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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Article info
Publication history
Accepted:
March 23,
2019
Received:
November 5,
2018
Footnotes
The authors report the following potential conflicts of interest or sources of funding: S.K.A. reports personal fees as a paid education consultant for Stryker Medical. T.G.M. reports personal fees as a paid speaker for Athrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 2832
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Neuropathy After Fascia Iliaca Blocks for Hip Arthroscopy: Should We Just Blame Anesthesia?ArthroscopyVol. 35Issue 10
- PreviewHip 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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