Indications and Outcomes of Secondary Hip Procedures After Failed Hip Arthroscopy: A Systematic Review

Shapira, Jacob; Kyin, Cynthia; Go, Cammille C.; Rosinsky, Philip J.; Maldonado, David R.; Lall, Ajay C.; Domb, Benjamin G.

doi:10.1016/j.arthro.2020.02.028

Cited by 49 publications

(64 citation statements)

References 41 publications

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“…This has implications in the ultimate success of primary labral repair; a recent systematic review investigating indications for revision hip arthroscopy demonstrated that labral retear was the most common reason for revision hip arthroscopy, present in approximately 75% of patients undergoing revision. 12 This labral repair method differs from those of previous authors because it allows for preservation of the chondrolabral junction with decreased violation of the intrasubstance fibers to provide anatomic eversion/ inversion of the labrum to restore the suction seal. This restores the normal anatomic function of the hip joint while preserving the articular cartilage.…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopic Labral Repair of the Hip Using a Self-Grasping Suture-Passing Device: Maintaining the Chondrolabral Junction

Ridley

Ruzbarsky

Seiter

et al. 2020

Arthroscopy Techniques

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In the setting of femoroacetabular impingement, the acetabular labrum may be torn or pathologic, and it must be surgically repaired to restore the native suction seal and hip function. However, the current methods of arthroscopic suture passage commonly result in some degree of disruption of the chondrolabral junction, with penetration and shuttling of the repair sutures. Novel instrumentation and surgical techniques have aimed to repair the acetabular labrum with decreased violation of the intrasubstance fibers to provide anatomic eversion/inversion of the labrum to restore the suction seal. In this Technical Note, we describe a method of suture passage through the use of a self-grasping suturepassing device that allows for anatomic labral repair while maintaining the chondrolabral junction as well as minimizing iatrogenic damage the labrum intrasubstance fibers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arthroscopic Labral Repair of the Hip Using a Self-Grasping Suture-Passing Device: Maintaining the Chondrolabral Junction

Ridley

Ruzbarsky

Seiter

et al. 2020

Arthroscopy Techniques

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“…In a systematic review, Shapira et al 51 reported that labral retear and residual femoroacetabular morphology were the 2 most common indications for failed primary hip arthroscopy. The present study demonstrated that these reasons were also prevalent in a population with borderline dysplasia.…”

Section: Discussionmentioning

confidence: 99%

Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group

et al. 2020

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Background: Hip arthroscopy in patients with borderline dysplasia continues to be surrounded by controversy. Even more controversial is the management of the failed hip arthroscopy in this population. There is a paucity of studies in contemporary literature regarding outcomes after arthroscopic revision surgery. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores in patients with borderline dysplasia who underwent revision hip arthroscopy and (2) to compare these PRO scores with those of a propensity-matched control group without dysplasia who underwent revision hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between August 2009 and November 2017. Inclusion criteria were revision arthroscopic surgery, capsular plication, and baseline and minimum 2-year follow-up for the following PROs: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with Tönnis grade >1 or previous hip conditions were excluded. Two groups were created: a study group with borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and a control group without dysplasia (LCEA, 25°-40°). Groups were propensity-matched in a 1:3 ratio for sex, age, body mass index, and follow-up time. Results: A total of 22 revision borderline dysplastic hips (21 patients) had a minimum 2-year follow-up during the study period. Patients in this group reported significant improvements for all PROs from baseline and achieved the minimal clinically important difference (MCID) for the mHHS at a rate of 70%. Moreover, 21 borderline dysplastic hips (21 patients) were matched to 63 control hips (63 patients). Mean LCEA for the study and control groups was 22.6 ± 1.7 and 32.0 ± 5.0, respectively. Both groups reported similar improvement in all PROs. The rate for achieving the MCID for the mHHS and VAS was similar between groups; however, the control group had higher rates of meeting the MCID for the HOS-SSS and NAHS ( P = .042 and P = .025, respectively). The rates of conversion to hip arthroplasty were 7.9% (n = 5) in the control group and 23.8% (n = 5) in the borderline dysplasia propensity-matched group ( P = .052). The rate of re-revision arthroscopy was 11.1% (n = 7) in the control group and 19.0% (n = 4) on the borderline dysplasia group ( P = .350). Conclusion: After revision hip arthroscopy, significant improvement was obtained for all PROs in patients with borderline dysplasia at a minimum 2-year follow-up. Moreover, outcomes, patient satisfaction, the rate for achieving the MCID for the mHHS and VAS, and the rate for secondary surgery were similar to those of a propensity-matched control group without dysplasia. Nevertheless, there was a nonsignificant trend toward higher secondary procedures in the study group; therefore, arthroscopic revision surgery in the borderline patients should be approached with measured prognosis.

