Nothing in life is ever as straightforward as one might wish. Fortunately, complications associated with hip arthroscopy are few, affecting only approximately 1.5% of patients. That said, you should read this section very carefully before surgery. Over the years the Practice has undertaken two large research projects in this field. Complications fall into two broad categories, those related to surgery in general and those related to hip arthroscopic surgery in particular.

General complications (can occur with any operation)
These are many and varied and would include such problems as:

• Anaesthetic complications (e.g. postoperative chest infection)
• Urinary complications (e.g. inability to pass urine after surgery)
• Gastrointestinal complications (e.g. inability to open bowels)
• Vascular complications (e.g. blood clots in leg veins, stroke)
• Cardiac complications (e.g. heart attack)
• Death (very rare but it can happen)

This list is by no means exhaustive, so if you have any queries, please ask your surgeon before hip arthroscopy is undertaken.

Complications specific to hip arthroscopy
These are perhaps best considered under the following headings:

• Neurological
• Vascular
• Infective
• Inflammatory
• Cutaneous
• Symptomatic
• Articular
• Technical
  

Neurological
Damage to nerves falls into two broad categories. Most injuries are due to a neurapraxia. This is a temporary malfunction of a nerve and recovery is usually complete over time. The bulk of nerve problems related to hip arthroscopic surgery fall into this category. However, there is also neuronotmesis where the damage can be permanent and recovery never occurs. Fortunately this is very uncommon. The following nerves can be damaged:

• Femoral (leading to paralysis of the upper leg)
• Sciatic (leading to paralysis of the lower leg)
• Lateral cutaneous nerve of thigh (leading to loss of feeling on the outer part of the thigh)
• Pudendal (leading to impotence)
• Obturator (leading to loss of feeling on the lower, inner aspect of the thigh and weak hip movements)
  

Vascular
Vascular complications are uncommon. They can be classified as follows:

• Bleeding during surgery. This is surprisingly uncommon, although can occur. The surgeon may choose to reduce bleeding by using adrenaline (epinephrine) in the arthroscopic irrigation fluid throughout the procedure. It is also possible to control the pressure of the irrigation fluid during surgery, which can again reduce the chances of bleeding during the procedure. There are also some major blood vessels (femoral, profunda femoris, internal pudendal and obturator arteries) near the hip joint, which can theoretically be damaged by surgery. Fortunately this is an unusual event but very rarely may require the arthroscopic procedure to be converted to an open one in order to control bleeding.
• Bleeding after surgery. Although the skin wounds are normally small, bleeding can still occur from them. This should not be confused with the post-operative fluid ooze, which is so common for a few hours after hip arthroscopic surgery and is the result of residual arthroscopic irrigation fluid making its way to the surface after the procedure.
• Deep-vein thrombosis after surgery. This was once thought to be the domain of joint replacement surgery only. However, it is now evident that deep-vein thrombosis (DVT) can also develop after hip arthroscopic surgery, albeit rarely. On occasion a pulmonary embolism can occur, where a blood clot can break away from the calf veins and become lodged in the lung. This is a life-threatening event. For this reason, and only on occasion, your surgeon may wish to place you on anti-DVT medication over the surgery period.

Infective
Fortunately this is rare, occurring after less than 1 in 1000 procedures. However, if it does happen it can be a major problem for the hip joint, particularly the articular cartilage (gristle), which is highly sensitive to infection and can be rapidly destroyed by it. The Practice would normally cover all hip arthroscopic surgery with a single dose of intravenous antibiotic given during the procedure. Occasionally it is necessary to prolong antibiotic use. However, not all surgeons see the need for antibiotic use during hip arthroscopic surgery.

Inflammatory
An occasional complication in this category is trochanteric bursitis. In a small percentage of patients pain and swelling can occur over the bony outer (lateral) aspect of the hip, known as the greater trochanter. This may be because of deeper bleeding, or may be a genuine soft-tissue inflammation. Whatever the cause, a conservative approach is normally successful, although occasionally an injection into the painful area is needed.

Cutaneous (skin)
Complications affecting the skin can include the following:

• Keloid scar formation (thickened scar formation –more common in black individuals)
• Perineal splitting (small tears in the area of the vagina)
• Pressure sores (usually created by the traction bollard which goes between the legs during surgery and may occasionally cause blistering of the upper, inner thigh).
• Damage to the genitalia (sometimes the male or female genitalia can become trapped between the thigh and the traction bollard and can be damaged in this way)
• Delayed healing (occasionally it can take several weeks for the skin wounds to heal, although normally all is complete within a week to ten days)
• Extravasation. This is when the arthroscopic irrigation fluid used during the operation escapes into the soft tissues beneath the skin. On occasion it can travel a very long way, sometimes down to the knee and sometimes into the abdominal cavity. In this latter situation a patient may complain of back pain after surgery, although this usually settles within a few hours.

Symptomatic
Despite the best efforts of the surgical team up to 5% of patients can be made worse by hip arthroscopic surgery. If the procedure is undertaken for osteoarthritis, this figure can rise to 15%.

Articular
Scuffing of the articular surfaces, particularly the femoral head, can occur although the use of a guide wire can minimise this. Whether there are any long-term consequences to the patient is not known, but the surgical team clearly tries to keep articular damage to a minimum.

Very rarely, the patient’s hip joint can dislocate after surgery. This is clearly a major problem if it occurs and the surgical team would normally take immediate action to rectify this

Technical
It may not be possible to gain access to the hip at all! The patient should be so warned and the surgeon should be prepared to abandon the procedure if too much difficulty is encountered. Also, if hip arthroscopy is being performed in order to retrieve loose bodies (loose bone particles) it is occasionally impossible for the surgical team to remove each and every loose body during the procedure.