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Indications and Outcomes of Secondary Hip Procedures After Failed Hip Arthroscopy: A Systematic Review

      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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      Linked Article

      • Editorial Commentary: Revision Hip Surgery After Arthroscopy—What Went Wrong? Are There Second Chances?
        ArthroscopyVol. 36Issue 7
        • Preview
          Hip 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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