Purpose
To identify the indications and outcomes in patients undergoing revision hip arthroscopy.
Methods
The electronic databases Embase, Medline, HealthStar, and PubMed were searched from
1946 to July 19, 2014. Two blinded reviewers searched, screened, and evaluated the
data quality of the studies using the Methodological Index for Non-Randomized Studies
scale. Data were abstracted in duplicate. Agreement and descriptive statistics are
presented.
Results
Six studies were included (3 prospective case series and 3 retrospective chart reviews),
with a total of 448 hips examined. The most common indications for revision hip arthroscopy
included residual femoroacetabular impingement (FAI), labral tears, and chondral lesions.
The mean interval between revision arthroscopy and the index procedure was 25.6 months.
Overall, the modified Harris Hip Score improved by a mean of 33.6% (19.3 points) from
the baseline score at 1-year follow-up. In 14.6% of patients, further surgical procedures
were required, including re-revision hip arthroscopy (8.0%), total hip replacement
(5.6%), and hip resurfacing (1.0%). Female patients more commonly underwent revision
hip arthroscopy (59.7%).
Conclusions
The current evidence examined in this review supports revision hip arthroscopy as
a successful intervention to improve functional outcomes (modified Harris Hip Score)
and relieve pain in patients with residual symptoms after primary FAI surgery, although
the outcomes are inferior when compared with a matched cohort of patients undergoing
primary hip arthroscopy for FAI. The main indication for revision is a candidate who
has symptoms due to residual cam- or pincer-type deformity that was either unaddressed
or under-resected during the index operation. However, it is important to consider
that the studies included in this review are of low-quality evidence. Surgeons should
consider incorporating a minimum 2-year follow-up for individuals after index hip-preservation
surgery because revisions tended to occur within this time frame.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
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Article info
Publication history
Published online: May 29, 2015
Accepted:
March 23,
2015
Received:
December 12,
2014
Footnotes
See commentary on page 2056
The authors report the following potential conflict of interest or source of funding: M.J.P. receives support from Smith & Nephew, MIS, Ossur, Siemens, Arthrosurface, DonJoy, Slack, Linvatec, and HIPCO. A.B. receives support from Smith & Nephew and A3 Surgical. O.R.A. receives support from Smith & Nephew.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
