Hip Arthroscopy - My Worst Day in the Operating Room in 2020: What Happened and How it Changed My Practice (2021 Annual Meeting)-Hip Arthroscopy - My Worst Day in the Operating Room in 2020: What Happened and How it Changed My Practice-Nho

Hip Arthroscopy - My Worst Day in the Operating Room in 2020: What Happened and How it Changed My Practice-Nho

Video Transcription

Video Summary

The discussion focuses on complications in hip arthroscopy, notably abdominal compartment syndrome from extra-articular fluid extravasation during iliopsoas releases, especially post-total hip replacement. Historically, iliopsoas release was common but is now less frequent due to these risks. The procedure carries risks of fluid leaking into the retroperitoneal and abdominal spaces, causing hemodynamic instability and abdominal distension, which can require emergency intervention like laparotomy. Prevention includes cautious pump pressure, avoiding the central compartment where major vessels are at risk, and close monitoring of abdominal signs intraoperatively. Surgeons emphasize teamwork with anesthesia to maintain low systolic pressure (<100 mmHg) to reduce bleeding. While iliopsoas tenotomy is rarely done now, it remains indicated for some post-THR cases. Surgeons shared experience managing fluid extravasation, including intraoperative aspiration and awareness of neurovascular anatomy. The importance of preparedness for complications even during seemingly simple procedures is stressed, especially in ambulatory surgery centers with limited resources.

Asset Caption

Dr. Shane Nho

Keywords

hip arthroscopy complications

abdominal compartment syndrome

iliopsoas release risks

fluid extravasation management

post-total hip replacement