» Hip Arthroscopy in Children: What Can Go Wrong?
Hip Arthroscopy in Children: What Can Go Wrong?

Most adults think about having a hip arthroscopy exam for hip pain from age-related degenerative osteoarthritis. Many are thinking they might need a hip replacement. But, in fact, inserting a surgical scope into the hip of a child or adolescent can be a very useful diagnostic tool.

Children can have many different hip disorders that would be better treated if the surgeon could look inside the hip and see exactly what's going on. That's what arthroscopy offers over a simple X-ray or even the more detailed CT scan or MRI.

Hip problems in patients 18 and under range from juvenile rheumatoid arthritis and fractures to labral (cartilage) tears and tendinitis. Treatment of specific hip diseases such as Legg-Perthes and slipped capital femoral epiphysis (SCFE) is also aided by arthroscopic exam.

For parents facing this type of surgery for their child or teen, the natural question is always, "What could go wrong?" This study was done to find out the rate and type of complications from hip arthroscopy in this age group.

They pulled the records of 175 patients who had this procedure done at the Children's Hospital in Boston. A total of 218 arthroscopic procedures performed by one surgeon were reviewed. Taking a look back like this after the events is called a retrospective study.

The rate of complications was low (1.8 per cent). That's about what rate of complications occur in adults (reported between 1.4 and 1.6 per cent). The difference is that in children there is the potential for disturbing the growth plate, altering bone growth, damaging developing cartilage, and causing osteonecrosis (bone death).

Fortunately, none of those problems occurred in this group. Temporary nerve palsy was the most common complication (affected two patients). Single cases of abscess around the stitches and a broken scope were the only other mishaps. Everyone was followed for a full year and no further problems related to the arthroscopic procedure were reported.

Hip arthroscopy is not a simple in and out procedure. Special training is required to learn how to perform this challenging procedure safely. Care must be taken when performing hip arthroscopy in children with abnormal hip anatomy. Fluoroscopy (real-time X-rays) and surgical tools designed for this procedure aid the surgeon.

The authors conclude that hip arthroscopy in children and adolescents 18 years old and younger is a valuable diagnostic tool. It is safe and effective in the hands of a skilled and highly trained orthopedic surgeon.

More and more children are participating in sports and activities that affect the hip such as gymnastics, ballet, track and field, and horseback riding. It is expected that the need for arthroscopic exam to diagnose and treat a variety of hip disorders will continue to expand its use in the future.

Studies like this help identify what to expect and allow surgeons to counsel patients and parents about what complications could (but most likely won't) occur.

Reference: Benedict U. Nwachukwu, BA, et al. Complications of Hip Arthroscopy in Children and Adolescents. In Journal of Pediatric Orthopaedics. April/May 2011. Vol. 31. No. 2. Pp. 227-231.