Does Revision Hip Arthroscopy Result in Improved Clinical Outcomes? - A 2-Year Clinical Follow-up On All Revision Hip Arthroscopies Performed at a High Volume Referral Center

Abstract

Objectives:The purpose of this study was to evaluate clinical outcomes, pain, and patient satisfaction following revision hip arthroscopy at a high volume referral center with a minimum 2-year follow-up.Methods:During the study period, April 2008 to October 2011, data was prospectively collected on all patients undergoing revision hip arthroscopy. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10.Results:Eighty-seven patients underwent revision hip arthroscopy during the study period. Seventy (80.5%) patients were included in our study. In terms of residual FAI morphology, 45.7% of patients had preoperative alpha angles ≥55 degrees and 7.14% of patients had a LCEA ≥40 degrees. The score improvement from preoperative to 2-year follow-up was 57.84 to 73.65 for mHHS, 62.79 to 83.04 for HOS-ADL, 37.33 to 54.93 for HOS-SSS, 55.65 to 70.79 for NAHS. VAS decreased from 6.72 preoperatively to 4.08 postoperatively. All scores demonstrated statistically significant improvement (P<.001). Overall patient satisfaction was 7.67. Our success rate was 74.58% for primary revision hip arthroscopy and 100% for secondary revision hip arthroscopy. Ten (14.29%) patients underwent total hip arthroplasty during the study period. Our hip survivorship was 85.7%. Five (7.14%) patients underwent secondary revision hip arthroscopy during the study period. We found an overall minor complication rate of 10%.Conclusion:Revision hip arthroscopy for all procedures performed on aggregate has excellent clinical outcomes for all PROs and patient satisfaction scores at short-term follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty, and the potential for revision surgery.

Outcomes for Hip Arthroscopy According to Sex and Age

“…Over the past decade, studies have demonstrated that outcomes after hip arthroscopy for the treatment of femoroacetabular impingement can lead to predictable pain relief, improvement of hip function, and a high return to baseline level of function 13,16,22,23,31,32 . Despite the substantial increase in recent publications analyzing hip arthroscopy and femoroacetabular impingement, there remains a paucity of literature discussing differences in hip arthroscopy according to sex or age.…”

“…In addition, understanding which patients may be at increased risk for complications [15][16][17][18][19][20][21] and reoperation is paramount and may assist clinicians in choosing alternative treatment options. Recently, Gupta et al 22 analyzed 595 patients undergoing hip arthroscopy at a mean follow-up of 29 months and found that increased patient age was significantly associated with increased total hip arthroplasty conversion rates. In addition, acute injury, microfracture, increased age, and female sex were associated with an increased need for revision arthroscopy.…”

Hip Arthroscopy Outcomes With Respect to Patient Acceptable Symptomatic State and Minimal Clinically Important Difference

“…Gupta et al 2 reported statistically significant improvements in clinical survey scores after 2 years in 595 patients undergoing primary hip arthroscopy at a single institution. A 2007 systematic review comparing arthroscopy with open and mini-open procedures found the former to be equally efficacious with a lower rate of complications, 3 and Byrd et al 4 have shown continued improvements through 10-year follow-up.…”

Arthroscopic release of iliopsoas tendon in patients with femoro-acetabular impingement: clinical results at mid-term follow-up

“…Patients undergoing hip arthroscopy for FAI and labral injuries showed excellent short-term results, significant increased clinical outcomes, high return-to-sport rates and few complications 17,18 . Due to the complex anatomic relationship between the iliopsoas tendon and the anterior surface of the hip joint, intra-articular pathologies can be associated with a iliopsoas tendinopathy and vice versa.…”