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Approach to a Failed Hip Arthroscopy

  • Outcomes Research in Orthopedics (O Ayeni, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

Hip arthroscopy has seen increasing utilization over the last decade. This is largely related to increased recognition and improved techniques for treating femoroacetabilar impingement (FAI). Though hip arthroscopy generally yields favorable outcomes, there are a subset of patients who have residual or recurrent symptoms that require reoperation. The current review discusses an algorithmic approach to evaluating patients following a failed hip arthroscopy including a framework for clinical and radiographic assessment, available treatment options, and associated outcomes in revision surgery.

Recent Findings

Residual FAI has been demonstrated to be the most common indication for revision arthroscopy. Other indications include residual or recurrent labral pathology, gross instability, microinstability, or adhesions. Appropriate history and imaging are important to determine the cause for residual symptoms. Novel techniques including labral and capsular reconstruction, and modified remplissage procedures have been developed to deal with complex revision cases. Though studies have shown improved outcomes after revision surgery, they have been shown to result in inferior outcomes compared to a matched cohort following primary hip arthroscopy.

Summary

Management of a failed hip arthroscopy remains a complex problem. Focused history, cross-sectional imaging, and revision hip arthroscopy with novel techniques can improve outcomes, albeit to a lesser extent than patients undergoing successful primary hip arthroscopy. The information provided here can help guide treatment and set appropriate patient expectations for revision surgery.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Montgomery SR, Ngo SS, Hobson T, Nguyen S, Alluri R, Wang JC, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy. 2013;29(4):661–5.

    PubMed  Google Scholar 

  2. Colvin AC, Harrast J, Harner C. Trends in hip arthroscopy. J Bone Joint Surg. 2012;94(4) e23-e23.

    Google Scholar 

  3. Bozic KJ, Chan V, Valone FH,3rd, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. J Arthroplast 2013 Sep;28(8 Suppl):140–143.

    PubMed  Google Scholar 

  4. Palmer AJ, Malak TT, Broomfield J, Holton J, Majkowski L, Thomas GE, et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med. 2016;2(1):e000082.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Harris JD, Mccormick FM, Abrams GD, Gupta AK, Ellis TJ, Bach BR, et al. Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy. 2013;29(3):589–95.

    PubMed  Google Scholar 

  6. • West CR, Bedard NA, Duchman KR, Westermann RW, Callaghan JJ. Rates and risk factors for revision hip arthroscopy. Iowa Orthop J. 2019;39(1):95–9 Study indicated that 4% of patients underwent revision hip arthroscopy over an 8-year period. Revisions occurred within 18months of primary surgery. Age < 50 was a risk factor for revision surgery. Residual impingement was the most common cause for revision.

    PubMed  PubMed Central  Google Scholar 

  7. Bogunovic L, Gottlieb M, Pashos G, Baca G, Clohisy JC. Why do hip arthroscopy procedures fail? Clin Orthop Relat Res. 2013;471(8):2523–9.

    PubMed  PubMed Central  Google Scholar 

  8. Gwathmey FW, Jones KS, Byrd JWT. Revision hip arthroscopy: findings and outcomes. J Hip Preserv Surg. 2017sssss;4(4):318–23.

    PubMed  PubMed Central  Google Scholar 

  9. Woodward RM, Philippon MJ. Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: a review of imaging findings. J Med Imaging Radiation Oncol. 2018;63(1):15–24.

    Google Scholar 

  10. •• Sardana V, Philippon MJ, de Sa D, Bedi A, Ye L, Simunovic N, et al. Revision hip arthroscopy indications and outcomes: a systematic review. Arthroscopy. 2015;31(10):2047–55 Systematic review indicating that though revision hip arthroscopy can improve PRO the improvements are inferior to those seen in primary hip arthroscopy. The main indication for revision was residual impingement.

