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Clinical outcomes after revision hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) are inferior compared to primary procedures. Results from the Danish Hip Arthroscopy Registry (DHAR)

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

As many as 10% of primary hip arthroscopies end up with a revision arthroscopy procedure when treating patients suffering from femoroacetabular impingement syndrome (FAIS). In general, revision procedures are indicated because of residual impingement, but only a few studies present outcome data from revision hip arthroscopy after failed FAIS surgical treatment. The purpose of this study was to evaluate clinical outcomes after revision hip arthroscopy in a FAIS cohort and compare outcomes with a primary FAIS hip arthroscopy cohort and describe potential causes of failure after the primary hip arthroscopy. It was hypothesized that subjective outcomes improve after revision hip arthroscopy although outcomes were expected to be inferior to primary hip arthroscopic outcomes.

Methods

Three-hundred and thirty-one arthroscopic revision hip FAIS patients were included from the Danish Hip Arthroscopy Registry (DHAR). Patient-related outcome measures (PROM’s), Copenhagen Hip and Groin Outcome Scores (HAGOS), Hip Sports Activity Scale (HSAS), EQ-5D and Numeric Rating Scale (NRS) pain, were assessed in the study cohort prior to the primary procedure and at revision and at follow-up one year after the revision procedure. These data were compared with 4154 primary hip arthroscopic FAIS patients.

Results

One-year after revision surgery, mean follow-up (in months ± SD): 12.3 ± 1.6, significant improvements (p < 0.05) in all PROMs was demonstrated, but FAIS patients in the primary hip arthroscopic cohort demonstrated significantly higher outcomes, in all PROMs, when compared at one-year follow-up. Scar tissue, residual osseous impingement and insufficient healing of the labral repair were reported as the main reasons for revision surgery. The conversion to total hip arthroplasty was low (6.4%).

Conclusion

Revision hip arthroscopy in FAIS patients improves subjective outcomes significantly, although they are poorer than after primary FAIS hip arthroscopy. Main reasons for revision arthroscopy was scar tissue, residual femoroacetabular impingement and insufficient healing of labral repair.

Level of evidence

Level III.

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Acknowledgements

The authors of this work would like to thank Andreas Chatterton (MD) for his hard work making an initial draft for this manuscript and presentation of this matter held at Aarhus University.

Funding

No funding was accepted for the study.

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Authors and Affiliations

  1. Department of Orthopedics, section of Sports Traumatology, Aarhus University Hospital, 8200, Aarhus N, Denmark

    Bjarne Mygind-Klavsen, Torsten Grønbech Nielsen & Martin Lind

  2. Department of Orthopedics, H-HiP Research Unit, Horsens Regional Hospital, 8700, Horsens, Denmark

    Bent Lund

Authors
  1. Bjarne Mygind-Klavsen
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  2. Torsten Grønbech Nielsen
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  3. Bent Lund
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  4. Martin Lind
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Correspondence to Bjarne Mygind-Klavsen.

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The author declares to have no conflicts of interest.

Ethical approval

Ethical approval was not needed for the present study. Handling of data from DHAR was approved by the Danish Data Protection Agency under case number 1-16-02-184-18. DHAR is approved by the Danish Health Authority.

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Formal consent was not required for this registry study.

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Mygind-Klavsen, B., Nielsen, T.G., Lund, B. et al. Clinical outcomes after revision hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) are inferior compared to primary procedures. Results from the Danish Hip Arthroscopy Registry (DHAR). Knee Surg Sports Traumatol Arthrosc 29, 1340–1348 (2021). https://doi.org/10.1007/s00167-020-06135-w

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