Advertisement

Salvage Revision Hip Arthroscopy Including Remplissage Improves Patient-Reported Outcomes After Cam Over-Resection

      Purpose

      To evaluate outcomes of arthroscopic hip remplissage with folded iliotibial band allograft to treat cam over-resection.

      Methods

      Patients who underwent arthroscopic iliotibial band hip remplissage from May 2013 to April 2018 were prospectively evaluated. Pre- and postoperative patient-reported outcome scores were compared and included the 12-Item Short Form Survey (SF12) Physical Health Composite Score (PCS), SF12 Mental Health Composite Score (MCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and Hip Outcome Score (HOS) (Activities of Daily Living [ADL] and Sport). Postoperative Tegner Activity Scale and patient satisfaction (1–10) were also evaluated.

      Results

      Thirteen patients (2 men, 11 women) with an average age of 39.8 ± 9 years underwent arthroscopic hip remplissage with minimum 2-year and mean 3.1-year follow-up (range, 2.1–4.1 years). One hundred percent follow-up was achieved. The average number of previous surgeries was 1.38 (range, 1–3). One patient underwent total hip arthroplasty 2 years after remplissage. All 12 patients who did not undergo total hip arthroplasty had improved patient-reported outcomes after remplissage (mean scores: SF12 PCS 36 vs 42, P = .02; SF12 MCS 45 vs 51, P = .14; mHHS 45 vs 66, P < .001; minimal clinically important difference [MCID] 83%; WOMAC 42 vs 28, P < .001; HOS ADL 52 vs 69, P = .003; MCID, 67%; HOS Sport 27 vs 46, P = .015; MCID, 67%). All improvements met statistical significance, besides the SF12 MCS. Median postoperative Tegner score was 2.9. Median postoperative patient satisfaction was 7 out of 10 (range, 5–10).

      Conclusions

      Arthroscopic hip remplissage is a successful salvage treatment option for hip instability caused by previous cam over-resection. Care must be taken during primary surgery not to over-resect the cam as patient-reported outcomes after remplissage are inferior to those undergoing primary hip arthroscopy.

      Level of Evidence

      Level IV, case series.
      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 access
      One-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 Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Byrd J.W.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 2-year follow-up.
        Arthroscopy. 2000; 16: 578-587
        • Martin R.L.
        • Philippon M.J.
        Evidence of validity for the hip outcome score in hip arthroscopy.
        Arthroscopy. 2007; 23: 822-826
        • Philippon M.J.
        • Briggs K.K.
        • Yen Y.M.
        • Kuppersmith D.A.
        Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: Minimum two-year follow-up.
        J Bone Joint Surg Br. 2009; 91: 16-23
        • Ross J.R.
        • Larson C.M.
        • Adeoye O.
        • Kelly B.T.
        • Bedi A.
        Residual deformity is the most common reason for revision hip arthroscopy: A three-dimensional CT study.
        Clin Orthop Relat Res. 2015; 473: 1388-1395
        • Frank J.M.
        • Chahla J.
        • Mitchell J.J.
        • Soares E.
        • Philippon M.J.
        Remplissage of the femoral head-neck junction in revision hip arthroscopy: A technique to correct excessive cam resection.
        Arthrosc Tech. 2016; 5: e1209-e1213
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Chahal J.
        • Van Thiel G.S.
        • Mather 3rd, R.C.
        • et al.
        The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement.
        Am J Sports Med. 2015; 43: 1844-1849
        • Vaughn Z.D.
        • Safran M.R.
        Arthroscopic femoral osteoplasty/chielectomy for cam-type femoroacetabular impingement in the athlete.
        Sports Med Arthrosc. 2010; 18: 90-99
        • Safran M.R.
        Microinstability of the hip-gaining acceptance.
        J Am Acad Orthop Surg. 2019; 27: 12-22
        • Woodward R.M.
        • Philippon M.J.
        Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: A review of imaging findings.
        J Med Imaging Radiat Oncol. 2019; 63: 15-24
        • Mansor Y.
        • Perets I.
        • Close M.R.
        • Mu B.H.
        • Domb B.G.
        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
        • Philippon M.J.
        • Nepple J.J.
        • Campbell K.J.
        • et al.
        The hip fluid seal--Part I: The effect of an acetabular labral tear, repair, resection, and reconstruction on hip fluid pressurization.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 722-729
        • McCarthy J.C.
        • Noble P.C.
        • Schuck M.R.
        • Wright J.
        • Lee J.
        The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease.
        Clin Orthop Relat Res. 2001; : 25-37
        • Newman J.T.
        • Briggs K.K.
        • McNamara S.C.
        • Philippon M.J.
        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
        • Newman J.T.
        • Briggs K.K.
        • McNamara S.C.
        • Philippon M.J.
        Revision hip arthroscopy: A matched-cohort study comparing revision to primary arthroscopy patients.
        Am J Sports Med. 2016; 44: 2499-2504