Hip arthroscopy is technically demanding. Complication rates range between 1.3% and 4.2%, but vary with surgeon experience patient factors, and procedural complexity. Minor complications include temporary neuropraxia, chondrolabral injury, adhesions, hypothermia, and perineal skin damage. Major complications include fluid extravasation, avascular necrosis, femoral neck stress fractures, deep infection, venous thromboembolism, iatrogenic hip instability, and residual impingement. Prevention strategies include meticulous surgical technique, traction control, accurate positioning and portal placement, soft-tissue preservation, and both pharmacologic and mechanical prophylaxis. Early detection through continuous intra-operative monitoring, structured post-operative surveillance, and patient education enables timely intervention.
Combined hip arthroscopy and periacetabular osteotomy (PAO) is associated with improved outcomes in patient who have symptomatic hip dysplasia with concomitant intra-articular or extra-articular hip pathology. Modifications to the arthroscopic procedure include illiocapsularis dissection from the underlying capsule after capsular closure to aid in and begin the dissection for the PAO. The outcomes of combined PAO and hip arthroscopy have been published in several recent studies, demonstrating favorable patient reported outcomes of the combined procedures. When used in combination, these procedures have been shown to be safe and effective in addressing symptomatic dysplasia.
Ischiofemoral impingement is an under-recognized source of buttock and groin pain resulting from abnormal contact between the proximal femur and the ischium. Entrapment of the quadratus femoris muscle results in pain, mechanical symptoms and in some cases irritation of the sciatic nerve. Characteristic MRI findings include narrowing of the ischiofemoral space and quadratus femoris edema or atrophy. The diagnosis is confirmed with guided injections. Recalcitrant symptoms are treated with surgical decompression of the ischiofemoral space either directly, via open or endoscopic approaches, or indirectly through femoral osteotomy or in rare cases hip arthroplasty.
