title: The Role of Hip Arthroscopy in Investigating and Managing the Painful Hip Resurfacing Arthroplasty.
abstract: OBJECTIVE
  To determine the safety and efficacy of hip arthroscopy performed in the peripheral compartment as a diagnostic and therapeutic treatment option for patients with hip pain after hip resurfacing surgery.
  
  
  METHODS
  Indications for hip arthroscopy after hip resurfacing included patients with a symptomatic hip-resurfaced arthroplasties who did not respond to nonoperative treatment. Patients who underwent a hip arthroscopy after a painful hip resurfacing were included with a minimum of 1 year follow-up. Subgroup analysis was performed according to whether an established diagnosis was made before arthroscopic intervention or not. Subjective measures were based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, and results were calculated and analyzed.
  
  
  RESULTS
  We included 68 patients (26 male [38%] and 42 female [62%]) who underwent subsequent hip arthroscopy from a population of 978 consecutive hip-resurfaced arthroplasties performed between 1999 and 2010. The average age was 58 (range, 37 to 78 years). The mean follow-up after hip arthroscopy was 3.4 years (range, 12 months to 5.8 years). Patients who had an established diagnosis (n = 41) before hip arthroscopy showed statistical improvement in their WOMAC scores (7 to 2, P < .001). Only 3 (7%) of these 41 patients failed and were converted to a total hip replacement (THR); however, patients who did not have an established diagnosis (n = 27) before undergoing hip arthroscopy showed statistical worsening of the WOMAC (15 to 21, P = .002). Ten (37%) of these 27 patients without a diagnosis failed and needed to be converted to a THR. A significant correlation was found between the collections found on ultrasound (psoas bursa and/or in the hip joint) and the need for synovectomy (P = .01). The overall revision rate to THR after hip resurfacing in our group of patients was 1.3% (n = 13). Female patients were more likely to require postresurfacing hip arthroscopy with 42 (60%) female to only 26 (40%) male patients undergoing this procedure. In our study population, 70% (14/21, P < .05) of patients with hip pain caused by severe metal synovial reaction or metal-on-metal reaction were women. A total of 5 (7%) patients had minor-to-mild complications after hip arthroscopy.
  
  
  CONCLUSIONS
  Hip arthroscopy is a safe surgical treatment option for those patients with a painful hip resurfacing arthroplasty. Having an accurate diagnosis before hip arthroscopy improves the likelihood a good outcome.
  
  
  METHODS
  Level IV - therapeutic case series.
authors.affiliation: Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado, Denver, Colorado, U.S.A.. Electronic address: omer.meidan@ucdenver.edu.
authors.forename: Omer
authors.initials: O
authors.lastname: Mei-Dan
authors.affiliation: Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado, Denver, Colorado, U.S.A.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pascual-Garrido
authors.affiliation: Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Moreira
authors.affiliation: Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado, Denver, Colorado, U.S.A.
authors.forename: Mark O
authors.initials: MO
authors.lastname: McConkey
authors.affiliation: Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis* / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology; D012086:Reoperation; D015203:Reproducibility of Results; D012189:Retrospective Studies