Abstract
Purposes
To report patient-reported outcomes (PROs) and survivorship following revision hip
arthroscopy in patients aged ≥ 40 years and to compare these results to a propensity-matched
primary hip arthroscopy control group.
Methods
Data were prospectively collected and retrospectively reviewed for all patients who
underwent revision hip arthroscopy between June 2008 and January 2019. Patients were
included if they were ≥ 40 years of age at the time of surgery and had minimum 2-year
follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS),
Visual Analog Scale for pain and the Hip Outcome Score-Sports Specific Subscale (HOS-SSS).
Patients who had a previous hip condition, or those who lacked minimum two-year follow-up,
were excluded. The revision group was further analyzed by conducting a 1:1 propensity-matched
sub-analysis to a primary hip arthroscopy control group based on age, sex, body mass
index (BMI), and acetabular labrum articular disruption grade. Statistical significance
was set at P < .05.
Results
Eighty-nine hips (92.7% follow-up) were included, with 66.3% being females. The mean
age, BMI, and follow-up time were 49.4 ± 8.0 years, 26.6 ± 4.1, and 62.7 ± 38.5 months,
respectively. Significant improvement in all PROs (P < .001) was reported, and 71.8%, 58 74.4%, and 65.2% achieved the minimal clinically
important difference (MCID) for the mHHS, NAHS, and HOS-SSS, respectively. Eighty-seven
revision hips were successfully propensity-matched to 87 primary hips. Both groups
reported similar improvement for all PROs, but the relative risk of THA conversion
was 2.63 times higher (95% CI, 1.20 – 5.79) for the revision group.
Conclusion
Patients aged ≥ 40 years who underwent revision hip arthroscopy reported significant
improvement in all PROs at a mean follow-up of 62.7 months with favorable rates of
achieving the MCID. When compared to the propensity-matched control group, both achieved
similar rates of improvement, but the revision group was 2.63 times more likely to
convert to THA.
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REFERENCES
Makhni EC, Ramkumar PN, Cvetanovich G, Nho SJ. Approach to the Patient With Failed Hip Arthroscopy for Labral Tears and Femoroacetabular Impingement: Journal of the American Academy of Orthopaedic Surgeons. Published online March 2020:1.
- Salvage Revision Hip Arthroscopy Including Remplissage Improves Patient-Reported Outcomes After Cam Over-Resection.Arthroscopy. 2021; 37: 2809-2816
- Multicenter Outcomes After Revision Hip Arthroscopy: Comparative Analysis of 2-Year Outcomes After Labral Repair Versus Labral Reconstruction.Am J Sports Med. 2021; 49: 2968-2976
- Minimum 5-Year Outcomes for Revision Hip Arthroscopy With a Prospective Subanalysis Against a Propensity-Matched Control Primary Group.Am J Sports Med. 2021; 49: 2090-2101
- Predictors of Clinical Outcomes After Hip Arthroscopy: 5-Year Follow-up Analysis of 1038 Patients.Am J Sports Med. 2021; 49: 112-120
- Validation of a Risk Calculator for Conversion of Hip Arthroscopy to Total Hip Arthroplasty in a Consecutive Series of 1400 Patients.J Arthroplasty. 2019; 34: 1700-1706
- Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older.Arthroscopy. 2012; 28: 59-65
- Hip Arthroscopy in Patients Age 40 or Older: A Systematic Review.Arthroscopy. 2017; 33 (e3): 464-475
- Outcomes of Revision Hip Arthroscopic Surgery: A Systematic Review and Meta-analysis.Am J Sports Med. 2020; 48: 1254-1262
- The nonarthritic hip score: reliable and validated.Clin Orthop Relat Res. 2003; 406: 75-83
- Evidence of validity for the hip outcome score in hip arthroscopy.Arthroscopy. 2007; 23: 822-826
- Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults.Journal of the American Academy of Orthopaedic Surgeons Global Research Reviews. 2018; 23
- Multicenter Arthroscopy of the Hip Outcomes Research Network. A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice.Arthroscopy. 2012; 28 (quiz 616-618): 611-616
- Validity of the Alpha Angle Measurement on Plain Radiographs in the Evaluation of Cam-type Femoroacetabular Impingement.Clin Orthop Relat Res. 2011; 469: 464-469
- [False profile of the pelvis. A new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies].Rev Rhum Mal Osteoartic. 1961; 28: 643-652
- Acetabular cover in congenital dislocation of the hip.J Bone Joint Surg Br. 1990; 72: 190-196
- A systematic approach to the plain radiographic evaluation of the young adult hip.J Bone Joint Surg Am. 2008; 90: 47-66
- Normal values of the hip joint for the evaluation of X-rays in children and adults.Clinical orthopaedics and related research. 1976; 119: 39-47