    PubMed  Google Scholar 

  11. Ekhtiari S, Coughlin RP, Simunovic N, Ayeni OR. Strategies in revision hip arthroscopy. Ann Joint. 2018:3(1).

    Google Scholar 

  12. Banerjee P, McLean CR. Femoroacetabular impingement: a review of diagnosis and management. Curr Rev Musculoskelet Med. 2011;4(1):23–32.

    PubMed  PubMed Central  Google Scholar 

  13. Groh M, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009;2(2):105–17.

    PubMed  PubMed Central  Google Scholar 

  14. Hase T, Ueo T. Acetabular labral tear: arthroscopic diagnosis and treatment. Arthroscopy. 1999;15(2):138–41.

    CAS  PubMed  Google Scholar 

  15. Lewis CL, Sahrmann SA. Acetabular labral tears. Phys Ther. 2006;86:110–21.

    PubMed  Google Scholar 

  16. Shu B, Safran MR. Hip instability: anatomic and clinical considerations of traumatic and atraumatic instability. Clin Sports Med. 2011;30(2):349–67.

    PubMed  Google Scholar 

  17. •• Safran MR. Microinstability of the hip-gaining acceptance. J Am Acad Orthop Surg. 2019;27(1):12–22 Review study discussing new concept of microinstability. The authors discuss the pathophysiology, diagnosis, and management or microinstability.

    PubMed  Google Scholar 

  18. Hoppe DJ, Truntzer JN, Shapiro LM, Abrams GD, Safran MR. Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability. Orthop J Sports Med. 2017;5(11):2325967117740121.

    PubMed  PubMed Central  Google Scholar 

  19. Domb BG, Brooks AG, Guanche CA. Physical examination of the hip. In: Guanche CA, editor. Hip and Pelvis Injuries in Sports Medicine Philidephia: Wolters Kluwer/Lipincott Williams and Wilkins; 2010. p. 62–70.

    Google Scholar 

  20. Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med. 2013;41(11):2591–8.

    PubMed  Google Scholar 

  21. Safran MR. Evaluation of the painful hip in tennis players. Aspetar Sports Med J. 2014;3:516–23.

    Google Scholar 

  22. Locks R, Bolia I, Utsunomiya H, Briggs K, Philippon MJ. Current concepts in revision hip arthroscopy. Hip Int. 2018;28(4):343–51.

    PubMed  Google Scholar 

  23. Philippon MJ, Ferro FP, Nepple JJ. Hip capsulolabral spacer placement for the treatment of severe capsulolabral adhesions after hip arthroscopy. Arthrosc Tech. 2014;3(2):e289–92.

    PubMed  PubMed Central  Google Scholar 

  24. Willimon SC, Briggs KK, Philippon MJ. Intraarticular adhesions following hip arthroscopy: a risk factor analysis. Knee Surg Sports Traumatol Arthrosc. 2014;22:822–5.

    PubMed  Google Scholar 

  25. Yen YM, Kocher MS. Chondral lesions of the hip: microfracture and chondroplasty. Sports Med Arthrosc Rev. 2010;18(2):83–9.

    PubMed  Google Scholar 

  26. Saito M, Tsukada S, Yoshida K, Okada Y, Tasaki A. Correlation of alpha angle between various radiographic projections and radial magnetic resonance imaging for cam deformity in femoral head-neck junction. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):77–83.

    PubMed  Google Scholar 

  27. Wong TT, Weeks JK, Ahmed FS, Francescone MA, Rasiej MJ, Liu MZ, et al. How many radiographs does it take to screen for femoral cam morphology?: a noninferiority study. Curr Probl Diagn Radiol. 2019;12.

  28. Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Relat Res. 2011;469(3):831–8.

    PubMed  Google Scholar 

  29. Crim J. Imaging evaluation of the hip after arthroscopic surgery for femoroacetabular impingement. Skelet Radiol. 2017;46(10):1315–26.

    Google Scholar 

  30. •• Su AW, Hillen TJ, Eutsler EP, Bedi A, Ross JR, Larson CM, et al. Low-dose computed tomography reduces radiation exposure by 90% compared with traditional computed tomography among patients undergoing hip-preservation surgery. Arthroscopy. 2019;35(5):1385–92 Low-dose CT results in a 90% reduction in radiation exposure compared with traditional CT without compromising image quality.

