Intra-abdominal fluid after hip arthroscopy: a case report

The use of hip arthroscopy for diagnostic and therapeutic reasons has been steadily increasing over the last decade. It is considered a safe procedure, but some complications may be potentially life threatening. We present a case of intra-abdominal accumulation of irrigation fluid during hip arthroscopy in a 26-year-old patient. A literature review revealed only six other cases of fluid extravasation and its potentially dangerous consequences. The use of transparent sterile dressings during surgery might help early recognition of this unusual complication.

Arthroscopically assisted reduction of an unstable severe slipped capital femoral epiphysis: a case report

Slipped capital femoral epiphysis (SCFE) is considered to be one of the most common disorders of the hip in children and adolescents. If left untreated, it may lead to progressive deformity, pain and decreased range of motion, and predisposes to early onset degenerative arthritis. Surgical treatment is advised, with in situ pinning across the physis being the gold standard for stable slips. Closed or open reduction can be considered in unstable or severe types. We report the arthroscopically assisted reduction of an unstable severe SCFE, followed by canulated screw fixation. A follow-up of 2.5 years shows an excellent clinical and acceptable radiological outcome. Our case demonstrates that arthroscopically assisted reduction of a slipped capital femoral epiphysis is feasible. Although the technique is technically challenging and requires familiarity with arthroscopy of the hip, it has some clear benefits as compared with both closed and open reduction techniques. Arthroscopically assisted reduction may therefore be a safe and effective treatment in unstable, severe SCFE.

Hip arthroscopy: outcome and patient satisfaction after 5 to 10 years

We retrospectively evaluated outcome, complications, reoperations and global patient satisfaction 5 to 10 years after an arthroscopy of the central compartment of the hip joint in 56 consecutive patients. All patients suffered from unsolved hip pain for at least 6 months, had a positive Flexion-Adduction-Internal rotation test (FADIR-test) and a normal radiograph. The mean follow-up was 72 months (range: 60 to 120 months). Thirty-seven patients were male and 19 female, with a mean age of 34 years (range, 17 to 59 years). Forty-five were improved (6 only temporarily) and 11 had no improvement (7 underwent total hip arthroplasty). Outcome and patient satisfaction differ significantly and are primarily determined by the grade of cartilage damage. Patient satisfaction 5 to 10 years after an arthroscopy of the central compartment of the hip is high: 80% (n = 45) of the patients would undergo the same procedure again.

Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: proof of concept in an open prospective study and in a randomized controlled study

OBJECTIVE

Osteoarthritis (OA) is a degenerative, disabling joint disease that affects >10% of the adult population. No effective disease-modifying treatment is available. In the present study, we used joint distraction, a relatively new treatment in which mechanical contact between the articular surfaces is avoided while intraarticular intermittent fluid pressure is maintained, to treat patients with severe OA of the ankle.

METHODS

Patients with severe ankle OA (n = 57) who were being considered for joint fusion (arthrodesis) were treated with joint distraction in an open prospective study. In addition, a randomized trial was performed in 17 patients to determine whether joint distraction had a better outcome than debridement. A standardized evaluation protocol (physical examination, assessment of pain, mobility, and functional ability) was used, and changes in radiographic joint space width and subchondral sclerosis were measured. Thirty-eight patients in the open study have been followed up for >1 year, with up to 5 years of followup in 7 of them (mean +/- SD followup 2.8 +/- 0.3 years). Patients in the randomized study have been followed up for 1 year.

RESULTS

Significant clinical benefit was found in three-fourths of the 57 patients in the open prospective study. Most interestingly, the improvement increased over time. Radiographic evaluation showed increased joint space width and decreased subchondral sclerosis. Moreover, joint distraction showed significantly better results than debridement.

CONCLUSION

The clinical benefit of joint distraction in the treatment of severe OA is proof of the concept. Although the followup remains relatively short and effects over time remain unpredictable, our study creates possibilities for the treatment of severe OA in general. Considering the high prevalence of OA and the lack of a cure for it, joint distraction as a treatment of severe OA may have great medical, social, and economic impact.