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“…44 Previously, labral treatment has included repair or debridement, but recent advancements in arthroscopic techniques have allowed for reconstruction when labral tears are irreparable. 35 According to Shapira et al, 55 after primary hip arthroscopic surgery in the context of femoroacetabular impingement syndrome and labral tears, a labral retear is the most common cause for revision hip arthroscopic surgery, followed by residual cam-or pincer-type morphology. Interestingly,…”

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confidence: 99%

Arthroscopic Circumferential Acetabular Labral Reconstruction for Irreparable Labra in the Revision Setting: Patient-Reported Outcome Scores and Rate of Achieving the Minimal Clinically Important Difference at a Minimum 2-Year Follow-up

Domb

Kyin

et al. 2021

Am J Sports Med

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Background: There is a paucity in the literature reporting patient-reported outcome (PRO) scores and the minimal clinically important difference (MCID) after revision hip arthroscopic surgery with circumferential labral reconstruction. Purpose: To report minimum 2-year PRO scores and the rate of achieving the MCID in patients who underwent revision hip arthroscopic surgery with circumferential labral reconstruction in the setting of irreparable labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were retrospectively reviewed for all patients who underwent revision hip arthroscopic surgery between February 2016 and November 2017. Patients were included if they had undergone circumferential labral reconstruction and had preoperative and postoperative scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), 12-Item Short Form Health Survey physical and mental components (SF-12 P and SF-12 M, respectively), Veterans RAND 12-Item Health Survey physical and mental components (VR-12 P and VR-12 M, respectively), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, fractures, hip dysplasia, or revision labral treatment different from circumferential labral reconstruction. The MCID was calculated. Secondary surgical procedures were documented. Results: A total of 26 hips (26 patients; 61.5% female) were included. The mean age and body mass index were 33.2 ± 10.4 years and 25.5 ± 4.9, respectively. Significant improvements were reported for the mHHS (17.0 ± 19.5; P = .0002), NAHS (17.9 ± 16.7; P < .0001), HOS-SSS (21.7 ± 23.1; P = .0005), VAS (–2.2 ± 3.0; P = .006), iHOT-12 (25.8 ± 32.5; P = .0007), SF-12 P (8.5 ± 11.2; P = .001), and VR-12 P (8.9 ± 11.6; P = .001). Rates of meeting the MCID for the mHHS, NAHS, HOS-SSS, iHOT-12, and VAS were 76.9%, 80.0%, 65.0%, 62.5%, and 69.2%, respectively. No case of re-revision arthroscopic surgery was documented, but 1 case of conversion to total hip arthroplasty was documented at 38.6 months. Conclusion: In the setting of revision hip arthroscopic surgery and irreparable labral tears, circumferential labral reconstruction resulted in significant improvements in all PRO and VAS scores at a minimum 2-year follow-up with a high rate of achieving the MCID.

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Indications and Outcomes of Secondary Hip Procedures After Failed Hip Arthroscopy: A Systematic Review

Cited by 49 publications

References 41 publications

Arthroscopic Labral Repair of the Hip Using a Self-Grasping Suture-Passing Device: Maintaining the Chondrolabral Junction

Arthroscopic Labral Repair of the Hip Using a Self-Grasping Suture-Passing Device: Maintaining the Chondrolabral Junction

Revision Hip Arthroscopy in the Borderline Dysplastic Population: Reporting Outcomes With Minimum 2-Year Follow-up, With a Subanalysis Against a Propensity-Matched Nondysplastic Control Group

Arthroscopic Circumferential Acetabular Labral Reconstruction for Irreparable Labra in the Revision Setting: Patient-Reported Outcome Scores and Rate of Achieving the Minimal Clinically Important Difference at a Minimum 2-Year Follow-up

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