Arthroscopy Should be Used With Caution for Gunshot Wounds to the Hip

Abstract

Purpose: To evaluate the safety and efficacy of hip arthroscopy immediately following gunshot wound (GSW) to the hip.

Methods: Patients who received hip arthroscopy for GSWs from 2006 to 2020 by 2 surgeons at a level I trauma center were identified by Current Procedural Terminology codes. Inclusion criteria were those patients who suffered a GSW to the hip, received hip arthroscopy for treatment, and had a minimum follow-up of 2 months. The exclusion criteria were any patients younger than 18 years of age. Medical records were reviewed for patient demographics, surgical details, clinical outcomes, and complications.

Results: A total of 50 hip arthroscopy cases were identified by Current Procedural Terminology codes. Of the 50 cases identified, 8 patients met the inclusion criteria. All 8 patients were male, African-American, and the mean age was 31 years (range, 19-54 years) with mean follow-up of 14 months. Five of 8 cases were noted to have poor visualization with arthroscopy. Common reasons for poor visualization were difficult access to the bullet fragments, morbid obesity, hematoma formation, and pre-existing arthritis. Of these 5 cases, 2 were converted to open procedures to retrieve the remaining bullet fragments. One patient developed abdominal compartment syndrome, most likely due to increased pulse pressure over a prolonged operative period and involvement of the acetabular fovea. Emergent exploratory laparotomy and abdominal compartment fluid release were performed, and the patient had an otherwise unremarkable hospital course.

Conclusions: There are risks with the use of arthroscopic methods to remove GSW fragments, which may be greater than elective hip arthroscopy. Certain factors, such as the surgeon's arthroscopic experience, locations of bullets fragments, visual quality, length of procedure, and concomitant acetabular fractures, must be considered before proceeding with arthroscopy.

Level of evidence: Therapeutic case series.

Fig 1

Patient 7 immediately after drapes were removed, showing significant abdominal distention from fluid extravasation. General surgery was immediately consulted.

Fig 2

Patient 8: Arthroscopic images taken intraoperatively as well as the bone fragment that was extracted. (A) Primary bullet fragment embedded in the articular surface of the. acetabulum. (B) Bone defect after bullet fragment was removed. (C) Major bullet fragment removed from the joint space.

Fig 3

Pelvic radiograph imaging of Patient 8. (A) Preoperative imaging of patient’s pelvis with bullet fragment dimensions shown. (B) Postoperative imaging of the hip joint showing. complete removal of the bullet fragment.