Purpose
(1) To identify present indications for secondary procedures in patients with failed
hip arthroscopy and (2) to assess patient-reported outcomes (PROs) of the secondary
procedures, including revision arthroscopy, periacetabular osteotomy (PAO), and total
hip arthroplasty (THA).
Methods
Study groups included patients who had a secondary procedure after failed previous
hip arthroscopy whereas the control groups were patients who had a primary procedure
but did not require a secondary procedure. Indications and procedures at the time
of the secondary operation were documented for each study. Average PROs were recorded,
and standardized mean difference was calculated to estimate effect size.
Results
Eighteen studies reporting on patients undergoing a secondary procedure after a previous
hip arthroscopy were included. The 3 main secondary procedure groups were revision
hip arthroscopy, secondary PAO, and secondary THA. Regarding the revision arthroscopy
group, the most common indications were labral tears, cam deformity, and pincer deformity.
In addition, the most common procedures were femoroplasty, acetabuloplasty, capsular
release, and labral reconstruction. The most common indications for the secondary
PAO and THA groups were dysplasia and osteoarthritis respectively. Five of the revision
arthroscopy studies found that revision patients had worse outcomes than the primary
arthroscopy group. One PAO study found that the previous arthroscopy group had slightly
worse outcomes, and 2 studies found no differences in PROs. Two THA studies reported
worse outcomes for the prior arthroscopy group, and 2 studies reported no differences
in outcomes.
Conclusions
The most common indications for revision hip arthroscopy were labral tears and femoroacetabular
impingement. Patients undergoing a revision hip arthroscopy demonstrated good postoperative
outcomes but to an overall lesser extent than their primary counterparts. The secondary
PAO and THA groups also had favorable PROs, but the studies were inconclusive in determining
superior outcomes between the primary and secondary groups.
Level of Evidence
IV, Systematic review of Level II-IV investigations.
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Article info
Publication history
Published online: March 04, 2020
Accepted:
February 20,
2020
Received:
August 8,
2019
Footnotes
See commentary on page 2008
The authors report the following potential conflict of interest or source of funding: B.G.D., or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000–USD 100,000 from Arthrex; an amount of USD 10,000–USD 100,000 from DJO Global; an amount of USD 10,000–USD 100,000 from Medacta International; an amount of less than USD 10,000 from Orthomerica Products; an amount of less than USD 10,000 from Pacira Pharmaceuticals; an amount of less than USD 10,000 from Medwest Associates; an amount of less than USD 10,000 from Prime Surgical; an amount of less than USD 10,000 from Trice Medical; an amount of less than USD 10,000 from Smith & Nephew; and an amount of USD 100,001–USD 1,000,000 from Stryker Corporation. He is the Medical Director of Hip Preservation at St. Alexius Medical Center; a board member for the American Hip Institute Research Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, and the Journal of Arthroscopy; and has had ownership interests in the American Hip Institute, Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. A.C.L., or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000–USD 100,000 from Arthrex; an amount of less than USD 10,000 from Medwest Associates; an amount of USD 10,000–USD 100,000 from Smith & Nephew; an amount of less than USD 10,000 from Stryker Corporation; and an amount of less than USD 10,000 from Zimmer Biomet Holdings. He is the Medical Director of Hip Preservation at St. Alexius Medical Center. D.R.M. reports nonfinancial support from Arthrex, Stryker, Smith & Nephew, and Ossur, outside the submitted work; and he is an editorial board member of the Journal of Arthroscopy. J.S. reports nonfinancial support from Arthrex, Stryker, Smith & Nephew, and Ossur, outside the submitted work. P.J.R. reports nonfinancial support from Arthrex, Stryker, Smith & Nephew, and Ossur, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
This study was performed at the American Hip Institute, Des Plaines, Illinois, U.S.A.
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Copyright
© 2020 by the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- Editorial Commentary: Revision Hip Surgery After Arthroscopy—What Went Wrong? Are There Second Chances?ArthroscopyVol. 36Issue 7
- PreviewHip arthroscopy allows minimally invasive treatment of femoroacetabular impingement (FAI) with labral tears. Over the last 2 decades, the indications and techniques for treatment of FAI have evolved, and complex pathology can now be treated arthroscopically. Short- and medium-term patient-reported outcomes demonstrate the reliability of hip arthroscopy for treatment of FAI, although a subset of patients fail to achieve desired results and require revision surgery. The indications for revision surgery after a primary hip arthroscopy are not well described in a large series, and most reviews focus on revision arthroscopy at the exclusion of open surgery (notably periacetabular osteotomy and total hip arthroplasty).
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