    PubMed  PubMed Central  Google Scholar 

  31. McCarthy JC, Glassner PJ. Correlation of magnetic resonance arthrography with revision hip arthroscopy. Clin Orthop Relat Res. 2013;471(12):4006–11.

    PubMed  PubMed Central  Google Scholar 

  32. •• O'Connor M, Steinl GK, Padaki AS, Duchman KR, Westermann RW, Lynch TS. Outcomes of Revision Hip Arthroscopic Surgery: A Systematic Review and Meta-analysis. Am J Sports Med. 2019:363546519869671 Recent systematic review and meta-analysis of over 4000 patients examining outcomes in revision hip arthroscopy. Patients had improvements in PRO. When compared to primary hip arthroscopy, the mean PROs were inferior. After revision hip arthroscopic surgery, the rates of conversion to total hip arthroplasty ranged from 0 to 14.3%, and the rates of further arthroscopic revision ranged from 2 to 14%.

  33. Nwachukwu BU, Chang B, Rotter BZ, Kelly BT, Ranawat AS, Nawabi DH. Minimal clinically important difference and substantial clinical benefit after revision hip arthroscopy. Arthroscopy. 2018;34(6):1862–8.

    PubMed  Google Scholar 

  34. Nwachukwu BU, Fields K, Chang B, Nawabi DH, Kelly BT, Ranawat AS. Preoperative outcome scores are predictive of achieving the minimal clinically important difference after arthroscopic treatment of femoroacetabular impingement. Am J Sports Med. 2017;45(3):612–9.

    PubMed  Google Scholar 

  35. Nho SJ, Beck EC, Nwachukwu BU, Cvetanovich GL, Neal WH, Harris JD, et al. Survivorship and outcome of hip arthroscopy for femoroacetabular impingement syndrome performed with modern surgical techniques. Am J Sports Med. 2019;47(7):1662–9.

    PubMed  Google Scholar 

  36. Ross JR, Larson CM, Adeoye O, Kelly BT, Bedi A. Residual deformity is the most common reason for revision hip arthroscopy: a three-dimensional CT study. Clin Orthop Relat Res. 2015;473(4):1388–95.

    PubMed  Google Scholar 

  37. Philippon MJ, Faucet SC, Briggs KK. Arthroscopic hip labral repair. Arthrosc Tech. 2013;2(2):e73–6.

    PubMed  PubMed Central  Google Scholar 

  38. Al Mana L, Coughlin RP, Desai V, Simunovic N, Duong A, Ayeni OR. The hip labrum reconstruction: indications and outcomes-an updated systematic review. Curr Rev Musculoskelet Med. 2019;12(2):156–65.

    PubMed  PubMed Central  Google Scholar 

  39. Chandrasekaran S, Vemula SP, Martin TJ, Suarez-Ahedo C, Lodhia P, Domb BG. Arthroscopic technique of capsular plication for the treatment of hip instability. Arthrosc Tech. 2015;4(2):e163–7.

    PubMed  PubMed Central  Google Scholar 

  40. Waterman BR, Chen A, Neal WH, Beck EC, Ukwuani G, Clapp IM, et al. Intra-articular volume reduction with arthroscopic plication for capsular laxity of the hip: a cadaveric comparison of two surgical techniques. Arthroscopy. 2019;35(2):471–7.

    PubMed  Google Scholar 

  41. Levy DM, Grzybowski J, Salata MJ, Mather RC 3rd, Aoki SK, Nho SJ. Capsular plication for treatment of iatrogenic hip instability. Arthrosc Tech. 2015;4(6):e625–30.

    PubMed  PubMed Central  Google Scholar 

  42. Nishikino S, Hoshino H, Hotta K, Furuhashi H, Koyama H, Matsuyama Y. Arthroscopic capsular repair using proximal advancement for instability following hip arthroscopic surgery: a case report. J Hip Preserv Surg. 2019;6(1):91–6.

