Ankle Pain Following Hip Arthroscopy Schiffman ED, McCarthy JC, Lee JA, Kwon JY

Introduction  



In 1988 hip arthroscopy accounted for 0.2% of all arthroscopy1 Since then the indications for hip arthroscopy have grown and the number of arthroscopies performed have grown tremendously The American Academy of Orthopaedic Surgeons projects that by 2013 the number of hip arthroscopies performed will double from its current levels2

Introduction 

Along with the increasing indications and increasing numbers, comes an increasing awareness of real and potential complications. – The overall complication rate reported has ranged between 1.34% and 21%3-8 – The most frequent complication reported is transient neuropraxia9-16 – Other reported complications include: direct injury to the lateral femoral cutaneous nerve, pressure necrosis of the foot, scrotum, and perineum, labial/scrotal hematoma, heterotopic ossification, abdominal pain/fluid extravasation, scuffing, AVN, instrument failure, and infection

Introduction 

Of all the reported complications in the literature there has been no mention of ankle injury/pain following hip arthroscopy – In our experience, ankle pain following hip arthroscopy is not uncommon



The focus of this study is to determine the incidence of ankle pain following hip arthroscopy and see if there is a correlate between post-op ankle pain and the amount of distraction through the ankle joint determined radiographically, as well if there are any pre-operative predictors of ankle pain

Materials and Methods  

IRB approval was obtained and all participants signed consent forms to participate in the study. Between January 2012 and March 2012, 41 hip arthroscopies were performed by the senior author (JCM) – The surgery was performed with the patient in the lateral decubitus position – A well-padded peroneal post and a carefully padded boot with the heel firmly seated and secured was used – A specialized distractor was used to obtain initial distraction, followed by joint distention by infiltrating normal saline into the joint with an 18guage needle – Axial traction was adjusted such that the foot was maintained in neutral position to avoid undue stress to the ligamentous structures around the ankle – General anesthesia was used in all cases



Flouroscopy was used to determine the distraction of the femoral head from the acetabulum of the hip joint. A fluoroscopic image at the ankle was taken pre and post distraction, in order to determine the amount of distraction occurring at the ankle joint

Lateral Position in Distractor

Distracted Hip

No Ankle Pain Date:

Side:

Post-Op Ankle Pain:

Pre-distraction:

1/20/2012

Right

No

2.71

4.07

1.36

1/27/2012

Right

No

3.71

5.97

2.26

1/27/2012

Right

No

5.46

7.89

2.43

1/27/2012

Right

No

5.1

8.32

3.22

1/27/2012

Right

No

3.35

6.95

3.6

2/3/2012

Right

No

4.94

8.91

3.97

2/3/2012

Right

No

4.57

7.38

2.81

2/3/2012

Left

No

3.18

6.97

3.79

2/3/2012

Left

No

4.5

9.48

4.98

2/14/2012

Right

No

4.27

9.6

5.33

2/17/2012

Left

No

3.37

7.53

4.16

2/24/2012

Right

No

3.04

5.25

2.21

2/24/2012

Right

No

2.34

7.2

4.86

2/24/2012

Left

No

2.69

4.1

1.41

3/2/2012

Right

No

2.69

6.86

4.17

3/2/2012

Right

No

4.16

8.13

3.97

3/2/2012

Right

No

3

6.5

3.5

3/2/2012

Right

No

3.98

6.81

2.83

3/9/2012

Right

No

2.25

6.4

4.15

3/9/2012

Right

No

2.96

6.05

3.09

3/9/2012

Left

No

4.86

8.51

3.65

3/9/2012

Left

No

5.33

10.08

4.75

3/12/2012

Left

No

3.21

6.79

3.58

3/26/2012

Right

No

1.83

5.94

4.11

3/30/2012

Left

No

4.65

7.62

2.97

3/30/2012

Right

No

4.43

6.6

2.17

3/30/2012

Right

No

3.88

5.8

1.92

3.720740741

7.10037037

3.37963

Average:

Post-distraction:

Delta:

Ankle Pain Date:

Side:

Post-Op Ankle Pain:

1/20/2012

Right

Yes

3.23

4.72

1.49

1/20/2012

Right

Yes

2.66

5.38

2.72

1/20/2012

Left

Yes

4.94

8.65

3.71

1/27/2012

Left

Yes

4.08

8.21

4.13

2/17/2012

Right

Yes

2.93

7

4.07

2/17/2012

Right

Dec sensation

3.07

7.22

4.15

2/24/2012

Right

Yes

3.51

6.78

3.27

2/24/2012

Right

Yes

3.27

5.4

2.13

3/2/2012

Left

Dec sensation

3.05

7.3

4.25

3/30/2012

Left

Yes

3.375

7.11

3.735

3.4115

6.777

3.3655

Average:

Pre-distraction:

Post-distraction:

Delta:

Radiograph of ankle during and after distraction

Discussion 



The patients with ankle pain had a similar amount of intraoperative distraction as patients who were asymptomatic We believe there is an “at risk” group.

– These patients have the following risk factors:    

History of ankle sprains Ligamentous laxity (more common in women) Small feet with large calves (more likely to become plantar flexed during traction) Distraction performed with the ankle rotated is also likely to place added stress on either the medial or lateral ligamentous structures

Conclusion 

It is important to counsel patients preoperatively about the risk of ankle pain after hip arthroscopy as well as be cognizant about the possibility of ankle pathology post-operatively

References 1.

Small, NC. Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 1988; 4:215221.

2.

Matsuda DK. Hip arthroscopy: Update, advances, and future applications. AAOS Now 2011; Vol 5: Number 8. Clarke MT, Arora A, Villar RN. Hip arthroscopy: Complications in 1054 cases. Clin Orthop Relat Res 2003; 406:84-88. Sampson TG. Complications of hip arthroscopy. Clin Sports Med 2001; 20: 831-835. Sampson TG. Complications of hip arthroscopy. Tech in Orthop 2005; 20:63-66. Griffin DR, Villar RN. Complications of arthroscopy of the hip. J Bone Joint Surg Br 1999; 81B: 604-606. Byrd JT. Complications associated with hip arthroscopy. In: Byrd JT, ed. Operative Hip Arthroscopy. New York: Thieme; 1998: 171176. Glick JM, Sampson TG, Gordon RB, Behr JT, Schmidt E. Hip arthroscopy by the lateral approach. Arthroscopy 1987; 3: 4-12.

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