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 18-guage 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: Post-distraction: Delta:

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

Average: 3.720740741 7.10037037 3.37963

Ankle Pain

Date: Side: Post-Op Ankle Pain: Pre-distraction: Post-distraction: Delta:

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

Average: 3.4115 6.777 3.3655

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 pre-operatively about the risk of ankle pain after hip arthroscopy as well as be cognizant about the possibility of ankle pathology post-operatively

References

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