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Traction Time, Force and Postoperative Nerve Block Significantly Influence the Development and Duration of Neuropathy Following Hip Arthroscopy

      Purpose

      To (1) evaluate the individual and combined effects of traction time and traction force on postoperative neuropathy following hip arthroscopy, (2) determine if perioperative fascia iliaca block has an effect on the risk of this neuropathy, and (3) identify if the these items had a significant association with the presence, location, and/or duration of postoperative numbness.

      Methods

      Between February 2015 and December 2016, a consecutive cohort of hip arthroscopy patients was prospectively enrolled. Traction time, force, and postoperative nerve block administration were recorded. The location and duration of numbness were assessed at postoperative clinic visits. Numbness location was classified into regions: 1, groin; 2, lateral thigh; 3, medial thigh; 4, dorsal foot; and 5,preoperative thigh or radiculopathic numbness.

      Results

      A total of 156 primary hip arthroscopy patients were analyzed, 99 (63%) women and 57 (37%) men. Mean traction time was 46.5 ± 20.3 minutes. Seventy-four patients (47%) reported numbness with an average duration of 157.5 ± 116.2 days. Postoperative fascia iliaca nerve block was a significant predictor of medial thigh numbness (odds ratio, 3.36; 95% confidence interval, 1.46-7.76; P = .04). Neither traction time nor force were associated with generalized numbness (P = .85 and P = .40, respectively). However, among those who experienced numbness, traction time and force were greater in patients with combined groin and lateral thigh numbness compared with those with isolated lateral thigh or medial thigh numbness (P = .001 and P = .005, respectively).

      Conclusions

      Postoperative neuropathy is a well-documented complication following hip arthroscopy. Concomitant pudendal and lateral femoral cutaneous nerve palsy may be related to increased traction force and time, even in the setting of low intraoperative traction time (<1 hour). Isolated medial thigh numbness is significantly associated with postoperative fascia iliaca blockade.

      Level of Evidence

      IV, case series.
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      Linked Article

      • Editorial Commentary: Neuropathy After Fascia Iliaca Blocks for Hip Arthroscopy: Should We Just Blame Anesthesia?
        ArthroscopyVol. 35Issue 10
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          Hip arthroscopy has been the subject of recent controversy in the literature with regard to outcomes and complications. The current investigation demonstrates a significant increase in the risk of postoperative medial thigh neuropathy with fascia iliaca block. Although the association between lateral thigh and groin numbness with traction and anterior portal instrumentation cannot be ruled out, this investigation begs the question: Should we just blame anesthesia? Probably not, as regional blocks, portal placement, and traction are all likely to play some role.
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