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Hip Arthroscopy: Prevalence of Intra-articular Pathologic Findings After Traumatic Injury of the Hip

      Purpose

      The purpose of this study was to document and compare the incidence of intra-articular hip pathologic findings identified using arthroscopy versus conventional imaging in patients with acute trauma to the hip.

      Methods

      This was a blinded prospective case series study designed to review the incidence of intra-articular pathologic disorders in patients with post-traumatic injury between the ages of 18 and 65 years who were referred to a single surgeon. Injuries included hip dislocation, proximal femur fracture, pelvic ring fracture, acetabular fracture, penetrating injury (gunshot wound), and soft tissue injury. Preoperative radiographs, computed tomographic (CT) scans, or magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) scans (or a combination of these) were obtained. Findings were documented and compared with intraoperative findings.

      Results

      A total of 29 post-traumatic hips were enrolled in this study. Hip arthroscopy identified 17 of 29 hips (59%) as having loose bodies, 11 of 29 (38%) hips as having an intra-articular step deformity, 14 of 29 (49%) hips as having an osteochondral lesion, and 27 of 29 (93%) hips as having a labral tear. Plain radiographs and CT scans yielded low sensitivity when compared with arthroscopy for the identification of loose bodies and step deformities. MRI/MRA comparison with arthroscopic findings suggest that MRI/MRA is an accurate tool for identification of labral tears, because 91% of tears seen on arthroscopy were also identified by MRI/MRA. In 4 hips, however, MRI/MRA failed to identify osteochondral lesions that were subsequently identified by arthroscopy.

      Conclusions

      Traumatic injuries of the hip result in substantial intra-articular pathologic findings, including loose bodies, labral tears, step deformities, and osteochondral lesions. The arthroscope is a powerful tool in identifying these injuries. Plain radiographs and CT scans appear to underestimate the true incidence of loose bodies and step deformities within the joint when compared with hip arthroscopy after a traumatic injury of the hip.

      Level of Evidence

      Level IV, diagnostic case series.
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      References

        • Keene G.S.
        • Villar R.N.
        Arthroscopic loose body retrieval following traumatic hip dislocation.
        Injury. 1994; 25: 507-510
        • Svoboda S.J.
        • Williams D.M.
        • Murphy K.P.
        Hip arthroscopy for osteochondral loose body removal after a posterior hip dislocation.
        Arthroscopy. 2003; 19: 777-781
        • Yamamoto Y.
        • Ide T.
        • Ono T.
        • Hamada Y.
        Usefulness of arthroscopic surgery in hip trauma cases.
        Arthroscopy. 2003; 19: 269-273
        • Mullis B.H.
        • Dahners L.E.
        Hip arthroscopy to remove loose bodies after traumatic dislocation.
        J Orthop Trauma. 2006; 20: 22-26
        • Owens B.D.
        • Busconi B.D.
        Arthroscopy for hip dislocation and fracture-dislocation.
        Am J Orthop. 2006; 35: 584-587
        • Bagaria V.
        • Sapre V.
        Arthroscopic removal of intraarticular fragments following fracture-dislocation of the hip.
        Indian J Orthop. 2008; 42: 225-227
        • Moed B.R.
        • Yu P.H.
        • Gruson K.I.
        Functional outcomes of acetabular fractures.
        J Bone Joint Surg Am. 2003; 85: 1879-1883
        • Epstein H.C.
        Traumatic dislocation of the hip.
        Williams & Wilkins, Baltimore, MD1980
        • Mitsionis G.I.
        • Lykissas M.G.
        • Motsis E.
        • et al.
        Surgical management of posterior hip dislocations associated with posterior wall acetabular fracture: A study with a minimum follow-up of 15 years.
        J Orthop Trauma. 2012; 26: 460-465
        • Thompson V.
        • Epstein H.C.
        Traumatic dislocation of the hip.
        J Bone Joint Surg Am. 1951; 33: 746
        • Jaskulka R.A.
        • Fischer G.
        • Fenzl G.
        Dislocation and fracture-dislocation of the hip.
        J Bone Joint Surg Br. 1991; 73: 465-469
        • Epstein H.C.
        • Wiss D.A.
        • Cozen L.
        Posterior fracture dislocation of the hip with fractures of the femoral head.
        Clin Orthop Relat Res. 1985; 201: 9-17
        • Byrd J.W.
        Labral lesions: An elusive source of hip pain: Case reports and literature review.
        Arthroscopy. 1996; 12: 603-612
        • Armstrong J.R.
        Traumatic dislocation of the hip joint: Review of 101 dislocations.
        J Bone Joint Surg Br. 1948; 30: 430-435
        • Stewart M.J.
        • McCarroll Jr., H.R.
        • Mulhollan J.S.
        Fracture-dislocation of the hip.
        Acta Orthop Scand. 1975; 46: 507-525
        • Brav C.E.
        Traumatic dislocation of the hip.
        J Bone Joint Surg Am. 1962; 44: 1115-1134
        • Upadhyay S.S.
        • Moulton A.
        • Srikrishnamurthy K.
        An analysis of the late effects of traumatic posterior dislocation of the hip without fracture.
        J Bone Joint Surg Br. 1983; 65: 150-152
        • Upadhyay S.S.
        • Moulton A.
        The long-term results of traumatic posterior dislocation of the hip.
        J Bone Joint Surg Br. 1981; 63: 548-551
        • Bozic K.J.
        • Chan V.
        • Valone III, F.H.
        • Feeley B.T.
        • Vail T.P.
        Trends in hip arthroscopy utilization in the United States.
        J Arthroplasty. 2013; 28: 140-143
        • Lansford T.
        • Munns S.W.
        Arthroscopic treatment of Pipkin type I femoral head fractures: A report of 2 cases.
        J Orthop Trauma. 2012; 26: e94-e96
        • Matsuda D.K.
        The clamshell fracture and adjunctive acetabuloplasty in the arthroscopic osteosynthesis of femoral head fractures with femoroacetabular impingement.
        Arthrosc Tech. 2012; 1: e5-e10
        • Yang J.H.
        • Chouhan D.K.
        • Oh K.J.
        Percutaneous screw fixation of acetabular fractures: Applicability of hip arthroscopy.
        Arthroscopy. 2010; 26: 1556-1561
        • Philippon M.J.
        • Kuppersmith D.A.
        • Wolff A.B.
        • Briggs K.K.
        Arthroscopic findings following traumatic hip dislocation in 14 professional athletes.
        Arthroscopy. 2009; 25: 169-174
        • Ilizaliturri V.M.
        • Gonzalez-Gutierrez B.
        • Gonzalez-Ugalde H.
        • Camacho-Galindo J.
        Hip arthroscopy after traumatic hip dislocation.
        Am J Sports Med. 2011; 39: 50S-57S
        • Baird R.A.
        • Schobert W.E.
        • Pais M.J.
        • et al.
        Radiographic identification of loose bodies in the traumatized hip joint.
        Radiology. 1982; 145: 661-665