Avoiding Complications in Hip Arthroscopy

Hip arthroscopy is becoming increasingly used to diagnose, classify, and treat hip pathology that has historically been unrecognized or treated exclusively with open surgical techniques. Complications, although rare in reported series, are often preventable with proper insight into their etiology and can be categorized in 2 main groups: perioperative complications and intraoperative complications. Perioperative complications include problems associated with adverse events that are not directly related to the hip arthroscopy itself, including patient positioning, heterotopic ossification, fluid management, pulmonary embolus, and deep venous thrombosis. Intraoperative complications include surgical maneuvers that may lead to immediate problems such as chondral scuffing or delayed complications such as avascular necrosis of the femoral head, femoral neck fracture, or the need for revision surgery because of incomplete treatment of the patient's hip pathology. To avoid the most common complications of hip arthroscopy, extra care should be taken in patient positioning, fluid management, portal placement, and working in close proximity to the blood supply to the femoral head. Awareness of potential pitfalls at all stages of peri- and intraoperative care of the patient allows the surgeon to prevent untoward events. Common complications of hip arthroscopy and techniques to prevent each are included here. Management strategies for each complication will be discussed where appropriate.