Arthroscopic bullet removal from the acetabulum

Abstract

Hip arthroscopy has been shown to offer minimally invasive access to the hip joint compared with standard open arthrotomy. The use of arthroscopy for diagnosing and treating disorders about the hip continues to evolve. The authors describe an arthroscopically assisted technique for the removal of a bullet lodged in the acetabulum of a patient who sustained a gunshot wound that entered the abdomen and traversed the rectum before ending up in the weight-bearing dome of the acetabulum. A number of issues led to the decision to use both arthroscopy and this specific technique. Most importantly was our desire to limit the amount of surrounding articular cartilage and local bone damage on removal. Minimizing the soft tissue dissection needed to access the bullet and keeping down our operative time also played a role in deciding to use this technique. We considered the risks of potential bullet fragmentation and migration, as well as a possible abdominal compartment syndrome before proceeding. This surgical technique afforded a very satisfactory outcome for this patient and serves as a model for others when encountering a similar injury pattern in a trauma patient. It is a procedure that can be performed safely, quickly, and with minimal complications for surgeons who have experience with arthroscopy of the hip joint.