2015 ISAKOS Biennial Congress ePoster #820
Complications After Combined Hip Arthroscopy and Peri-Acetabular Osteotomy
Raymond J. Kenney, MD, Rochester, NY UNITED STATES
Christopher Cook, MD, Rochester, NY UNITED STATES
Kelly McMullen, MEd, ATC, Rochester, NY UNITED STATES
Brian Giordano, MD, Rochester, NY UNITED STATES
University of Rochester, Rochester, NY, USA
FDA Status Not Applicable
Summary: The purpose of this study was to delineate the complications in patients who have undergone combined hip arthroscopy and PAO at a high volume hip preservation center.
Uncorrected symptomatic acetabular dysplasia may increase the risk of functional impairment and degenerative joint disease. Previous studies have linked acetabular dysplasia to premature osteoarthritis and the increased likelihood of requiring arthroplasty. In the presence of acetabular dysplasia, there is insufficient containment of the femoral head, leading to focal articular overload. An increased sheer vector places strain on the acetabular rim and may encourage hypertrophic development of the labrum, as a compensatory mechanism to improve congruity of the femoral head within the acetabulum. The resulting hypertrophic labrum commonly fails, and may contribute to hip pain and pelvic dysfunction.
Isolated arthroscopic hip preservation surgery in the setting of uncorrected acetabular dysplasia may perpetuate structural instability and accelerate the progression of osteoarthritis, leading to a compromised long-term outcome. Moreover, solitary acetabular reorientation, such as peri-acetabular osteotomy (PAO), without concomitant treatment of intra-articular labral-chondral damage, may not fully optimize the outcome of surgery. Labral pathology has been reported in up to 86% of patients undoing PAO, further reinforcing the coexistence of structural malalignment and intra-articular joint damage. A combined arthroscopic and open surgical approach addresses both structural malalignment as well as intra-articular hip disease.
Complications have been reported for both arthroscopic and open hip preservation surgery, but to date, there have not been any publications that have explored complications for combined hip preservation surgery. The purpose of this study was to delineate the complications in patients who have undergone combined hip arthroscopy and PAO at a high volume hip preservation center.
A retrospective review was conducted to determine the complication rate for 29 consecutive patients with 33 surgically treated hips who underwent combined hip arthroscopy and PAO from June 2012 through October 2013. Patients were reviewed at a minimum of 6 months following surgery.
29 consecutive patients were reviewed with an average age of 30 years at the time of surgery (range 13-55). There were 44 total complications documented post-operatively in 21 of 33 hips (64%). Dysesthesia of the lateral femoral cutaneous nerve was present in 15 hips (46%). Hardware irritation requiring removal was documented for 6 hips (18%). Heterotopic ossification or symptomatic exostosis was reported in 6 hips (18%); 3 required exostectomy performed in conjunction with removal of hardware, and 1 required arthroscopic capsular debridement. Iliospoas tendinitis, necessitating treatment with injection or surgery was encountered for 5 hips (15%), and one required arthroscopic iliopsoas lengthening. Non-union of the PAO was documented in 4 hips (12%). All cases of nonunion were in patients greater than 40 years of age. Pulmonary embolism, intra-operative posterior column fracture, recurrent labral tear, complex regional pain syndrome, wound dehiscence, sciatic neuralgia, peroneal neuropathy and obturator neuropathy were each documented for 1 hip (3%).
The number of major complications after combined hip arthroscopy and PAO was low. The most common complication was lateral femoral cutaneous nerve palsy in 46% of cases, which caused no significant functional deficit. The rate of re-operation was 24%, largely due to removal of hardware and exostectomy.