Purpose
To (1) report on pre- and postoperative patient-reported outcome (PRO) scores for
patients undergoing repeat revision surgery in short-term follow-up and (2) compare
minimal clinically important difference (MCID) and patient acceptable symptomatic
state achievement between primary, revision, and repeat revision hip arthroscopy cohorts.
Methods
Data from consecutive patients undergoing revision hip arthroscopy from January 2012
to February 2019 were retrospectively reviewed. Hips that underwent 2 revision hip
arthroscopic surgeries were identified and matched 1:3 to patients undergoing revision
surgery and 1:3 to patients undergoing primary surgery by age, sex, and body mass
index. Baseline demographic data, surgical indications, and hip-specific PROs were
collected were obtained preoperatively and at minimum 1-year follow-up. MCID was calculated
individually for each cohort.
Results
Twenty patients who underwent repeat revision were matched to 60 patients who underwent
revision and 60 primary patients. Patients who underwent repeat revision achieved
MCID on all investigated PROs at a similar rate to patients undergoing primary surgery
(90.0% vs 91.7%, P = .588) and at a greater rate than patients undergoing first-time revision surgery
(90.0% vs 71.7%, P = .045). Patients who underwent repeat revision achieved patient acceptable symptomatic
state on all investigated PROs at a similar rate to patients who underwent first-time
revision (30.0% vs 55.0%, P = .053) but at a significantly lower rate than primary patients (30.0% vs 76.7%,
P < .001). However, patients undergoing repeat revision surgery had significantly lower
preoperative PROs (P < .001 for all) and no significant difference in PROs at minimum 1-year follow-up
compared with patients undergoing revision (P > .05). Compared with the primary cohort, patients who underwent repeat revision
had significantly lower Hip Outcome Score–Activities of Daily Living (77.3 ± 16.7
vs 86.1 ± 14.4; P = .034), Hip Outcome Score–Sports Subscale (60.6 ± 27.2 vs 76.1 ± 23.8; P < .001), and modified Harris Hip Score (69.2 ± 19.3 vs 81.7 ± 16.1; P = .048) at a minimum of 1-year follow-up.
Conclusions
Second-time revision hip arthroscopy, which often requires advanced procedures, results
in clinically significant improvement in PROs; however, outcomes for repeat revision
cases are similar to first-time revision cases but inferior to those obtained following
primary surgeries.
Level of Evidence
Level III, retrospective case-control study.
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Article info
Publication history
Published online: April 30, 2021
Accepted:
April 15,
2021
Received:
July 28,
2020
See commentary on page 3442Footnotes
The authors report the following potential conflicts of interest or sources of funding: S.J.N. reports other from AlloSource, American Journal of Orthopaedics, American Orthopaedic Society for Sports Medicine; nonfinancial support from Arthrex; other from Arthroscopy Association of North America; nonfinancial support from Athletico, DJ Orthopaedics, Linvatec, and Miomed; personal fees from Ossur; nonfinancial support from Smith & Nephew, personal fees from Springer; and nonfinancial support from Stryker , outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2021 by the Arthroscopy Association of North America
