title: Why do hip arthroscopy procedures fail?
abstract: BACKGROUND
  Despite the successes of hip arthroscopy, clinical failures do occur, and identifying risk factors for failure may facilitate refinement of surgical indications and treatment. Knowledge regarding the reasons for treatment failures may also improve surgical decision making.
  
  
  OBJECTIVE
  We (1) characterized patients whose symptoms recurred after hip arthroscopy necessitating a revision hip preservation procedure or hip arthroplasty, (2) determined the etiologies of failure, (3) and reported the profile of revision surgical procedures.
  
  
  METHODS
  In a prospective database of 1724 consecutive hip surgeries, we identified 58 patients (60 hips) with a history of failed hip arthroscopy. Thirty-seven patients (38 hips) underwent revision hip preservation and 21 (22) hip arthroplasty. Thirty-nine (67%) were female. Demographics, etiology of failure, and type of revision surgery were analyzed.
  
  
  RESULTS
  Patients treated with revision hip preservation were younger, had a lower BMI, and lower Tönnis osteoarthritis grade at the time of revision surgery compared to patients treated with hip arthroplasty. Common etiologies of failure were residual femoroacetabular impingement (68%) and acetabular dysplasia (24%) in patients treated with revision hip preservation and advanced osteoarthritis in patients treated with hip arthroplasty. The revision preservation procedures included arthroscopy in 16 (42%), arthroscopy with limited open capsulorraphy in two (5.3%), periacetabular osteotomy in nine (24%), and surgical dislocation in 12 (32%).
  
  
  CONCLUSIONS
  Residual or unaddressed structural deformity of the hip and underlying osteoarthritis are commonly associated with failure after hip arthroscopy. Thorough patient evaluation with detailed characterization of structural hip anatomy and articular cartilage integrity are critical to the selection of proper surgical intervention and successful patient outcome.
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Hospital Plaza, Suite 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110, USA.
authors: Ljiljana
authors: L
authors: Bogunovic
authors: Meghan
authors: M
authors: Gottlieb
authors: Gail
authors: G
authors: Pashos
authors: Geneva
authors: G
authors: Baca
authors: John C
authors: JC
authors: Clohisy
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D001182:Arthroscopy / Q000009:adverse effects*; D005260:Female; D057925:Femoracetabular Impingement / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D015207:Osteoarthritis, Hip / Q000601:surgery; D010027:Osteotomy; D018579:Patient Selection; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017211:Treatment Failure; D055815:Young Adult
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