title: Causes and risk factors for revision hip preservation surgery.
abstract: BACKGROUND
  Identifying causes and risk factors for failure of hip preservation surgery is critical to properly address residual pathological abnormalities in the revision setting and improve outcomes in this subset of patients.
  
  
  OBJECTIVE
  To identify the structural causes of failure in both open and arthroscopic hip preservation procedures and to identify demographic and radiographic risk factors that correlate with the need for revision surgery.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  A single-center hip preservation registry was reviewed (N = 1898 procedures in 1600 patients) to identify 147 patients (n = 152 procedures) who had undergone previous pelvic surgery. Exclusion criteria included residual deformity from pediatric hip disease (n = 5 patients). Preoperative demographics, intraoperative findings, radiographic data, and clinical outcome scores were compared between cohorts with and without revision surgery in the registry. Postoperative, short-term patient-reported outcome scores for the revision cohort were described.
  
  
  RESULTS
  The most common reason for revision was residual intra-articular femoroacetabular impingement (74.8%), followed by extra-articular impingement (9.5%). The majority of revision cases (78.9%) could be addressed with arthroscopic surgery, with the exception of extra-articular impingement or residual acetabular dysplasia, which necessitated open approaches. Patients who underwent revision were more likely to be female, were younger in age, and had worse preoperative outcome scores than did those in the primary cohort. Abnormal femoral version and the presence of acetabular dysplasia were not significantly different between the revision and primary cohorts. Short-term improvements in patient-reported outcome scores were found in the revision cohort at a mean of 15.0 months from the last revision surgery.
  
  
  CONCLUSIONS
  Residual intra- and extra-articular impingement were the most common reasons for revision in this cohort. Patients who underwent revision tended to be younger in age, were female, and had worse preoperative hip functional outcomes than did those in the primary cohort. Abnormal femoral version or acetabular coverage was not increased in our revision cohort.
authors.affiliation: Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Ricciardi
authors.affiliation: Department of Biostatistics, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Kara
authors.initials: K
authors.lastname: Fields
authors.affiliation: Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
authors.affiliation: Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Anil S
authors.initials: AS
authors.lastname: Ranawat
authors.affiliation: Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA.
authors.forename: Struan H
authors.initials: SH
authors.lastname: Coleman
authors.affiliation: Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, New York, USA sinke@hss.edu.
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Sink
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001182:Arthroscopy; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D057925:Femoracetabular Impingement / Q000601:surgery*; D006617:Hip Dislocation / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: extra-articular impingement; femoroacetabular impingement; hip arthroscopic surgery; hip preservation