Removal of retained bullets from the hip joint in civilian gunshot injuries.

Abstract

Purpose Removal of bullets retained within joints is indicated to prevent mechanical blockade, 3^rd body wear and resultant arthritis, plus lead arthropathy and rarely, systemic lead poisoning. We aimed to report on the largest series of removal of bullets from the hip joint using open surgical techniques. Methods This is a retrospective cohort study of all patients who presented to a single Level 1 Trauma Unit with civilian gunshot injuries that had breached the hip joint between 01 January 2009 and 31 December 2022. Results: We identified one hundred and seventeen (117) adult patients who met our inclusion criteria. Of these patients 72 had bullets retained within the hip joint area. Forty-six patients underwent bullet removal using the following techniques: hip arthrotomy (n=19), surgical hip dislocation (n=18), direct removal without capsulotomy (tractotomy) (n=5), removal at site of fracture fixation/replacement (n=3), posterior wall osteotomy (n=1). No patients underwent hip arthroscopy. In 26 patients we did not remove bullets for the following reasons: final location was extra-capsular embedded in the soft tissues (n=17), clinical decision to not remove though bullet due to the patients’ clinical condition not allowing for further surgery (n=8) and patient refusal (n=1). Conclusion: With adequate pre-operative imaging and surgical planning, removal of retained bullets from the hip joint can be achieved using open surgical techniques without the need for hip arthroscopy.