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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Return to preinjury activity levels after surgical management of femoroacetabular impingement in athletes.Arthroscopy. 2012; 28: 1567-1576
- Adhesive capsulitis of the hip.Arthroscopy. 2006; 22: 89-94
- Femoroacetabular impingement: A cause for osteoarthritis of the hip.Clin Orthop. 2003; 417: 112-120
- Diagnosis and management of traumatic and atraumatic hip instability in the athletic patient.Clin Sports Med. 2006; 25: 309-326
- In search of the spherical femoroplasty: Cam overresection leads to inferior functional scores before and after revision hip arthroscopic surgery.Am J Sports Med. 2018; 46: 2061-2071
- Revision hip arthroscopy indications and outcomes: A systematic review.Arthroscopy. 2015; 31: 2047-2055
- Methodological index for non-randomized studies (minors): Development and validation of a new instrument.ANZ J Surg. 2003; 73: 712-716
- Reading and reviewing the orthopaedic literature: A systematic, evidence-based medicine approach.J Am Acad Orthop Surg. 2005; 13: 220-229
- The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.J Bone Joint Surg Br. 2002; 84: 556-560
- Anteroposterior pelvic radiographs to assess acetabular retroversion: High validity of the “cross-over-sign.”.J Orthop Res. 2007; 25: 758-765
- Radiographic markers of acetabular retroversion: Correlation of the cross-over sign, ischial spine sign and posterior wall sign.Acta Orthop Belg. 2010; 76: 166-173
- Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy.J Bone Joint Surg Am. 2003; 85-A: 278-286
- Normal values of the hip joint for the evaluation of X-rays in children and adults.Clin Orthop. 1976; 119: 39-47
- Joint space predicts THA after hip arthroscopy in patients 50 years and older.Clin Orthop. 2013; 471: 2492-2496
- The effect of joint space on midterm outcomes after arthroscopic hip surgery for femoroacetabular impingement.Am J Sports Med. 2014; 42: 1127-1133
- Outcomes of hip arthroscopy in the older adult: A systematic review of the literature.Am J Sports Med. 2017; 45: 1928-1936
- Estimating the mean and variance from the median, range, and the size of a sample.BMC Med Res Methodol. 2005; 5: 13
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. In: 5.10. The Cochrane Collaboration; 2011. www.training.cochrane.org/handbook.
- Statistical Power Analysis for the Behavioral Sciences.Routledge, Philadelphia2013
- Meta-analyses and Forest plots using a Microsoft Excel spreadsheet: Step-by-step guide focusing on descriptive data analysis.BMC Res Notes. 2012; 5: 52
- Revision hip arthroscopic surgery: Outcome at three years.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 932-937
- Clinical outcomes and causes of arthroscopic hip revision surgery.Sci Rep. 2019; 9: 1230
- Revision hip arthroscopy: Findings and outcomes.J Hip Preserv Surg. 2017; 4: 318-323
- Reasons for and functional results of repeated hip arthroscopy: A continuous prospective study of 17 revisions out of 295 primary hip arthroscopies at mean 28 months’ follow-up.Orthop Traumatol Surg Res. 2017; 103: 645-649
- Arthroscopic capsular repair for symptomatic hip instability after previous hip arthroscopic surgery.Am J Sports Med. 2016; 44: 39-45
- Revision arthroscopic acetabular labral treatment: repair or reconstruct?.Arthroscopy. 2016; 32: 2513-2520
- Clinical outcomes of hip arthroscopic surgery: A prospective survival analysis of primary and revision surgeries in a large mixed cohort.Am J Sports Med. 2016; 44: 2505-2517
- Arthroscopic Hip Revision surgery for residual femoroacetabular impingement (FAI) surgical outcomes compared with a matched cohort after primary arthroscopic FAI correction.Am J Sports Med. 2014; 42: 1785-1790
- Revision Hip Arthroscopy after labral reconstruction using iliotibial band autograft: Surgical findings and comparison of outcomes with labral reconstructions not requiring revision.Arthroscopy. 2018; 34: 1244-1250
- Outcomes after revision hip arthroscopic surgery in adolescent patients compared with a matched cohort undergoing primary arthroscopic surgery.Am J Sports Med. 2016; 44: 3063-3069
- Revision hip arthroscopy: A matched-cohort study comparing revision to primary arthroscopy patients.Am J Sports Med. 2016; 44: 2499-2504
- Periacetabular osteotomy after failed hip arthroscopy for labral tears in patients with acetabular dysplasia.J Bone Joint Surg Am. 2011; 93: 57-61
- Previous failed hip arthroscopy negatively impacts early patient-reported outcomes of the periacetabular osteotomy: an ANCHOR Matched Cohort Study.J Hip Preserv Surg. 2018; 5: 370-377
- Early Functional outcomes of periacetabular osteotomy after failed hip arthroscopic surgery for symptomatic acetabular dysplasia.Am J Sports Med. 2017; 45: 2460-2467
- The effect of prior hip arthroscopy on patient-reported outcomes after total hip arthroplasty: An institutional registry-based, matched cohort study.J Arthroplasty. 2018; 33: 1806-1812
- Outcomes of hip arthroplasty after failed hip arthroscopy: A case-control study.J Arthroplasty. 2017; 32: 3082-3087.e2
- Prior arthroscopy leads to inferior outcomes in total hip arthroplasty: A match-controlled study.J Arthroplasty. 2017; 32: 3665-3668
- Does previous hip arthroscopy negatively influence the short term clinical result of total hip replacement?.Arch Orthop Trauma Surg. 2012; 132: 299-303
- Are Range of motion measurements needed when calculating the Harris Hip Score?.J Arthroplasty. 2016; 31: 815-819
- Decision making for labral treatment in the hip: Repair versus débridement versus reconstruction.J Am Acad Orthop Surg. 2017; 25: e53-e62
- Revision hip arthroscopy: A systematic review of diagnoses, operative findings, and outcomes.Arthroscopy. 2015; 31: 1382-1390
- Patient and disease characteristics associated with hip arthroscopy failure in acetabular dysplasia.J Arthroplasty. 2014; 29: 160-163
- Catastrophic failure of hip arthroscopy due to iatrogenic instability: Can partial division of the ligamentum teres and iliofemoral ligament cause subluxation?.Arthroscopy. 2012; 28: 440-445
- Arthroscopic management of dysplastic hip deformities: Predictors of success and failures with comparison to an arthroscopic FAI cohort.Am J Sports Med. 2016; 44: 447-453
- Does prior hip arthroscopy affect outcomes of subsequent hip arthroplasty? A Systematic Review.Arthroscopy. 2019; 35: 631-643
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.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
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).
- Full-Text
- Preview
