Paper #16 - ISHA Annual Scientific Meeting 2016

Complications after Combined Hip Arthroscopy and Peri-acetabular Osteotomy

Raymond James Kenney, MD, Rochester, NY UNITED STATES
Kelly Lynne Adler, MEd, ATC, Pittsford, NY UNITED STATES
Christopher Cook, MD, Rochester, NY UNITED STATES
Brian D. Giordano, MD, Rochester, NY UNITED STATES

University of Rochester Medical Center, Rochester, NY, UNITED STATES

FDA Status Not Applicable

Summary: The purpose of this study was to further delineate the types and rate of complications in a large series of patients who have undergone combined Hip Arthroscopy and PAO at a high volume hip preservation center.

Abstract:
Background: Previous studies have reported outcomes, complications and intra-articular pathology in small series of patients who have undergone hip preservation surgery. A low rate of major complications has been reported in patients undergoing combined Hip Arthroscopy and Peri-acetabular Osteotomy (PAO). Purpose: The purpose of this study was to further delineate the types and rate of complications in a large series of patients who have undergone combined Hip Arthroscopy and PAO at a high volume hip preservation center. Methods: A retrospective review was conducted to determine the complication rate for 73 consecutive patients with 76 surgically treated hips who underwent combined Hip Arthroscopy and PAO at a single academic medical center from June 2012 through February 2016. Patients were reviewed at a minimum of 3 months following surgery. Results: Electronic medical records were reviewed for 73 consecutive patients with 76 surgically treated hips who underwent combined hip arthroscopy and PAO from June 2012 through February 2016. The average age at the time of surgery was 30 years old; range 13-55 years old. 15 patients (21%) were male and 58 patients (79%) female. There were 84 total complications documented post-operatively in 52 of 76 hips (68%). Minor complications: Dysesthesia of the lateral femoral cutaneous nerve occurred in 30 hips (39%). Hardware irritation requiring screw removal was documented for 23 hips (30%). Heterotopic ossification or symptomatic exostosis was reported in 5 hips (7%). Iliospoas tendinitis, necessitating treatment with injection or surgery was encountered for 4 hips (5%). Recurrent labral tear was noted in 2 hips (3%). Pelvic osteotomy delayed union was observed in 2 hips (3%). Peroneal neuropathy in 3 hips (4%), sciatic neuralgia in 2 hips (3%) and obturator neuropathy in 1 hip (1%) were documented. Complex regional pain syndrome (CRPS) was noted in 3 hips (4%). Major complications: Non-union of the PAO was documented in 4 hips (5%). All cases of nonunion were in patients greater than 40 years of age. Conversion to total hip arthroplasty, pulmonary embolism, intra-operative posterior column fracture, wound dehiscence and infection were each documented for 1 hip (1%). Conclusion: There were 9 (12%) major complications documented in a large series of patients after combined Hip Arthroscopy and PAO. The most common complication was lateral femoral cutaneous nerve palsy in 39% of cases, which caused no significant functional deficit. The rate of re-operation was 32%, largely due to removal of hardware and exostectomy.