Radiologic and intraoperative findings in revision hip arthroscopy.
OBJECTIVE
The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy.


METHODS
We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction "cam" lesions or anterosuperior acetabular "pincer" lesions).


RESULTS
The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery.


CONCLUSIONS
Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery.


METHODS
Level IV, prognostic case series.
Hospital for Special Surgery, New York, New York 10021, USA. heyworthb@hss.edu
Benton E
BE
Heyworth
Michael K
MK
Shindle
James E
JE
Voos
Jonas R
JR
Rudzki
Bryan T
BT
Kelly
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001175:Arthrography / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D025981:Hip Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies