Original Article
Revision Hip Preservation Surgery With Hip Arthroscopy: Clinical Outcomes

https://doi.org/10.1016/j.arthro.2014.02.005Get rights and content

Purpose

To analyze and report the clinical outcomes of a cohort of patients who underwent revision hip preservation with arthroscopy and determine predictors of positive and negative outcomes.

Methods

During the study period from April 2008 to December 2010, all patients who underwent revision hip preservation with arthroscopy were included. This included patients who had previous open surgery and underwent revision with arthroscopy. Patient-reported outcome (PRO) scores were obtained preoperatively and at 3-month, 1-year, 2-year, and 3-year follow-up time points. Any revision surgeries and conversions to total hip arthroplasty were noted. A multiple regression analysis was performed to look for positive and negative predictive factors for improvement in PROs after revision hip arthroscopy.

Results

Forty-seven hips in 43 patients had completed 2 years' follow-up or needed total hip arthroplasty. The mean length of follow-up was 29 months (range, 24 to 47 months). Of the hips, 31 (66%) had either unaddressed or incompletely treated femoroacetabular impingement. There was a significant improvement in all PRO scores at a mean of 29 months after revision (P < .0001). The visual analog scale score improved from 7.3 ± 1.5 to 3.9 ± 2.5 (P < .0001). Improvements in the Non-Arthritic Hip Score of at least 10 points and 20 points were found in 28 hips (65%) and 19 hips (44%), respectively. Four hips in 3 patients required conversion to total hip arthroplasty. Positive predictive factors for PRO improvement were previous open surgery, pincer impingement, cam impingement, symptomatic heterotopic ossification, and segmental labral defects treated with labral reconstruction.

Conclusions

On the basis of multiple PROs, revision hip preservation with hip arthroscopy can achieve moderately successful outcomes and remains a viable treatment strategy after failed primary hip preservation surgery. Preoperative predictors of success after revision hip arthroscopy include segmental labral defects, unaddressed or incompletely addressed femoroacetabular impingement, heterotopic ossification, and previous open surgery.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

During the study period from April 2008 to December 2010, all patients who underwent hip arthroscopy for the revised treatment of previous hip preservation surgery, including open procedures, were included in the study. Patients with a Tönnis grade of 2 or greater are excluded from undergoing hip arthroscopy at our institution and thus are not part of this study group. In addition, patients with dysplasia (lateral center-edge angle <20°) are generally not arthroscopy candidates. Patients were

Results

During the study period (April 2008 through December 2010), 633 hip arthroscopies were performed by the senior author (B.G.D.). Forty-seven hips in 43 patients had completed 2 years' follow-up or met the endpoint of requiring THA. Patient demographic data are listed in Table 2. The mean age was 37.1 years (range, 16 to 70 years), and the mean length of follow-up was 29 months (range, 24 to 47 months). Nine patients had reached 3 years' follow-up at the time of analysis (March 2013). Of the

Discussion

This study shows that revision hip preservation with arthroscopy can result in successful outcomes in selected patients but overall scores tend to be lower than those in patients undergoing primary hip arthroscopy with questionable durability, as has been shown in previous studies.3 Segmental labral defects treated with labral reconstruction, unaddressed or incompletely addressed FAI, HO, and patients previously operated on by open techniques were positive predictive factors for changes in PROs

Conclusions

On the basis of multiple PROs, revision hip preservation with hip arthroscopy can achieve moderately successful outcomes and remains a viable treatment strategy after failed primary hip preservation surgery. Preoperative predictors of success after revision hip arthroscopy include segmental labral defects, unaddressed or incompletely addressed FAI, HO, and previous open surgery.

Acknowledgment

The authors thank Dr Jeffrey Gornbein for the statistical analysis.

References (12)

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    Citation Excerpt :

    They noted that there was a success rate of 63.4% at 1 year. In a similar fashion, Domb et al.13 and Gupta et al.14 reported significant patient-reported outcome improvement after revision hip arthroscopy. Prior studies have performed psychometric analyses for MCID and SCB after primary hip arthroscopy.

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The authors report the following potential conflict of interest or source of funding: T.J.J., B.G.D., C.E.S., D.L., and Y.E-B. receive support from American Hip Institute (nonprofit research organization). B.G.D. receives support from MAKO Surgical and Arthrex.

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