title: Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes.
abstract: OBJECTIVE
  To determine indications for, operative findings of, and outcomes of revision hip arthroscopy.
  
  
  METHODS
  A systematic review was registered with PROSPERO and performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Therapeutic clinical outcome studies reporting the indications for, operative findings of, and outcomes of revision hip arthroscopy were eligible for inclusion. All study-, patient-, and hip-specific data were extracted and analyzed. The Modified Coleman Methodology Score was used to assess study quality.
  
  
  RESULTS
  Five studies were included (348 revision hip arthroscopies; 333 patients; mean age, 31.4 ± 4.2 years; 60% female patients). All 5 studies were either Level III or IV evidence. The surgeon performing revision hip arthroscopy was the same as the primary hip surgeon in only 25% of cases. The mean time between primary and revision hip arthroscopy was 27.8 ± 7.0 months (range, 2 to 193 months). Residual femoroacetabular impingement was the most common indication for and operative finding of revision hip arthroscopy (81% of cases). The most commonly reported revision procedures were femoral osteochondroplasty (24%) and acetabuloplasty (18%). The modified Harris Hip Score was used in all 5 analyzed studies, with significant (P < .05) improvements observed in all 5 studies (weighted mean, 56.8 ± 3.6 preoperatively v 72.0 ± 8.3 at final follow-up [22.4 ± 9.8 months]; P = .01). Other patient-reported outcomes (Non-Arthritic Hip Score, Hip Outcome Score, 33-item International Hip Outcome Tool, Short Form 12) showed significant improvements but were not used in all 5 analyzed studies. After revision hip arthroscopy, subsequent reported operations were hip arthroplasty in 11 patients and re-revision hip arthroscopy in 8 patients (5% total reoperation rate).
  
  
  CONCLUSIONS
  Revision hip arthroscopy is most commonly performed for residual femoroacetabular impingement, with statistically significant and clinically relevant improvements shown in multiple patient-reported clinical outcome scores at short-term follow-up. The reoperation rate after revision hip arthroscopy is 5% within 2 years, including further arthroscopy or conversion to hip arthroplasty.
  
  
  METHODS
  Level IV, systematic review of Level III and IV studies.
authors.affiliation: Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, U.S.A.. Electronic address: gregory.cvetanovich@gmail.com.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Cvetanovich
authors.affiliation: Sports Medicine Division, Department of Orthopaedic Surgery, Houston Methodist Hospital, Houston, Texas, U.S.A.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
authors.affiliation: Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, U.S.A.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Erickson
authors.affiliation: Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, U.S.A.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bach
authors.affiliation: Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, U.S.A.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Bush-Joseph
authors.affiliation: Hip Preservation Center, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College, Rush University, Chicago, Illinois, U.S.A.
authors.forename: Shane J
authors.initials: SJ
authors.lastname: Nho
mesh_terms: D001182:Arthroscopy / Q000379:methods / Q000706:statistics & numerical data; D057925:Femoracetabular Impingement / Q000601:surgery; D006615:Hip / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D016896:Treatment Outcome