- Correlations between the alpha angle and femoral head asphericity: Implications and recommendations for the diagnosis of cam femoroacetabular impingement.Eur J Radiol. 2014; 83: 788-796
- 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
- Hip arthroscopy: an evidence-based approach.The Lancet. 2018; 391: 2189-2190
- Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial.Lancet. 2018; 391: 2225-2235
- Perineal Pressure During Hip Arthroscopy Is Reduced by Use of Trendelenburg: A Prospective Study With Randomized Order of Positioning.Clin Orthop Relat Res. 2019; 477: 1851-1857
- Forget the Greater Trochanter! Hip Joint Access With the 12 O’clock Portal in Hip Arthroscopy.Arthrosc Tech. 2019; 8: e575-e584
- The Modified Mid-Anterior Portal for Hip Arthroscopy.Arthrosc Tech. 2014; 3: e469-e474
- The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement.Arthroscopy. 2008; 24 (8): 1019-1026
- Anatomy, histologic features, and vascularity of the adult acetabular labrum.Clin Orthop Relat Res. 2001; 382: 232-240
- Classification and localization of acetabular labral tears.Skeletal Radiol. 2007; 36: 391-397
- The etiology of chondromalacia patellae.J Bone Joint Surg Br. 1961; 43-B: 752-757
- The ligamentum teres of the adult hip.J Bone Joint Surg Br. 2009; 91: 8-15
- Can the change in center-edge angle during pincer trimming be reliably predicted?.Clin Orthop Relat Res. 2011; 469: 1071-1074
- Impingement-free hip motion: the “normal” angle alpha after osteochondroplasty.Clin Orthop Relat Res. 2009; 467: 699-703
- Labral Gracilis Tendon Allograft Reconstruction and Cartilage Regeneration Scaffold for an Uncontained Acetabular Cartilage Defect of the Hip.Arthroscopy Techniques. 2017; 6: e613-e619
- Arthroscopic hip labral reconstruction with a gracilis autograft versus labral refixation: 2-year minimum outcomes.Am J Sports Med. 2013; 41: 980-987
- Microfracture in Hip Arthroscopy. Keep It Simple.Arthroscopy Techniques. 2019; 8: e1063-e1067
- Correlation Between Changes in Visual Analog Scale and Patient-Reported Outcome Scores and Patient Satisfaction After Hip Arthroscopic Surgery.Orthop J Sports Med. 2017; 5
- Interpretation of Changes in Health-related Quality of Life: The Remarkable Universality of Half a Standard Deviation.Medical Care. 2003; 41: 582-592
- The Minimal Clinical Important Difference (MCID) And Patient Acceptable Symptomatic State (PASS) For The Modified Harris Hip Score And Hip Outcome Score Among Patients Undergoing Surgical Treatment For Femoroacetabular Impingement.Orthopaedic Journal of Sports Medicine. 2014; 22325967114S00105
- Determining Clinically Meaningful Thresholds for the Nonarthritic Hip Score in Patients Undergoing Arthroscopy for Femoroacetabular Impingement Syndrome.Arthroscopy. 2021 Oct; 37: 3113-3121
- Outcomes for Hip Arthroscopy According to Sex and Age: A Comparative Matched-Group Analysis.J Bone Joint Surg Am. 2016; 98: 797-804
- High Risk of Conversion to THA After Femoroacetabular Osteoplasty for Femoroacetabular Impingement in Patients Older than 40 Years.Clin Orthop Relat Res. 2021; 479: 1112-1118
- Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: A Randomized Controlled Trial.Am J Sports Med. 2021; 49: 1199-1208
- Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship.Am J Sports Med. 2018; 46: 1284-1293
- Hip Arthroscopy in Patients Aged 40 Years and Older: Greater Success With Labral Reconstruction Compared With Labral Repair.Arthroscopy. 2020 Aug; 36: 2137-2144
Article Info
Publication History
Accepted:
June 3,
2022
Received in revised form:
April 11,
2022
Received:
February 15,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. This study was carried out in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA). Details that might disclose the identity of the subjects under study have been omitted. This study was approved by the IRB. (IRB ID: 5276)
David R. Maldonado, MD. - Data collection/analysis, data interpretation, study design, and writing of the manuscript
Samantha C. Diulus, BS - Data collection/analysis and writing of the manuscript
Michael S. Lee, BA - Data collection/analysis and writing of the manuscript
Jade S. Owens, BS - Data collection and revision of the manuscript
Andrew E. Jimenez, MD. - Data analysis and revision of the manuscript
Paulo A. Perez-Padilla, MD – Data analysis and revision of the manuscript
Benjamin G. Domb, MD. - Data interpretation, revision of manuscript and writing of the manuscript
This study was performed at the American Hip Institute Research Foundation.
Level of Evidence: 3. Case-Control Study.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
