Clin Orthop Surg.  2015 Dec;7(4):443-448. 10.4055/cios.2015.7.4.443.

Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation

• Hwang JT
• Lee WY
• Kang C
• Hwang DS
• Kim DY
• Zheng L

• KMID: 2360257
• DOI: http://doi.org/10.4055/cios.2015.7.4.443

Abstract

BACKGROUND
Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma.
METHODS
From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up.
RESULTS
There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up.
CONCLUSIONS
Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

Keyword

Hip; Wounds and injuries; Osteoarthritis; Arthroscopy

MeSH Terms

Adult
Arthroscopy/*methods
Female
Hip/*physiopathology/radiography/*surgery
Hip Dislocation/*surgery
Hip Fractures/*surgery
Humans
Male
Middle Aged
Osteoarthritis
Pain/physiopathology/*surgery
Pain Measurement
Range of Motion, Articular
Retrospective Studies
Young Adult

Figure

• 

  Fig. 1 A 50-year-old male who had traumatic hip dislocation underwent arthroscopic treatment. (A) Arthroscopic view shows posterior labral tear. (B) Arthroscopic view shows arthroscopic partial labrectomy. (C) Arthroscopic view shows intra-articular loose body on acetabular articular surface. (D) Arthroscopic view shows removal of loose body and microfracture.

• 

  Fig. 2 Pre- and postoperative three-dimensional computed tomography (3D CT) images. (A) Preoperative 3D CT image shows loose body on femoral head and neck (arrow). (B) Postoperative 3D CT image shows removal of loose body and femoroplasty (arrowhead).

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