Emergent hip arthroscopy: life-saving intervention for septic hip and secondary multiorgan failure.
This article describes the case of a 27-year-old female athletic trainer who presented to the emergency department in acute renal failure with rhabdomyolysis and disseminated intravascular coagulation following a brief onset of right hip pain and staphylococcal facial infection. Despite the absence of fever, peripheral leukocytosis, or organisms on gram stain from emergent joint aspiration, magnetic resonance imaging revealed a large hip effusion; a presumptive diagnosis of septic hip was made. Emergent hip arthroscopy was performed in the middle of the night within 3 hours of presentation. Minimally invasive, high-volume irrigation and debridement was rapidly performed using dual-portal arthroscopy. Although this approach required prolonged critical respiratory and hemodynamic support, the patient recovered from a life-threatening situation not often seen by arthroscopic or sports medicine surgeons. The unusual diagnosis of staphylococcal hip sepsis with multifocal dissemination was established, as was an atypical but important indication for emergent hip arthroscopy. Although generally implemented to improve quality of life, this case represents the use of hip arthroscopy to increase its quantity as well. Hip arthroscopy may have an emergent indication with life-saving potential.
Department of Orthopedics, Kaiser West Los Angeles Medical Center, 6041 Cadillac Ave, Los Angeles, CA 90034, USA. dean.k.matsuda@kp.org
Dean K
DK
Matsuda
Charito P
CP
Calipusan
D000328:Adult; D001170:Arthritis, Infectious / Q000150:complications / Q000628:therapy*; D001182:Arthroscopy / Q000379:methods*; D003646:Debridement / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome