, Volume 471, Issue 8, pp 2523-2529

Why Do Hip Arthroscopy Procedures Fail?

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Topic
Hip

Abstract

Background

Despite the successes of hip arthroscopy, clinical failures do occur, and identifying risk factors for failure may facilitate refinement of surgical indications and treatment. Knowledge regarding the reasons for treatment failures may also improve surgical decision making.

Questions/purposes

We (1) characterized patients whose symptoms recurred after hip arthroscopy necessitating a revision hip preservation procedure or hip arthroplasty, (2) determined the etiologies of failure, (3) and reported the profile of revision surgical procedures.

Methods

In a prospective database of 1724 consecutive hip surgeries, we identified 58 patients (60 hips) with a history of failed hip arthroscopy. Thirty-seven patients (38 hips) underwent revision hip preservation and 21 (22) hip arthroplasty. Thirty-nine (67%) were female. Demographics, etiology of failure, and type of revision surgery were analyzed.

Results

Patients treated with revision hip preservation were younger, had a lower BMI, and lower Tönnis osteoarthritis grade at the time of revision surgery compared to patients treated with hip arthroplasty. Common etiologies of failure were residual femoroacetabular impingement (68%) and acetabular dysplasia (24%) in patients treated with revision hip preservation and advanced osteoarthritis in patients treated with hip arthroplasty. The revision preservation procedures included arthroscopy in 16 (42%), arthroscopy with limited open capsulorraphy in two (5.3%), periacetabular osteotomy in nine (24%), and surgical dislocation in 12 (32%).

Conclusions

Residual or unaddressed structural deformity of the hip and underlying osteoarthritis are commonly associated with failure after hip arthroscopy. Thorough patient evaluation with detailed characterization of structural hip anatomy and articular cartilage integrity are critical to the selection of proper surgical intervention and successful patient outcome.

Level of Evidence

Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

One of the authors certifies that he (JCC), or a member of his immediate family, has or may receive payments or benefits during the study period, an amount of less than USD 10,000 from Pivot Medical (Sunnyvale, CA, USA), an amount of less than USD 10,000 from Biomet, Inc (Warsaw, IN, USA), and an amount of USD 10,000 to USD 100,000 from Zimmer, Inc (Warsaw, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.