Letter to the Editor: Unilateral postoperative visual loss in a patient undergoing hip arthroscopy in the supine position

Article information

Korean J Anesthesiol. 2016;69(6):644-644

Publication date (electronic) : 2016 August 18

doi : https://doi.org/10.4097/kjae.2016.69.6.644

Halis Atil Atilla¹, Sivashanmugam Raju²

¹Division of Hip Preservation Surgery, Department of Orthopedics, Wake Forest University Baptist Medical Center, Winston Salem, NC, USA.

²Division of Sports Medicine, Department of Orthopedics, Wake Forest University Baptist Medical Center, Winston Salem, NC, USA.

Corresponding author: Sivashanmugam Raju, MBBS, MS in Orthopedics. Department of Orthopedics, Wake Forest University Baptist Medical Center, 1, Medical Center Blvd., Winston Salem, NC 27157, USA. Tel: 1-7168613869, Fax: 1-3367166286, drsivashanmugam.raju@gmail.com

Received 2016 June 22; Accepted 2016 June 27.

We read with great interest your article titled ‘Unilateral postoperative visual loss in a patient undergoing hip arthroscopy in the supine position: a case report [1].’ Thank you for reporting this complication, which is the first of its kind in hip arthroscopy. We have the following observations.

Paradoxical air embolism is certainly a possibility and has been reported after shoulder arthroscopic procedures in the sitting posture, but we feel that septic embolism could also be considered in differential diagnosis since this patient's preoperative diagnosis was hematogenous osteomyelitis with possible septicemia.

Osteomyelitis and septic arthritis are independent risk factors for septic embolism [2], and there have been cases reported after osteomyelitis [3]. Recurrent septic retinal emboli have also been reported following drainage of a dental abscess [4]. Transient bacteremia and paradoxical septic emboli were implicated as the probable cause of central retinal artery occlusion. Additionally, subclinical endocarditis cannot be ruled out, especially in the setting of septic hip arthritis, which could be a potential source of direct septic embolism.

We think that, besides air embolism, septic embolism should be considered in the differential diagnosis in a patient undergoing hip arthroscopy for a septic condition.