to the bullet fragments, morbid obesity, hematoma formation and pre-existing arthritis. Of these five cases, two were converted to open procedures to retrieve the remaining bullet fragments. Three patients developed postoperative hip pain, with two of these patients developing radiographic and clinical signs of post-traumatic arthritis. One patient developed intraabdominal fluid extravasation, most likely due to utilization of a pressure inflow system over a prolonged operative period due to involvement of the acetabular fovea. Emergent exploratory laparotomy and abdominal compartment fluid release were performed, and the patient had an otherwise unremarkable hospital course. One patient developed a delayed diagnosis of septic arthritis, necessitating operative hip arthroscopy two weeks after sustaining a gunshot wound. Of note, 9 of 11 cases were able to remove a majority if not all of the bullet fragments in the joint space. 9 of the 11 cases were able to successfully remove all foreign debris, which was confirmed through intra- and/or post-operative plain films. The average surgical time was 110 minutes and blood loss was 87mL (range 5-600 mL).
Certain factors, such as bullet location, visual quality, estimated procedural time, arthroscopic experience, and pre-existing hip arthritis must be considered before arthroscopy is performed in patients with GSW to the hip. Hip arthroscopy following GSW to the hip appears to have benefit for less invasive methods to remove bullet fragments and perform joint irrigation to treat additional contamination. There are also accompanied risks with the use of arthroscopic methods to remove GSW fragments, which should be considered when limited invasive treatments are indicated.