    PubMed  PubMed Central  Google Scholar 

  43. Fagotti L, Soares E, Bolia IK, Briggs KK, Philippon MJ. Early outcomes after arthroscopic hip capsular reconstruction using iliotibial band allograft versus dermal allograft. Arthroscopy. 2019;35(3):778–86.

    PubMed  Google Scholar 

  44. Dierckman BD, Guanche CA. Anterior hip capsuloligamentous reconstruction for recurrent instability after hip arthroscopy. Am J Orthop (Belle Mead NJ). 2014;43(12):E319–23.

    Google Scholar 

  45. Fujishiro T, Nishikawa T, Takikawa S, Saegusa Y, Yoshiya S, Kurosaka M. Reconstruction of the iliofemoral ligament with an artificial ligament for recurrent anterior dislocation of total hip arthroplasty. J Arthroplast. 2003;18(4):524–7.

    Google Scholar 

  46. Trindade CA, Sawyer GA, Fukui K, Briggs KK, Philippon MJ. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft. Arthrosc Tech. 2015;4(1):e71–4.

    PubMed  PubMed Central  Google Scholar 

  47. Perez-Carro L, Escajadillo NF, Escajadillo LF, Arriaza CR, Garcia MS, Fernandez AA. Simultaneous acetabular labrum reconstruction and remplissage of the femoral head-neck junction. Arthrosc Tech. 2019;8(12):e1443–9.

    PubMed  PubMed Central  Google Scholar 

  48. Frank JM, Chahla J, Mitchell JJ, Soares E, Philippon MJ. Remplissage of the femoral head-neck junction in revision hip arthroscopy: a technique to correct excessive cam resection. Arthrosc Tech. 2016;5(6):e1209–13.

    PubMed  PubMed Central  Google Scholar 

  49. Tahoun MF, Tey M, Mas J, Abd-Elsattar Eid T, Monllau JC. Arthroscopic repair of Acetabular cartilage lesions by chitosan-based scaffold: clinical evaluation at minimum 2 years follow-up. Arthroscopy. 2018;34(10):2821–8.

    PubMed  Google Scholar 

  50. Degen RM, Pan TJ, Chang B, Mehta N, Chamberlin PD, Ranawat AS, et al. Risk of failure of primary hip arthroscopy-a population-based study. J Hip Preserv Surg. 2017;4(3):214–23.

    PubMed  PubMed Central  Google Scholar 

  51. •• Rosinsky PJ, Go CC, Shapira J, Maldonado DR, Lall AC, Domb BG. Validation of a Risk Calculator for Conversion of Hip Arthroscopy to Total Hip Arthroplasty in a Consecutive Series of 1400 Patients. J Arthroplast. 2019;34(8):1700–6 A recent study identifying multiple risk factors for conversion to THA including older age, femoral head chondral lesions, lack of performing a femoral osteochondroplasty, performance of an acetabular osteochondroplasty, and revision arthroscopy. The authors used these variables to create a predictive tool for the need of THA following hip arthroscopy and found greater than 70% accuracy. Patients with risk factors presenting with ongoing symptoms following arthroscopy may need to be appropriately counseled on their potential risk of requiring THA.

    Google Scholar 

  52. Rosinsky PJ, Kyin C, Shapira J, Maldonado DR, Lall AC, Domb BG. Hip arthroplasty after hip arthroscopy: are short-term outcomes affected? A systematic review of the literature. Arthroscopy. 2019 Sep;35(9):2736–46.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopedic Surgery, Western University, London, ON, Canada

    Michelle E. Arakgi & Ryan M. Degen

  2. Fowler Kennedy Sport Medicine Clinic, London, ON, Canada

    Michelle E. Arakgi & Ryan M. Degen

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Arakgi, M.E., Degen, R.M. Approach to a Failed Hip Arthroscopy. Curr Rev Musculoskelet Med 13, 233–239 (2020). https://doi.org/10.1007/s12178-020-09629-9

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